Suddenly, Samedi jumps to his feet. He has just finished translating my story of the Samaritan woman who meets Jesus by the well. We are in front of a packed house. Daniel, a school teacher, has just gotten up to sing in his tribal language, Kera. The rhythm is catchy and many heads are bobbing. The drums are pounding and Samedi can't hold back any longer. His overweight, yet strong, body has lost it's flexibility as he stomps to the small group surrounding Daniel and raises his fist pumping into the air. He circles around with the inner foot pounding out the beat as his body weaves back and forth. Bruno jumps up. The smallest of Pierre's boys, he has stayed to same size since he was 13 and despite being almost 18, he still has that pre-teen look. His energetic body bounces up alongside Samedi his knees bobbing up and down and both arms raised. Doulgue slides in smoothly stepping fluidly in and out of the dancing circle. The beat intensifies. Lam is whipping the drum as if it was a delinquent child while Allah lifts up his chin staring to the sky as his little hands flap in a furious blur all over the surface of the goat skin drum head. Koumakoy sets his drum down and hauls his lanky, athletic body across the aisle to join the fray, his shoulders bobbing up and down as his bent arms are held in closed fists against his chest.
It started with me telling stories of a woman caught in adultery and brought before Jesus and that same woman washing Jesus' feet with her tears at a dinner party. The young people around me seemed shocked at a God that would love that much. I finally went around and reluctantly got all of them to admit that God loved them just as much. Then the festivities began. Pierre's second oldest daughter and three friends got things off to a slow start as the younger girls were embarrassed to dance and the older girl was embarrassed to be dancing by herself. Amos then kicked things off in Nangjere with a furious rendition of "Kukusebur ne Jesu Christi" as Tabitha rounded it up with a raised, twirling fist and a high pitched "Ayyyee yi yi yi yiiiiiiiiiii." A flat song in English with the guitar and several Chadians singing in bad Nigerina English was soon forgotten as the same group kicked up their heels and clapped their hands to a up beat French song accompanied by a tight, but simple guitar stacatto.
Doulgue jumps up and looks directly at me. "It's not only Nangjere that can sing Nangere songs. James, come here." Grinning from ear to ear and throughly loving the first truly spontaneous church service I've ever been a part of I stand up and walk over to him, my brightly colored matching pants and shirt swishing as I walk. It's a song about Peter walking on water and we belt it out at the top of our lungs as Amos and a couple others join us. I'm not much of a dancer but I find my head, shoulders, and legs unable to resist the pull of the rhythm. We finish strong to many hearty amens. Degaulle's daughter stands up in the back, her baby hanging from her breast and lets out a high pitched wail. Antoinette echos from the back row of the choir, keeping herself hidden shyly behind the kids in front, but she can't hide her smile as Tabitha finishes off the response with a piercing cry that can only be appreciated by those who have lived in an African village.
We go into the early afternoon, much later than usual as group after group gets up to sing. We have sung in English, French, Nangjere, Ngambai, and Kera. No one has understood everything, but everyone has been moved.
That afternoon finds me on the new bridge staring down into the muddy, swirling water below. A crowd has gathered and I can't back down. I step up on the railing and launch myself out. My outstretched arms smack the water hard 30 feet below as the current quickly sweeps me under the bridge. I swim over to the support posts and find an eddy in the center. I rest briefly before striking out for the shore and clambering up the stony bank. Back on the bridge, someone shouts out "Lapia." I turn and see Marty smiling in the midst of the crowd along the rail.
Marty has survived a hippo attack and tuberculosis and looks in perfect health.
I rush over and grab his hand with both of mine shaking it vigorously as I greet him in Nangjere.
I call Jamie and Tammy over.
"Hey, this is the guy in the documentary that was bitten by the hippo!"
Carson and Michelle come over. Tim and Melody join us as well. All the foreigners want to shake his hand. I tell the crowd that Marty is famous in the United States, that's why all the white folk want to greet him. Everyone laughs as a local man translates my French into Nangjere. As everyone gets there picture taken with Marty I think how ironic this is. Usually it's the foreigners who are the center of attention that everyone wants to stare at or greet. Now, it's a poor fisherman who just happens to have been bitten my a hippo right before a film student came to make a documentary of our hospital. The film won some awards and was shown all over in the Adventist Church in the US and Denmark. Because of that film, many people gave money to support the hospital allowing it to become one of the best in the country.
I walk back over to Marty and the man who translated before.
"Tell Marty that while getting bit by a hippo was a tragedy, that God used that experience to help the hospital to become what it is today thanks to the film that he was in. Despite all he suffered, God turned it around to help many more people who are suffering."
As the man translates, Marty looks at me with a warm smile out of his small, bearded face. He nods and shakes my hand before walking off down the bridge.
James
Monday, October 5, 2009
Sunday, October 4, 2009
Moundou
I think my hand is stuck. I've been sticking it up the pipe trying to clear out 30 years of junk in the drain but I couldn't get it up far enough. Now, I'd managed to twist and angle my arm just right but now I can't get it out. I almost panic, but I twist turn and finally, scraping the skin off my knuckles on the rough cement, my dirty hand pops out.
Jamie and I are in Moundou putting the plumbing in the new surgery center. Everything has had to be redone.
We go to the local Quincaillerie or hardware store. Everything that you thought you could never find in Chad is stacked from floor to ceiling in a dusty, brick warehouse. We spend hours hunting down all we need. A large Arab in a simple white Jallibiya and a well trimmed gray beard walks in. He is the owner, Mahamat.
"As-salaam alekum. Wa alekum as-salaam. Inta afe? Afe, taybin? Al hamdullilah. Mashallah." And the greetings are over. He walks behind the counter. We continue shopping. After early afternoon prayers, Mahamat returns.
"You...eat..." he starts in broken French and then switches over to Arabic. "We want to you to eat with us. What do you think?" He almost seems sure we'll refuse. He is pleasantly surprised by my profuse response.
"Shukran, shukran, it would be an honor, thank you."
He calls outside to the others and ushers us into a tiny side room under the overhead office built high in the corner of the warehouse. We are seated and a huge platter is slung on the table before us. Piles of fluffy rice fill one huge bowl. A cast iron pot from Nigeria holds the steaming goat meat sauce while a shallow bowl to the side is bursting with a fresh tomato and onion salad. Surprisingly, we are given spoons to eat with as generous portions are heaped into our bowls. Jamie, the vegetarian, digs right in ripping the goat meat off the bones. Our host comes in last and there are no more chairs. We try to rise and give him ours, but he insists. A special bowl of cumin flavored yogurt sauce is placed in front of him along with a plastic bag filled with fluffy flat bread the size of large crepes.
Mahamat wishes us "bon appetit" and grabs a pancake. He bunches the whole thing into his hand leaving the ragged edges pointing out with which he mops up some yogurt sauce and shoves the whole mess into his hand. When we are all finally able to resist his efforts to get us to eat more he reaches outside the door and pulls a plastic bottle of wild honey off the shelf. He dumps some more rice in a bowl and covers it with honey. He tells me to dip in and try. When I say I like it and go for more he shakes his head and pulls the bowl over to him. Then he motions to one of his workers to pour me some of my own. I can't figure out if he just really wants to eat it all himself or doesn't want to have too much direct contact with an infidel.
Mahamat rises and thanks us again. "The French are always too busy. The Chinese sometimes take a snack or something, but this is the first time I've eaten a meal with a client here in my shop. Vraiment, merci beaucoup. Merci, merci, merci." He continues to thank us. He is quite pleased and so are we to be so honored.
We return to the job site.
I'm in the new operating room. I grab the jackhammer with the drill attachment. I lean into it and as it engages a puff of cement dust bursts out of the floor until it turns red when it hits the compacted earth beneath the slab. I slip out the drill bit, put in the small chisel bit and feel the vibrations up my arm and shoulder as the chirping and cracking of cement fills the room.
That night I find myself sitting on a hard stool under the stars in front of Antoine's house. The moon is 3/4 and provides enough light to eat the tiny, twisted potato like tubers covered with cabbage and peanut sauce. Antoine seems discouraged. The junior high that he runs has a drop in enrollment. I try to encourage him. We have brought some building materials that are still piled in the shipping container. Once we finish with the clinic, we can maybe help him with a couple of new buildings. Also, I hope to get a volunteer to help teach English to give his school an edge over the competition. I tell him that God has a plan and won't abandon something He has started.
The ladder is a little unsteady as I get to the top rung. There was no attic hole left in the new ceiling but one angle at the corner of the roof has been left open. I think I can squeeze through. I reach my hands up and grab the truss. I pull up as my feet kick out in mid air. I get to my waist and my tiny butt almost gets stuck but I slither through. I hop from truss to truss dragging the loops of plumbing pipe that I punch through the holes down to the sterilization room and consulting rooms below. The sweat makes the cobwebs stick easier as I try not to fall through the fragile ceiling below.
We pull up the van outside a brightly painted wooden shelter. Their are cartoon images of fish, chicken and millet painted garishly on the corners. Inside a crowd is loosely seated around a selection of differently sized rickety tables and wobbly benches. There is a tiny one open right in the middle. Someone, maybe a waiter, quickly wipes off the plastic mat covering the wood with his bare hand leaving a mixture of spilled beer and salad juice on the surface. Jamie and I sit down and nod hello to those sitting at other tables just a few inches from ours. Most seem to have liter bottles of Gala beer in various stages of consumption. The two men dressed in suits next to us are dipping their hands into a common bowl of lettuce and tomatoes covering some kind of meat.
"What's good to eat here?" I ask one of the men.
"Mutton ribs and salad's what we're having, c'est tres bon!"
"Merci."
We order two servings from the overweight Tchadian woman in charge of the kitchen carved out of one corner of the room. The sounds of popping oil and the smells of wood fire smoke waft out from the clatter of cast iron pots and cooking utensils.
A man approaches selling watches and cheap sunglasses. In the far corner, a man is stretching a piece of cloth between his hands to show a woman how strong it is. Several other woman are looking on eagerly as they sip their beers. A large man who looks more Nigerian than Tchadian comes up behind me and holds out a package of medication over my shoulder and in front of my face. There is a picture of a smiling black man on a yellow and red backdrop with "Super King" emblazoned boldly across the front. In small letters underneath I see the generic name for what is known in other circles as Viagra. I turn to look at the man who raises his eyebrows and winks.
"Super King?"
"Non, merci, I'm deja un Super King," I joke with him as I shake my head.
Disappointed he moves on to greener pastures.
Our meal has arrived. The cook holds out the traditional plastic basin with a plastic pitcher and brown soap for hand washing. I rip off pieces of tender, savory flesh off the sheep ribs, topping it off with lettuce, tomato and onion drenched in a vinaigrette. A small pile of grilled yellow chilies adds some spice to the mix. I was it all down with some Top pineapple soda and then help Jamie finish off the last of his meat.
Jamie and I are in Moundou putting the plumbing in the new surgery center. Everything has had to be redone.
We go to the local Quincaillerie or hardware store. Everything that you thought you could never find in Chad is stacked from floor to ceiling in a dusty, brick warehouse. We spend hours hunting down all we need. A large Arab in a simple white Jallibiya and a well trimmed gray beard walks in. He is the owner, Mahamat.
"As-salaam alekum. Wa alekum as-salaam. Inta afe? Afe, taybin? Al hamdullilah. Mashallah." And the greetings are over. He walks behind the counter. We continue shopping. After early afternoon prayers, Mahamat returns.
"You...eat..." he starts in broken French and then switches over to Arabic. "We want to you to eat with us. What do you think?" He almost seems sure we'll refuse. He is pleasantly surprised by my profuse response.
"Shukran, shukran, it would be an honor, thank you."
He calls outside to the others and ushers us into a tiny side room under the overhead office built high in the corner of the warehouse. We are seated and a huge platter is slung on the table before us. Piles of fluffy rice fill one huge bowl. A cast iron pot from Nigeria holds the steaming goat meat sauce while a shallow bowl to the side is bursting with a fresh tomato and onion salad. Surprisingly, we are given spoons to eat with as generous portions are heaped into our bowls. Jamie, the vegetarian, digs right in ripping the goat meat off the bones. Our host comes in last and there are no more chairs. We try to rise and give him ours, but he insists. A special bowl of cumin flavored yogurt sauce is placed in front of him along with a plastic bag filled with fluffy flat bread the size of large crepes.
Mahamat wishes us "bon appetit" and grabs a pancake. He bunches the whole thing into his hand leaving the ragged edges pointing out with which he mops up some yogurt sauce and shoves the whole mess into his hand. When we are all finally able to resist his efforts to get us to eat more he reaches outside the door and pulls a plastic bottle of wild honey off the shelf. He dumps some more rice in a bowl and covers it with honey. He tells me to dip in and try. When I say I like it and go for more he shakes his head and pulls the bowl over to him. Then he motions to one of his workers to pour me some of my own. I can't figure out if he just really wants to eat it all himself or doesn't want to have too much direct contact with an infidel.
Mahamat rises and thanks us again. "The French are always too busy. The Chinese sometimes take a snack or something, but this is the first time I've eaten a meal with a client here in my shop. Vraiment, merci beaucoup. Merci, merci, merci." He continues to thank us. He is quite pleased and so are we to be so honored.
We return to the job site.
I'm in the new operating room. I grab the jackhammer with the drill attachment. I lean into it and as it engages a puff of cement dust bursts out of the floor until it turns red when it hits the compacted earth beneath the slab. I slip out the drill bit, put in the small chisel bit and feel the vibrations up my arm and shoulder as the chirping and cracking of cement fills the room.
That night I find myself sitting on a hard stool under the stars in front of Antoine's house. The moon is 3/4 and provides enough light to eat the tiny, twisted potato like tubers covered with cabbage and peanut sauce. Antoine seems discouraged. The junior high that he runs has a drop in enrollment. I try to encourage him. We have brought some building materials that are still piled in the shipping container. Once we finish with the clinic, we can maybe help him with a couple of new buildings. Also, I hope to get a volunteer to help teach English to give his school an edge over the competition. I tell him that God has a plan and won't abandon something He has started.
The ladder is a little unsteady as I get to the top rung. There was no attic hole left in the new ceiling but one angle at the corner of the roof has been left open. I think I can squeeze through. I reach my hands up and grab the truss. I pull up as my feet kick out in mid air. I get to my waist and my tiny butt almost gets stuck but I slither through. I hop from truss to truss dragging the loops of plumbing pipe that I punch through the holes down to the sterilization room and consulting rooms below. The sweat makes the cobwebs stick easier as I try not to fall through the fragile ceiling below.
We pull up the van outside a brightly painted wooden shelter. Their are cartoon images of fish, chicken and millet painted garishly on the corners. Inside a crowd is loosely seated around a selection of differently sized rickety tables and wobbly benches. There is a tiny one open right in the middle. Someone, maybe a waiter, quickly wipes off the plastic mat covering the wood with his bare hand leaving a mixture of spilled beer and salad juice on the surface. Jamie and I sit down and nod hello to those sitting at other tables just a few inches from ours. Most seem to have liter bottles of Gala beer in various stages of consumption. The two men dressed in suits next to us are dipping their hands into a common bowl of lettuce and tomatoes covering some kind of meat.
"What's good to eat here?" I ask one of the men.
"Mutton ribs and salad's what we're having, c'est tres bon!"
"Merci."
We order two servings from the overweight Tchadian woman in charge of the kitchen carved out of one corner of the room. The sounds of popping oil and the smells of wood fire smoke waft out from the clatter of cast iron pots and cooking utensils.
A man approaches selling watches and cheap sunglasses. In the far corner, a man is stretching a piece of cloth between his hands to show a woman how strong it is. Several other woman are looking on eagerly as they sip their beers. A large man who looks more Nigerian than Tchadian comes up behind me and holds out a package of medication over my shoulder and in front of my face. There is a picture of a smiling black man on a yellow and red backdrop with "Super King" emblazoned boldly across the front. In small letters underneath I see the generic name for what is known in other circles as Viagra. I turn to look at the man who raises his eyebrows and winks.
"Super King?"
"Non, merci, I'm deja un Super King," I joke with him as I shake my head.
Disappointed he moves on to greener pastures.
Our meal has arrived. The cook holds out the traditional plastic basin with a plastic pitcher and brown soap for hand washing. I rip off pieces of tender, savory flesh off the sheep ribs, topping it off with lettuce, tomato and onion drenched in a vinaigrette. A small pile of grilled yellow chilies adds some spice to the mix. I was it all down with some Top pineapple soda and then help Jamie finish off the last of his meat.
Friday, August 14, 2009
Sign
It's 3;46 AM and I can't sleep. My eyes are bloodshot and heavy, my head pounds, but I can't sleep. Jet lag is at it again. As I huddle under the blankets to keep from freezing in the airconditioned hotel room in Richland, Washington it's hard to imagine that just a few sleepless days ago I was in the bush of the Sahel. A six hour bus ride from Bere to N'Djamena, a 5 hour overnight flight to Paris arriving at 6AM followed by 45 minutes to Amsterdam and a direct flight across Greenland and Canada to Seattle where I met Greg. We grab a rental car and head over the mountains covered with pines and firs into the central valley with it's rolling golden hills, small farming towns and fresh, cold cherries. Following a smaller river down we hit the Columbia River in the TriCities and we've arrived for the SIGN conference.
I get out of bed at about 4:30, strap on my running shoes and head out the door. The night is just beginning to turn a lighter shade of black but the well-lit streets need no natural light and guide me across the street, around the middle school with it's sprinklers caressing it's well manicured lawns, soccer and football fields, up a side street, off the road up a grassy slope and onto the riverside walking trail. The scent of sage, mountain misery, pine and fir wafts across the early morning breeze which would've surely chilled me if not for the vigorous sweat I've already worked up in my out of shape body. A grove of trees and dense shrubbery gives me only glimpses of the dark, alabaster surface of the river until I turn a corner and see an opening leading down a pebbly bank onto a small sandy beach. I stumble down and after some pushups squat on the sand to reflect.
Yesterday, I found myself surrounded by an international aura of languages swirling around me: Urdu, Hindi, Vietnamese, Slavic, Arabic, French, Spanish, and a wide variety of English from Nigeria, Cameroon, Tanzania, Kenya, India, Bangladesh, Mongolia, England and the wide variety of American accents. There is the slender Dr. Shah with his ample gray beard and thin, fierce face with a long pointed nose from Pakistan describing doing more than 1000 intramedullary nails for long bone fractures starting during the terrible earthquake in northern Pakistan and continuing on today in some of the most remote areas of the world. There is the dignified, dark skinned Dr. Faruque from Bangladesh speaking calmly out from under his mop of black hair and half smile. Dr. Shahab from Peshawar lectures us elegantly on bomb blast injuries, his portly figure fitting well in his classy suit framing a jolly face encompassed in a well trimmed white beard outlining his dark features. I find myself being guided through the machine shop where intramedullary rods, screws and instruments are made at a fraction of the competitors prices but with the same levels of quality control. I enter into a workshop where 20 artificial femurs and an equal number of tibias await our inexperienced hands.
I am led through the process by an orthopedist from Vietnam who explains how to attach the guiding frame to the rod and adjust it so the distal fixing screws will be able to be placed without intraoperative imagery. I am shown the technique of insertion with frequent side to side sweeps interspersed with gentle taps of the mallet. The whole process of guided drilling, finding the slot in the nail and inserting the screws is simple and elegant allowing most lower limb long bone fractures to be treated with the highest standard of care in the world without needing the normal high-tech equipment or even electricity! I go over the process many times in the next few days until I've mastered it. Of course, real bone covered with real flesh on a real person will be different but I'm confident I can do it...inshallah.
SIGN was started 10 years ago by Dr. Zirkle, an american orthopedist who has spent his life in developing countries with the idea of equality of fracture treatment around the world. By the end of 2008 SIGN had over 144 programs in 49 countries involving over 3000 surgeons who have performed over 36,000 operations. Now, Chad and the Bere Adventist Hospital will make it at least 50 countries. We have been given the instruments, our first set of 30 intramedullary nails, a cordless drill with sterile cover, training videos, wound suction treatment systems and the full support of the SIGN team...all on faith that we will raise the money to help cover the costs of this equipment.
Anyone interested in knowing more or donating to this program in the name of Bere Adventist Hospital can contact SIGN at www.sign-post.org.
James
I get out of bed at about 4:30, strap on my running shoes and head out the door. The night is just beginning to turn a lighter shade of black but the well-lit streets need no natural light and guide me across the street, around the middle school with it's sprinklers caressing it's well manicured lawns, soccer and football fields, up a side street, off the road up a grassy slope and onto the riverside walking trail. The scent of sage, mountain misery, pine and fir wafts across the early morning breeze which would've surely chilled me if not for the vigorous sweat I've already worked up in my out of shape body. A grove of trees and dense shrubbery gives me only glimpses of the dark, alabaster surface of the river until I turn a corner and see an opening leading down a pebbly bank onto a small sandy beach. I stumble down and after some pushups squat on the sand to reflect.
Yesterday, I found myself surrounded by an international aura of languages swirling around me: Urdu, Hindi, Vietnamese, Slavic, Arabic, French, Spanish, and a wide variety of English from Nigeria, Cameroon, Tanzania, Kenya, India, Bangladesh, Mongolia, England and the wide variety of American accents. There is the slender Dr. Shah with his ample gray beard and thin, fierce face with a long pointed nose from Pakistan describing doing more than 1000 intramedullary nails for long bone fractures starting during the terrible earthquake in northern Pakistan and continuing on today in some of the most remote areas of the world. There is the dignified, dark skinned Dr. Faruque from Bangladesh speaking calmly out from under his mop of black hair and half smile. Dr. Shahab from Peshawar lectures us elegantly on bomb blast injuries, his portly figure fitting well in his classy suit framing a jolly face encompassed in a well trimmed white beard outlining his dark features. I find myself being guided through the machine shop where intramedullary rods, screws and instruments are made at a fraction of the competitors prices but with the same levels of quality control. I enter into a workshop where 20 artificial femurs and an equal number of tibias await our inexperienced hands.
I am led through the process by an orthopedist from Vietnam who explains how to attach the guiding frame to the rod and adjust it so the distal fixing screws will be able to be placed without intraoperative imagery. I am shown the technique of insertion with frequent side to side sweeps interspersed with gentle taps of the mallet. The whole process of guided drilling, finding the slot in the nail and inserting the screws is simple and elegant allowing most lower limb long bone fractures to be treated with the highest standard of care in the world without needing the normal high-tech equipment or even electricity! I go over the process many times in the next few days until I've mastered it. Of course, real bone covered with real flesh on a real person will be different but I'm confident I can do it...inshallah.
SIGN was started 10 years ago by Dr. Zirkle, an american orthopedist who has spent his life in developing countries with the idea of equality of fracture treatment around the world. By the end of 2008 SIGN had over 144 programs in 49 countries involving over 3000 surgeons who have performed over 36,000 operations. Now, Chad and the Bere Adventist Hospital will make it at least 50 countries. We have been given the instruments, our first set of 30 intramedullary nails, a cordless drill with sterile cover, training videos, wound suction treatment systems and the full support of the SIGN team...all on faith that we will raise the money to help cover the costs of this equipment.
Anyone interested in knowing more or donating to this program in the name of Bere Adventist Hospital can contact SIGN at www.sign-post.org.
James
Sunday, August 9, 2009
Moonlight
I could never have imagined that things would turn out they did.
As I stare out into the moonlight filtering through the flamboyant tree branches casting shifting shadows with every breath of wind, as I hear the soft shuffle and breathing of our sweat-flecked horses outside the stable, as I draw my gaze back to the pile of pineapple carvings in front of the cutting board and bring the ice-cold pineapple to my mouth and slowly savor crunching into the juicy morsel, as I think back over the past few days I find it incredible to think of how this afternoon ended...I can only call it an unexpected grace, a surprising joy, a metaphysical moment when all things good come together out of the midst of all things wrong.
As I gallop through the forest, grasping Pepper's mane as fiercely as I hold to the reins; as I stand up in the stirrups and hug my body to the horse's powerful neck; as the leaves slap my face and a branch rips through the skin of my shoulder; as the full moon lights up the sandy trail like a river of silver stretching lazily out before me through the dark shadows of the trees; as my sweat soaked shirt clings to my back; as I am surrounded by the silence of an African evening in the bush I find myself carried way beyond the horrors, sorrows and sufferings of the last few days.
I can hardly remember the strong features of the handsome Arab man staring steadfastly upward with a look of incomprehensible peace as he is lugged up the ramp to the operating room in a vinyl stretcher with wooden handles held firmly in the grips of a dozen turbaned comrades his mangled body wrapped in a blood soaked turban in stark contrast to the serenity of his gaze. I almost forget the hours of working on his bilateral open fibula and tibia fractures uncovered on his right by a flap of skin running from his heel and achilles tendon up his calf and across the top of his foot revealing the anatomy of the muscles, tendons, ligaments and bones as I can only barely remember from Anatomy lab in medical school. The almost can't bring up the vague memory of him calmly complaining of neck pain since he can't move or feel the rest of his body is a silent grace to him allowing us to work on his tattered limbs without anesthesia after framing his chiseled face in a cervical collar. I thought I'd never survive the emotional roller coaster of the myriads of swishing robed, turbaned men and brightly wrapped head scarved women that filed incessantly in and out, many of the men leaving with tears unashamedly rolling down their cheeks as I had to console them to leave all in Allah's hands as only He can know the day of our death and we should trust Him. The memories flood in of fighting my way through crowds and over colorful mats and rugs to try and do his complicated dressings after spending what seemed like ages of emotional energy trying to get the swarming family and friends to respect visiting hours and hospital policies. When his paralysis didn't get better after three days I was almost relieved when the nurse came to get me yesterday morning to say "Ca ne va pas" and I arrived in time to see his unconscious, but still dignified face take it's last shallow breaths and feel his heart beat in his neck slow down and become weak. He was bound for a long road of suffering in this environment as a quadriplegic and it was certainly God's mercy that laid him to sleep.
As I stand on the bank of the river, looking down on the swirling eddies of the brown, engorged river; as I see the sun slowly set behind the great branching trees of the African plain; as I turn around and see the full moon rising through a circle made by two rounded trees and a small hill; as I watch the slow transformation of the day into moonlit night; as I feel the wet of the river slowly drying on my body; as I watch Stefan desperately trying to capture the moment on film; as Eddie slowly makes his way upstream against the current; as I pull on my jeans over my moist swimming suit and prepare for the ride home; as untangle Pepper from the bush I've tied him to I am amazed at how quickly depression and overwhelming burnout can be replaced by wonder and marvel and ecstasy.
Can it be that only this morning I found myself deep in a belly under the ribs carefully cauterizing a gallstone filled gallbladder from the liver of an elderly, lighter-skinned Muslim man? Is it possible that yesterday I was about to throw up and finally gave in and started taking malaria treatment only to go out immediately and take out an ovarian tumor stuck to all the intestines, omentum and uterus? Is it possible that only two days ago I didn't think I'd make it through the morning much less the weak because of fatique I refused to believe was another bout of Plasmodium falciparum destroying my blood cells? Is it possible that only three days ago the hospital was full to overflowing while we spent all of a Sunday afternoon filling it up with sick babies needing blood transfusions and malaria treatment? Is it possible that only four days ago I spent all Saturday in the OR with two motorcycle accidents needing emergent orthopedic intervention? Is it possible considering how things later turned out?
I come back from work almost collapsing. It's been another day of neverending hospital rounds, complicated surgeries, ER patients, ultrasounds all pleasantly muffled with the ringing of Quinine in my ears. I feel a little nauseated and drink some cold water. I sit down and finish reading "Flying Doctor of the Philippines". I just want to sleep, but decide I better go out and feed the horses to keep my wife happy. The next thing I know I'm in the saddle trotting past the mud huts of Bere, around the pond, through the forest and onto the river road mounted on Pepper while Stefan rides Bob and Eddie rides Libby. Out into the open Stefan and Eddie cluck their horses into a gallop. I can feel Pepper tensing beneath me and I give him the releasing cry and squeeze and he quickly closes the gap and passes the others through a mud puddle as Bob goes left and Libby goes right around it. We're in the open now and I slow down. We arrive quickly at the river ride down the ridges gauged out by the rain leading to the cattle crossing and then climb up the hill next to it. A quick assessment confirms the possibilities and Eddie and I strip down and race off the cliff arms and legs flailing wildly before crashing into the swift moving current below. It's not enough for Eddie, so we find ourselves pulling our reluctant bodies up the bank using exposed tree roots before climbing up the tree as high as possible with still a path clear of branches to the rushing waters below. I crouch on two diverging limbs my hands in front as I propel myself through the gap, past the other branches below and into the welcoming arms of the cool, refreshing liquid beneath. I'm glad there are no crocs and lions in this part of Africa.
As Eddie and I climb up the bank for the last time after multiple jumps from different levels, Stefan's face is glowing. It's hard to believe just last night he was talking about maybe wanting to leave. Now all he says is, "the only thing that could make this better would be a little ice cream."
Later as I walk through the cool of the moonlit evening from my house to his carrying the plate of chilled fruit I think to myself, "well, cold pineapple could arguably be as good or better..."
Then the clapping comes again...it's Salomon...
"There's an old man peeing blood since this morning..."
And I'm off to the hospital as the moonlight leads the way.
As I stare out into the moonlight filtering through the flamboyant tree branches casting shifting shadows with every breath of wind, as I hear the soft shuffle and breathing of our sweat-flecked horses outside the stable, as I draw my gaze back to the pile of pineapple carvings in front of the cutting board and bring the ice-cold pineapple to my mouth and slowly savor crunching into the juicy morsel, as I think back over the past few days I find it incredible to think of how this afternoon ended...I can only call it an unexpected grace, a surprising joy, a metaphysical moment when all things good come together out of the midst of all things wrong.
As I gallop through the forest, grasping Pepper's mane as fiercely as I hold to the reins; as I stand up in the stirrups and hug my body to the horse's powerful neck; as the leaves slap my face and a branch rips through the skin of my shoulder; as the full moon lights up the sandy trail like a river of silver stretching lazily out before me through the dark shadows of the trees; as my sweat soaked shirt clings to my back; as I am surrounded by the silence of an African evening in the bush I find myself carried way beyond the horrors, sorrows and sufferings of the last few days.
I can hardly remember the strong features of the handsome Arab man staring steadfastly upward with a look of incomprehensible peace as he is lugged up the ramp to the operating room in a vinyl stretcher with wooden handles held firmly in the grips of a dozen turbaned comrades his mangled body wrapped in a blood soaked turban in stark contrast to the serenity of his gaze. I almost forget the hours of working on his bilateral open fibula and tibia fractures uncovered on his right by a flap of skin running from his heel and achilles tendon up his calf and across the top of his foot revealing the anatomy of the muscles, tendons, ligaments and bones as I can only barely remember from Anatomy lab in medical school. The almost can't bring up the vague memory of him calmly complaining of neck pain since he can't move or feel the rest of his body is a silent grace to him allowing us to work on his tattered limbs without anesthesia after framing his chiseled face in a cervical collar. I thought I'd never survive the emotional roller coaster of the myriads of swishing robed, turbaned men and brightly wrapped head scarved women that filed incessantly in and out, many of the men leaving with tears unashamedly rolling down their cheeks as I had to console them to leave all in Allah's hands as only He can know the day of our death and we should trust Him. The memories flood in of fighting my way through crowds and over colorful mats and rugs to try and do his complicated dressings after spending what seemed like ages of emotional energy trying to get the swarming family and friends to respect visiting hours and hospital policies. When his paralysis didn't get better after three days I was almost relieved when the nurse came to get me yesterday morning to say "Ca ne va pas" and I arrived in time to see his unconscious, but still dignified face take it's last shallow breaths and feel his heart beat in his neck slow down and become weak. He was bound for a long road of suffering in this environment as a quadriplegic and it was certainly God's mercy that laid him to sleep.
As I stand on the bank of the river, looking down on the swirling eddies of the brown, engorged river; as I see the sun slowly set behind the great branching trees of the African plain; as I turn around and see the full moon rising through a circle made by two rounded trees and a small hill; as I watch the slow transformation of the day into moonlit night; as I feel the wet of the river slowly drying on my body; as I watch Stefan desperately trying to capture the moment on film; as Eddie slowly makes his way upstream against the current; as I pull on my jeans over my moist swimming suit and prepare for the ride home; as untangle Pepper from the bush I've tied him to I am amazed at how quickly depression and overwhelming burnout can be replaced by wonder and marvel and ecstasy.
Can it be that only this morning I found myself deep in a belly under the ribs carefully cauterizing a gallstone filled gallbladder from the liver of an elderly, lighter-skinned Muslim man? Is it possible that yesterday I was about to throw up and finally gave in and started taking malaria treatment only to go out immediately and take out an ovarian tumor stuck to all the intestines, omentum and uterus? Is it possible that only two days ago I didn't think I'd make it through the morning much less the weak because of fatique I refused to believe was another bout of Plasmodium falciparum destroying my blood cells? Is it possible that only three days ago the hospital was full to overflowing while we spent all of a Sunday afternoon filling it up with sick babies needing blood transfusions and malaria treatment? Is it possible that only four days ago I spent all Saturday in the OR with two motorcycle accidents needing emergent orthopedic intervention? Is it possible considering how things later turned out?
I come back from work almost collapsing. It's been another day of neverending hospital rounds, complicated surgeries, ER patients, ultrasounds all pleasantly muffled with the ringing of Quinine in my ears. I feel a little nauseated and drink some cold water. I sit down and finish reading "Flying Doctor of the Philippines". I just want to sleep, but decide I better go out and feed the horses to keep my wife happy. The next thing I know I'm in the saddle trotting past the mud huts of Bere, around the pond, through the forest and onto the river road mounted on Pepper while Stefan rides Bob and Eddie rides Libby. Out into the open Stefan and Eddie cluck their horses into a gallop. I can feel Pepper tensing beneath me and I give him the releasing cry and squeeze and he quickly closes the gap and passes the others through a mud puddle as Bob goes left and Libby goes right around it. We're in the open now and I slow down. We arrive quickly at the river ride down the ridges gauged out by the rain leading to the cattle crossing and then climb up the hill next to it. A quick assessment confirms the possibilities and Eddie and I strip down and race off the cliff arms and legs flailing wildly before crashing into the swift moving current below. It's not enough for Eddie, so we find ourselves pulling our reluctant bodies up the bank using exposed tree roots before climbing up the tree as high as possible with still a path clear of branches to the rushing waters below. I crouch on two diverging limbs my hands in front as I propel myself through the gap, past the other branches below and into the welcoming arms of the cool, refreshing liquid beneath. I'm glad there are no crocs and lions in this part of Africa.
As Eddie and I climb up the bank for the last time after multiple jumps from different levels, Stefan's face is glowing. It's hard to believe just last night he was talking about maybe wanting to leave. Now all he says is, "the only thing that could make this better would be a little ice cream."
Later as I walk through the cool of the moonlit evening from my house to his carrying the plate of chilled fruit I think to myself, "well, cold pineapple could arguably be as good or better..."
Then the clapping comes again...it's Salomon...
"There's an old man peeing blood since this morning..."
And I'm off to the hospital as the moonlight leads the way.
Sunday, July 26, 2009
INSHALLAH
I find myself in an SUV with a group of Muslims roaring across the desert towards Eastern Chad and the crisis in Darfur. We pass Bedouin caravans heading north. Women in brightly colored body wraps and head scarves with huge gold nose rings frantically beat donkeys to get them to move off the road as we come cruising past. Robed, turbaned and bearded, the men lumber by swaying on the backs of heavily loaded camels, bounce along on horseback or plod along on foot chasing the goats and sheep. Most are armed with bows and arrows or spears or staffs. Tucked away in the robes is the ever present dagger and many probably have rifles hidden in their saddle bags.
Dead animals in various states of decomposition and drying litter the shoulders of the highway. Poor rainfall this year has lead to famine and the loss of cattle, donkeys, horses and other vital livestock. Occasionally the smell of a rotting carcass sneaks it's way in through the windows of our passing vehicles.
The African plain starts to be interrupted by wadis, rolling hills and piles of boulders. In the distance, jagged peaks and granite outcroppings break up the horizon. We enter into the central Chadian Sahel where rain has been more abundant and the grasslands are bright green and crops of millet are starting to push their way out of the soil as local farmers dig up the ground with small spades on the end of long poles. Women coming back from the fields carry water and rations in woven net bags suspended from poles slung across one shoulder. No one carries things balanced on top of their heads like they do in Bere in the South.
We stop by the side of the road for a picnic. Tea and Arabic coffee is poured from thermoses as we wait in the shade of a thorny desert scrub tree. A platter of grilled goat chunks and French baguettes is shared among our two groups of five.
We continue on with regular stops for tea, milk and ritual prayer. One stop for prayer finds us in the midst of a cluster of mountains and date palms. The prayer rugs are rolled out and the absolution's begun in front of a man slicing up a sheep into large portions to be roasted on a piece of tin roofing suspended over a wood fire.
We spend the night in Mongo at the World Food Program compound and are up before five for morning prayers, milk, tea and Chadian beignets. We arrive late in the afternoon at Abeche, Chad's fourth largest city.
As we enter the mud brick compound and seat ourselves on enormous mats, I experience for the first time what an Arabic greeting really is. A rhythmic, staccato exchange of words proceeds for at least five minutes with at least 20 "mashallah's", 15 "Al hamdullilah's" and countless other words asking about health for everybody, strength, improvement, etc. I soon join in and find it very satisfying. Hands are shook during most of the greeting, eyes look down and occasionally the hand is released to bring one's own hand into touch the chest over the heart before reaching out again to take the other's hand in greeting. To end the salutation, one releases the hand and slowly sits down on the mat letting one's "mashallah's" and "al hamdullilah's" slowly fade out.
Adding to the milk and tea we now have local coffee seasoned with cardamom and added to the meat and bread is "boule" (millet or corn paste) and some of the best sauces I've had in Chad: ground meat with lots of cumin and okra.
I then take a shower in a walled in corner with a poop hole and a step up for showering from a bucket. Just outside, in the other corner, about 20 small girls are learning to recite the Koran in Arabic. Their sweet voices blend together in a cacophony of different rhythms as none of them is in sync with the other. It is beautiful and cute. It feels good to splash water on me and wash the red dust out of my hair and off my face and arms.
The men stretch out and sleep together on the mats in the men's courtyard where the women don't dare to enter. Whenever a female family member has arrived she starts her greeting and then kneels down just outside the low wall of the courtyard while the male family member goes outside to greet her and kneels down beside her for the prolonged ritual greeting.
The morning starts with sunrise at 4:30am and prayer. I read some passages of scripture, we drink milk and eat beignets and head out to see the local authorities.
First stop is the governor. Our host, Mahamat Saleh Abakar, explains that he's invited us out to look at the possibility of opening a medical center in his village of Gnelme. The Governor doesn't seem to keen since there's a health center in the neighboring town of Abougoudam. However, when Mahamat Saleh explains that it will be more than a health center, more like a hospital, the Governor reluctantly gives his ok. On walking out with his "Directeur du Cabinet", we receive a much warmer reception. The lighter skinned man with obvious Arabic features dressed in an ample robe and white turban beams a smile and says that he is from Gnelme and will do everything to help us get the paperwork pushed through for the land and anything else we need.
We miss the Prefet and Sultan who are out of town so we head out of Abeche towards the sous-prefecture of Abougoudam to see the local sous-prefet, the chief political figure of the group of villages including Gnelme.
He welcomes us into his old, colonial thick walled mansion that unfortunately hasn't been maintained since independence in 1960. We sit down on mats and drink tea and local coffee along with sodas and some goat meat. Directly in front of us is a room stacked to the ceiling with cement, all that's left of a project to build the sous-prefet a new house. Apparently, the rest of the supplies where stolen by bandits and the builder assassinated.
We follow the sous-prefet out to the village where he shows us a flat, barren stretch of ground he wants to give us. It doesn't feel right. We move onto where Mahamat Saleh and his brother have drilled a well for the village so they can have water. It's down in the wadi, too low for construction and likely to be washed away by flash floods. Next to the pump are three dried out cattle carcasses...the water came a little too late for them. About 10 boys mounted bareback on horses have come to water their flocks. I point to a fairly close plateau next to a small mountain and say that's more what I'm interested in. They say it's in another county and so they can't help.
We seem at an impasse when a local man almost hidden by his enormous turban rattles off something quickly in Arabic. We hop back in the SUVs and head a little out of the village towards another village where we find a small hill crowned with huge boulders that is unfarmed. In all directions stretches the African plain broken up by wadis and scrub brush and mountains in the distance ringing us in on all sides. It's perfect. They are happy and agree to give us 10 hectares (almost 25 acres). The location will also allow us to build using local stones.
That evening, I speak with Yacoub Abdoulaye, Mahamat Saleh's cousin.
"What's the hospital in Abeche like? For example, how's the surgery service?"
"Well, let's put it this way, if 10 people are operated on, 5 will live, 5 will die. Plus, often people die in the hallways of the hospital without even being seen by a doctor or nurse because they have nothing."
That goes along with what I'd heard last week in N'Djamena from a German mid-wife working at an Orphanage in Abeche.
"A few weeks ago, during a single week, three women died during c-sections while still on the table. Most of our orphans are orphans because of their mothers dying in childbirth. It's not AIDS or the refugee crisis or the war...it's almost complete lack of health care during deliveries."
If you have money, you can get health care, it just might be a little sketchy. An old Arab man with a skull cap, white robe and a wizened face with years of smile wrinkles shows me his lab slip and prescription. He has malaria and a negative Typhoid test. He was prescribed Typhoid fever treatment anyway along with 5 other meds including quinine for malaria. The total was the equivalent of $50, more than a month's wage for most. To top it off, they hadn't even filled the prescription right as he showed me his malaria medication which was actually Chloroquine instead of the prescribed Quinine.
That night, a funeral next door allows all the local Imam wannabes to practice their oral recitation of the Koran...with a microphone and speakers. All night long until 6am the next morning we are alternately soothed by those who have the talent and annoyed by those who seem to be screeching like dying mules trying to sing the otherwise beautiful Arabic of the Koran. I sleep well anyway.
On the way back, Mahamat Saleh tells us a story:
A man gets up one morning to go to the market. He fishes his money out from under the mattress and sticks it in his pocket.
"I'm going to the market to buy a donkey" he says to his wife.
"Inshallah" she responds.
Halfway out the door he looks back at her. "Inshallah? If God wills it? What has God got to do with it? I've got my money in my pocket and there are plenty of donkeys at the market. I'm going to buy one. Keep your 'Inshallah' to yourself"
With that he slams the door and marches off. Halfway to the market, he is waylaid by bandits who tie him up and take his money. They leave him under a tree all day and when it's dark they release him and take off into the bush. The man makes his way slowly back to his house where he finds the door locked. He knocks on the door.
"Who's there?" His wife asks from inside.
"It's me. Open the door...inshallah!"
As I finally pull up into Bere after two straight days of traveling back from Abeche I'm reminded of the story. I pray silently that God will continue to open the doors for us to have a hospital there in Eastern Chad...INSHALLAH!
Dead animals in various states of decomposition and drying litter the shoulders of the highway. Poor rainfall this year has lead to famine and the loss of cattle, donkeys, horses and other vital livestock. Occasionally the smell of a rotting carcass sneaks it's way in through the windows of our passing vehicles.
The African plain starts to be interrupted by wadis, rolling hills and piles of boulders. In the distance, jagged peaks and granite outcroppings break up the horizon. We enter into the central Chadian Sahel where rain has been more abundant and the grasslands are bright green and crops of millet are starting to push their way out of the soil as local farmers dig up the ground with small spades on the end of long poles. Women coming back from the fields carry water and rations in woven net bags suspended from poles slung across one shoulder. No one carries things balanced on top of their heads like they do in Bere in the South.
We stop by the side of the road for a picnic. Tea and Arabic coffee is poured from thermoses as we wait in the shade of a thorny desert scrub tree. A platter of grilled goat chunks and French baguettes is shared among our two groups of five.
We continue on with regular stops for tea, milk and ritual prayer. One stop for prayer finds us in the midst of a cluster of mountains and date palms. The prayer rugs are rolled out and the absolution's begun in front of a man slicing up a sheep into large portions to be roasted on a piece of tin roofing suspended over a wood fire.
We spend the night in Mongo at the World Food Program compound and are up before five for morning prayers, milk, tea and Chadian beignets. We arrive late in the afternoon at Abeche, Chad's fourth largest city.
As we enter the mud brick compound and seat ourselves on enormous mats, I experience for the first time what an Arabic greeting really is. A rhythmic, staccato exchange of words proceeds for at least five minutes with at least 20 "mashallah's", 15 "Al hamdullilah's" and countless other words asking about health for everybody, strength, improvement, etc. I soon join in and find it very satisfying. Hands are shook during most of the greeting, eyes look down and occasionally the hand is released to bring one's own hand into touch the chest over the heart before reaching out again to take the other's hand in greeting. To end the salutation, one releases the hand and slowly sits down on the mat letting one's "mashallah's" and "al hamdullilah's" slowly fade out.
Adding to the milk and tea we now have local coffee seasoned with cardamom and added to the meat and bread is "boule" (millet or corn paste) and some of the best sauces I've had in Chad: ground meat with lots of cumin and okra.
I then take a shower in a walled in corner with a poop hole and a step up for showering from a bucket. Just outside, in the other corner, about 20 small girls are learning to recite the Koran in Arabic. Their sweet voices blend together in a cacophony of different rhythms as none of them is in sync with the other. It is beautiful and cute. It feels good to splash water on me and wash the red dust out of my hair and off my face and arms.
The men stretch out and sleep together on the mats in the men's courtyard where the women don't dare to enter. Whenever a female family member has arrived she starts her greeting and then kneels down just outside the low wall of the courtyard while the male family member goes outside to greet her and kneels down beside her for the prolonged ritual greeting.
The morning starts with sunrise at 4:30am and prayer. I read some passages of scripture, we drink milk and eat beignets and head out to see the local authorities.
First stop is the governor. Our host, Mahamat Saleh Abakar, explains that he's invited us out to look at the possibility of opening a medical center in his village of Gnelme. The Governor doesn't seem to keen since there's a health center in the neighboring town of Abougoudam. However, when Mahamat Saleh explains that it will be more than a health center, more like a hospital, the Governor reluctantly gives his ok. On walking out with his "Directeur du Cabinet", we receive a much warmer reception. The lighter skinned man with obvious Arabic features dressed in an ample robe and white turban beams a smile and says that he is from Gnelme and will do everything to help us get the paperwork pushed through for the land and anything else we need.
We miss the Prefet and Sultan who are out of town so we head out of Abeche towards the sous-prefecture of Abougoudam to see the local sous-prefet, the chief political figure of the group of villages including Gnelme.
He welcomes us into his old, colonial thick walled mansion that unfortunately hasn't been maintained since independence in 1960. We sit down on mats and drink tea and local coffee along with sodas and some goat meat. Directly in front of us is a room stacked to the ceiling with cement, all that's left of a project to build the sous-prefet a new house. Apparently, the rest of the supplies where stolen by bandits and the builder assassinated.
We follow the sous-prefet out to the village where he shows us a flat, barren stretch of ground he wants to give us. It doesn't feel right. We move onto where Mahamat Saleh and his brother have drilled a well for the village so they can have water. It's down in the wadi, too low for construction and likely to be washed away by flash floods. Next to the pump are three dried out cattle carcasses...the water came a little too late for them. About 10 boys mounted bareback on horses have come to water their flocks. I point to a fairly close plateau next to a small mountain and say that's more what I'm interested in. They say it's in another county and so they can't help.
We seem at an impasse when a local man almost hidden by his enormous turban rattles off something quickly in Arabic. We hop back in the SUVs and head a little out of the village towards another village where we find a small hill crowned with huge boulders that is unfarmed. In all directions stretches the African plain broken up by wadis and scrub brush and mountains in the distance ringing us in on all sides. It's perfect. They are happy and agree to give us 10 hectares (almost 25 acres). The location will also allow us to build using local stones.
That evening, I speak with Yacoub Abdoulaye, Mahamat Saleh's cousin.
"What's the hospital in Abeche like? For example, how's the surgery service?"
"Well, let's put it this way, if 10 people are operated on, 5 will live, 5 will die. Plus, often people die in the hallways of the hospital without even being seen by a doctor or nurse because they have nothing."
That goes along with what I'd heard last week in N'Djamena from a German mid-wife working at an Orphanage in Abeche.
"A few weeks ago, during a single week, three women died during c-sections while still on the table. Most of our orphans are orphans because of their mothers dying in childbirth. It's not AIDS or the refugee crisis or the war...it's almost complete lack of health care during deliveries."
If you have money, you can get health care, it just might be a little sketchy. An old Arab man with a skull cap, white robe and a wizened face with years of smile wrinkles shows me his lab slip and prescription. He has malaria and a negative Typhoid test. He was prescribed Typhoid fever treatment anyway along with 5 other meds including quinine for malaria. The total was the equivalent of $50, more than a month's wage for most. To top it off, they hadn't even filled the prescription right as he showed me his malaria medication which was actually Chloroquine instead of the prescribed Quinine.
That night, a funeral next door allows all the local Imam wannabes to practice their oral recitation of the Koran...with a microphone and speakers. All night long until 6am the next morning we are alternately soothed by those who have the talent and annoyed by those who seem to be screeching like dying mules trying to sing the otherwise beautiful Arabic of the Koran. I sleep well anyway.
On the way back, Mahamat Saleh tells us a story:
A man gets up one morning to go to the market. He fishes his money out from under the mattress and sticks it in his pocket.
"I'm going to the market to buy a donkey" he says to his wife.
"Inshallah" she responds.
Halfway out the door he looks back at her. "Inshallah? If God wills it? What has God got to do with it? I've got my money in my pocket and there are plenty of donkeys at the market. I'm going to buy one. Keep your 'Inshallah' to yourself"
With that he slams the door and marches off. Halfway to the market, he is waylaid by bandits who tie him up and take his money. They leave him under a tree all day and when it's dark they release him and take off into the bush. The man makes his way slowly back to his house where he finds the door locked. He knocks on the door.
"Who's there?" His wife asks from inside.
"It's me. Open the door...inshallah!"
As I finally pull up into Bere after two straight days of traveling back from Abeche I'm reminded of the story. I pray silently that God will continue to open the doors for us to have a hospital there in Eastern Chad...INSHALLAH!
Tuesday, June 30, 2009
Snakebite
The sound of a load diesel motor and the sudden appearance of headlights outside the fence sucks me quickly out of a deep sleep into the darkness of a moonless Chadian night. The truck stops in front of the hospital. I have a feeling I might as well get up already.
Sure enough, within minutes, the all-too-familiar knock, knock, knock on the sheet metal door confirms my suspicions.
"Oui?" I mumble as I roll out of bed trying not to disturb Sarah.
"It's me." Sounds out from through the screen door and across the porch into the bedroom. It sounds like the night nurse, Augustin. I pull on some shorts, grab my glasses and fumble through the dark of the living room which is lit eerily by a blue bug lamp.
"They've just brought in a Fulani boy with a snake bite."
I arrive at the door and take the blue carnet from Augustin's outstretched arm.
"He's agitated and his leg is swollen."
"How long has it been."
"About two hours. They're camped out over by Lai and he went to get some water or something and was bit on the foot."
"How did they find a car at this hour?"
"They ran to Lai and found someone."
"Ok, give him a vial of anti-venom in 500cc of Ringer's. Let it run in over 30 minutes. There's not much else really to do. Either it'll work or it won't...oh, give him some Diazepam to calm him down."
"Ok." And Augustin disappears into the night.
I walk inside and pour some water into a canning jar which serves as my guide to make sure I drink at least 5 liters of water a day. As I stare out into the shadows of the yard my thoughts wander to the boy.
Should I go up to the hospital? Would it make a difference? Won't he just probably die anyway?
Then I start to think, of the two forces in this world, good and evil, which would want me to go up to the hospital and which would recommend I go back to sleep. It's a no brainer, so I put on scrubs, grab my keys and head up to the ER.
On the way I send up a quick prayer. "Whatever happens, make sure You get the glory. If I can pray with them, give me the chance so they'll recognize You as the One who heals."
I arrive in the ER and pull back the green and yellow curtain. Writhing on the bed in agony, looking like death warmed over is a slender, wiry nomad boy with dreads, traditional scarring on his face, leather fetish bags around his neck, string bracelets on his wrists and wild colored pants blood stained on the right leg. His right ankle is covered with blood-soaked gauze and the entire leg is swollen and already blistering.
He is moaning and non-responsive with gingival bleeding thrashing his legs and arms around from time to time.
A shaven headed man in a dark gray pant-suit and traditional tattoos and the obligatory leather pouches around the neck is remarkable amongst his people for the lack of dreads and the presence of a cell phone on a string around his neck and sticking out of his shirt pocket. He stands at the head of the bed. Squatting all around the ER are more men and several women with the crazy dreads and black, charcoal based lined tattoos on the face, arms and chest. Plastic shoes are standard. Another family member stands in a corner, the bottom of his left foot pushed against his inner right thigh as he balances on one foot like a flamingo.
Augustin arrives with the IV and we hold the boy's left arm still while the IV perfusion gets running.
"Give him an ampoule of Pentazocine sub-cue since obviously the Diazepam isn't enough."
As Augustin leaves to get the Pentazocine I motion to the Fulani men and speak to them in my broken Arabic.
"We pray to Allah. Allah give him health. Allah only. Ok?"
Heads nod vigorously in agreement as arms outstretch in the Muslim prayer position.
"Rabbina Allah! Give this boy health. Give this boy life. In the name of Isa al-Masih, Amin!"
As the simple prayer finishes our hands move to our faces to take in Allah's blessing as murmurs of "Shukran" and "Alhamdullilah" whisper around the sleeping, snake-bit boy. The bald man points to the sky and pronounces solemnly, "Allah only gives health and life. Allah only."
Augustin arrives and gives the Pentazocine.
I go to the OR and get a 60cc syringe. I draw up 20cc of Ringers and combine it with the 10cc of anti-venom and give it slow IV push over 10 minutes. Within minutes of starting the anti-venom, the gingival bleeding stops and the ankle bleeding slows down.
The boy is asleep now, thanks to the meds. In fact, he's gurgling. I show the Fulani man with the bald head how to do a jaw thrust to open his airway and the boy starts breathing easier. I keep reminding him to keep the airway open as he keeps getting distracted. Finally, he buckles down and gets it.
I tell Augustin to get some IV Chlorpheniramine ready in case he has an allergic reaction. He comes back to say that the pharmacy is out.
Just then, I notice some welts showing up on the boys arms and abdomen. I rush to the OR and come back with Adrenaline and Benadryl. We give him the shots. It seems to stop spreading. His heart is racing but he's still knocked out.
I go back to the OR into the stock room and find the Hydrocortisone we'd just finally found last week at the pharmacy in Lai. Augustin adds 100mg to the perfusion.
I stay by the boy's side often placing my hand on his chest to feel his heart beat and see if he has a fever. He's breathing is slow and shallow and without the constant pressure of his Fulani uncle's hands thrusting his lower jaw forward he would drown in his own saliva.
What I wouldn't give for an old foot powered suction pump!
The bleeding has all but stopped and the hives aren't spreading and, maybe it's my imagination, but they seem to be receding a little.
The Fulani faces around me seem to relax a little. They sense that he might live.
"Alhamdullilah!" I say and point skyward, "Allah only!"
I go home.
The next morning, the boy starts to wake up. We find he has malaria, after 3 more days of malaria treatment, he is eating, sitting up, moving around and the swelling in his leg has started to go down.
I bid them farewell after thanking God again one more time for saving his life.
James
Sure enough, within minutes, the all-too-familiar knock, knock, knock on the sheet metal door confirms my suspicions.
"Oui?" I mumble as I roll out of bed trying not to disturb Sarah.
"It's me." Sounds out from through the screen door and across the porch into the bedroom. It sounds like the night nurse, Augustin. I pull on some shorts, grab my glasses and fumble through the dark of the living room which is lit eerily by a blue bug lamp.
"They've just brought in a Fulani boy with a snake bite."
I arrive at the door and take the blue carnet from Augustin's outstretched arm.
"He's agitated and his leg is swollen."
"How long has it been."
"About two hours. They're camped out over by Lai and he went to get some water or something and was bit on the foot."
"How did they find a car at this hour?"
"They ran to Lai and found someone."
"Ok, give him a vial of anti-venom in 500cc of Ringer's. Let it run in over 30 minutes. There's not much else really to do. Either it'll work or it won't...oh, give him some Diazepam to calm him down."
"Ok." And Augustin disappears into the night.
I walk inside and pour some water into a canning jar which serves as my guide to make sure I drink at least 5 liters of water a day. As I stare out into the shadows of the yard my thoughts wander to the boy.
Should I go up to the hospital? Would it make a difference? Won't he just probably die anyway?
Then I start to think, of the two forces in this world, good and evil, which would want me to go up to the hospital and which would recommend I go back to sleep. It's a no brainer, so I put on scrubs, grab my keys and head up to the ER.
On the way I send up a quick prayer. "Whatever happens, make sure You get the glory. If I can pray with them, give me the chance so they'll recognize You as the One who heals."
I arrive in the ER and pull back the green and yellow curtain. Writhing on the bed in agony, looking like death warmed over is a slender, wiry nomad boy with dreads, traditional scarring on his face, leather fetish bags around his neck, string bracelets on his wrists and wild colored pants blood stained on the right leg. His right ankle is covered with blood-soaked gauze and the entire leg is swollen and already blistering.
He is moaning and non-responsive with gingival bleeding thrashing his legs and arms around from time to time.
A shaven headed man in a dark gray pant-suit and traditional tattoos and the obligatory leather pouches around the neck is remarkable amongst his people for the lack of dreads and the presence of a cell phone on a string around his neck and sticking out of his shirt pocket. He stands at the head of the bed. Squatting all around the ER are more men and several women with the crazy dreads and black, charcoal based lined tattoos on the face, arms and chest. Plastic shoes are standard. Another family member stands in a corner, the bottom of his left foot pushed against his inner right thigh as he balances on one foot like a flamingo.
Augustin arrives with the IV and we hold the boy's left arm still while the IV perfusion gets running.
"Give him an ampoule of Pentazocine sub-cue since obviously the Diazepam isn't enough."
As Augustin leaves to get the Pentazocine I motion to the Fulani men and speak to them in my broken Arabic.
"We pray to Allah. Allah give him health. Allah only. Ok?"
Heads nod vigorously in agreement as arms outstretch in the Muslim prayer position.
"Rabbina Allah! Give this boy health. Give this boy life. In the name of Isa al-Masih, Amin!"
As the simple prayer finishes our hands move to our faces to take in Allah's blessing as murmurs of "Shukran" and "Alhamdullilah" whisper around the sleeping, snake-bit boy. The bald man points to the sky and pronounces solemnly, "Allah only gives health and life. Allah only."
Augustin arrives and gives the Pentazocine.
I go to the OR and get a 60cc syringe. I draw up 20cc of Ringers and combine it with the 10cc of anti-venom and give it slow IV push over 10 minutes. Within minutes of starting the anti-venom, the gingival bleeding stops and the ankle bleeding slows down.
The boy is asleep now, thanks to the meds. In fact, he's gurgling. I show the Fulani man with the bald head how to do a jaw thrust to open his airway and the boy starts breathing easier. I keep reminding him to keep the airway open as he keeps getting distracted. Finally, he buckles down and gets it.
I tell Augustin to get some IV Chlorpheniramine ready in case he has an allergic reaction. He comes back to say that the pharmacy is out.
Just then, I notice some welts showing up on the boys arms and abdomen. I rush to the OR and come back with Adrenaline and Benadryl. We give him the shots. It seems to stop spreading. His heart is racing but he's still knocked out.
I go back to the OR into the stock room and find the Hydrocortisone we'd just finally found last week at the pharmacy in Lai. Augustin adds 100mg to the perfusion.
I stay by the boy's side often placing my hand on his chest to feel his heart beat and see if he has a fever. He's breathing is slow and shallow and without the constant pressure of his Fulani uncle's hands thrusting his lower jaw forward he would drown in his own saliva.
What I wouldn't give for an old foot powered suction pump!
The bleeding has all but stopped and the hives aren't spreading and, maybe it's my imagination, but they seem to be receding a little.
The Fulani faces around me seem to relax a little. They sense that he might live.
"Alhamdullilah!" I say and point skyward, "Allah only!"
I go home.
The next morning, the boy starts to wake up. We find he has malaria, after 3 more days of malaria treatment, he is eating, sitting up, moving around and the swelling in his leg has started to go down.
I bid them farewell after thanking God again one more time for saving his life.
James
Friday, June 26, 2009
Horses
It's a gray Saturday morning. 6:30 am and a cool breeze is blowing in a cloudy sky bringing out the deepness of the green starting to push up through the desert soil. The transformation of desert into lush grasslands has begun with the first rains. Stefan and I are going for a ride. Pepper and Bob are standing near the stables but Libby is nowhere to be found. I search the compound and finally find her standing under a tree staring blankly through the chain link fence across the soccer field into the horizon. I grab her halter. She resists briefly with her head pulled back before resigning herself to her fate.
I tie Bob up to the tree right outside the stables and grab the new, synthetic saddle someone just gave Sarah and cinch it up as tight as I can across Bob's ever increasing girth. He's getting so strong I'll use the bit today. I slide the beautifully worked leather and silver harness and bit into his mouth and squeeze it over his ears and attach it under his chin. I attach the saddle bags over Libby's rump and fill it with water bottles, and a French Bible and Nangere songbook. I place my left purpose into Bob's stirrup and swing up and into place.
We saunter up to the gate and out into the street. Most people are just waking up huddled around smoky leaf fires warming themselves up after a long "cold" night. Some are gathered around a pot of bouillie anticipating the temporary assuaging of the ever present hunger of the end of the dry season. We cross Bere and approach Bendele. Gary and Wendy's empty house stares at us from the left, it's gate locked with a padlock and it's windows barred. A heavy silence reigns.
A few meters up Noel's children wave and flash huge grins as they shout out the obligatory "lapia! James-uh! Stef-ahn!
Passing Noel's house takes us out of the village into the bush. The main road is packed with a steady procession of people on their way to market. Women in brightly colored wraps saunter along their arms swinging in rhyme keeping in balance on their heads the large basins filled with sweet potatoes, sugar, millet, rice, corn, bean leaves and other marketable items. An ox cart plods slowly by loaded with sacks of grain, a few young kids piled on top and one lazily sitting across the pulling bar with a stick in hand to swat the two long-horned cows into the right direction. More women pass, long piles of twisted sticks cut into six feet lengths, tied and bundled onto their heads. Old and young mix in a never ending procession heading for the biggest event of the week, the Bere market.
Further up, we enter a small village where some of the travelers have stopped under a mango tree gathering around a large pot of freshly prepared rice wine to fill their bellies for the exhausting trip to Bere on foot and to prepare themselves for the social scene and eventually a staggering stumble home, dead drunk. They wave wildly their faces lighting up with white, toothy grins as we pass and call out our greetings.
I've switched to Libbly now, as Stefan was having some troubles controlling her. We've been trotting for a while when an open stretch of road heading to Dabague opens up before us. I give a cluck and a kick with my heels and Libby is off on a fast gallop. She's our newest addition to the stables and like Pepper and Bob came to us at a good price thanks to her malnourishment. When Sarah walked her back from the Arab village where we bought her, she could barely do 5 kilometers at a slow walk. Now that she's put on some weight and become one of the friendliest horses around I want to see if she can run and if she's at all competitive.
I'm in front for a while before Bob catches up and barely passes us. Libby picks up speed a little but seems content to stay with Bob and not pass him. Alternately walking, trotting and galloping the 18 kilometers to Delbian pass quickly accompanied by a thousand "Lapias" and "As-salaam alekums".
We tie up Libby and Bob near some grass while a short man with a limp brings a bucket, fills it at the local water pump and gives the horses a much needed drink. We take off the saddle bags and saddles and hang them over mango tree branches out of the reach of curious little hands. I get to tell the story of David and Goliath to a group of kids where practically every other boy his carrying his own sling and sheep are grazing in the background. The story of a shepherd boy killing a giant with a stone and sling has never seemed more real.
I then am told by Noel that I'll be preaching so I pull out of my past the sermon I borrowed from the Pineapple Story guy about God loving impossibilities in using Gideon and 300 men to fight off an army of 135,000; Elijah taking on 400 prophets of Baal on a mountain and God burning up the wet wood, bull, stone and earth with fire from the sky; and Daniel's three friends being saved from a fiery furnace heated up seven times hotter.
In a surprising lack of African hospitality, Stefan and I are allowed to escape the usually obligatory millet paste and slime sauce meal and head back to Bere. Just outside of Dabegue, we come across three young boys bareback on tiny ponies herding cattle. As we trot past, one of them turns and starts running alongside heading towards the road. He wants to race! I cluck loudly and give a big kick to Libby's flanks and she almost shoots out from under me as she pushes to catch the pony. Within seconds we pull even and leave the surprisingly fast pony in the dust. Entering Dabegue we tear around puddles of water, under trees and around people scampering to get out of the way. I'd seen Stefan gunning Bob and was sure he'd catch us by now. I quickly over my shoulder and he's nowhere to be found. A commanding "whoa", a sharp pull on the reins and a lean back with all my force and Libby stops dead in her tracks.
Stefan finally catches up explaining that he lost his hat as Bob sprung forward to enter the race. We continue trotting and walking until we are about 5 kilometers from Bere.
"Let's race Bob and Libby. I want to really see what she can do. See that tree to the left just beyond that puddle? It'll be a walk up start. As soon as we enter the shadow of the tree, the race starts."
I feel my heart beat pick up as the tree approaches and we try to keep the horses even. It's a slow walk up. We're only a few feet away. The horses start to sense our excitement...and...we're there. Libby seems to have been expecting it as she rockets forward almost pulling my feet out of the stirrups. I'm holding on for dear life. We're ahead! I then see Bob cut around a little to the left where a side path goes around some bushes. He's picking up speed. At the same time I feel Libby fading, she's just not in shape and running out of energy. Bob leaves us way behind as we continue a slow gallop to the entrance to Bere and do a cool-down walk the rest of the way home.
As i finally pull myself out of the saddle, I can't believe how tired I am. I'm so wobbly I cna barely stay a foot. I'm covered with sweat and fine dust. The horses slurp up bucketfuls of water and then go for a roll as soon as their saddles are off. I take a quick shower and fall into a deep sleep before being awakened shortly by the nurse on duty.
"There's a woman with high blood pressure and seizures. She's seven months pregnant. The cervix is completely dilated."
I give some instructions and go back down to lay down, but then think better of it and get up, put on scrubs and head to the hospital.
The woman is thrashing around on the bed moaning and whining. The cervix is only at three centimeters. We start an oxytocin drip to give her better contractions and I go to see some other patients. The nurse runs to get me.
"She's having a crisis again!"
I enter the labor and delivery room. The husband is at the bed side and the woman is hysterical. It's not a seizure, though, and she quickly calms down when the husband leaves. I order some pain medication and then she has a grand mal seizure. We hurry her to the OR. Luckily Simeon is there and Samedi lives right next door. The woman is combative and agitated and difficult to get on the OR table. We tie her arms and legs down good, prep the abdomen, scrub and gown and drape.
We pray and Simeon gives one milliliter of Ketamine and I slice down to fascia, rip the fascia and muscles open, lift up a bladder flap, slice into the uterus, poke into the amniotic sac and squeeze out a full term baby boy who after a little rubbing and slapping starts to give a healthy cry. I suture up the uterus and skin and head home to finally rest.
James
I tie Bob up to the tree right outside the stables and grab the new, synthetic saddle someone just gave Sarah and cinch it up as tight as I can across Bob's ever increasing girth. He's getting so strong I'll use the bit today. I slide the beautifully worked leather and silver harness and bit into his mouth and squeeze it over his ears and attach it under his chin. I attach the saddle bags over Libby's rump and fill it with water bottles, and a French Bible and Nangere songbook. I place my left purpose into Bob's stirrup and swing up and into place.
We saunter up to the gate and out into the street. Most people are just waking up huddled around smoky leaf fires warming themselves up after a long "cold" night. Some are gathered around a pot of bouillie anticipating the temporary assuaging of the ever present hunger of the end of the dry season. We cross Bere and approach Bendele. Gary and Wendy's empty house stares at us from the left, it's gate locked with a padlock and it's windows barred. A heavy silence reigns.
A few meters up Noel's children wave and flash huge grins as they shout out the obligatory "lapia! James-uh! Stef-ahn!
Passing Noel's house takes us out of the village into the bush. The main road is packed with a steady procession of people on their way to market. Women in brightly colored wraps saunter along their arms swinging in rhyme keeping in balance on their heads the large basins filled with sweet potatoes, sugar, millet, rice, corn, bean leaves and other marketable items. An ox cart plods slowly by loaded with sacks of grain, a few young kids piled on top and one lazily sitting across the pulling bar with a stick in hand to swat the two long-horned cows into the right direction. More women pass, long piles of twisted sticks cut into six feet lengths, tied and bundled onto their heads. Old and young mix in a never ending procession heading for the biggest event of the week, the Bere market.
Further up, we enter a small village where some of the travelers have stopped under a mango tree gathering around a large pot of freshly prepared rice wine to fill their bellies for the exhausting trip to Bere on foot and to prepare themselves for the social scene and eventually a staggering stumble home, dead drunk. They wave wildly their faces lighting up with white, toothy grins as we pass and call out our greetings.
I've switched to Libbly now, as Stefan was having some troubles controlling her. We've been trotting for a while when an open stretch of road heading to Dabague opens up before us. I give a cluck and a kick with my heels and Libby is off on a fast gallop. She's our newest addition to the stables and like Pepper and Bob came to us at a good price thanks to her malnourishment. When Sarah walked her back from the Arab village where we bought her, she could barely do 5 kilometers at a slow walk. Now that she's put on some weight and become one of the friendliest horses around I want to see if she can run and if she's at all competitive.
I'm in front for a while before Bob catches up and barely passes us. Libby picks up speed a little but seems content to stay with Bob and not pass him. Alternately walking, trotting and galloping the 18 kilometers to Delbian pass quickly accompanied by a thousand "Lapias" and "As-salaam alekums".
We tie up Libby and Bob near some grass while a short man with a limp brings a bucket, fills it at the local water pump and gives the horses a much needed drink. We take off the saddle bags and saddles and hang them over mango tree branches out of the reach of curious little hands. I get to tell the story of David and Goliath to a group of kids where practically every other boy his carrying his own sling and sheep are grazing in the background. The story of a shepherd boy killing a giant with a stone and sling has never seemed more real.
I then am told by Noel that I'll be preaching so I pull out of my past the sermon I borrowed from the Pineapple Story guy about God loving impossibilities in using Gideon and 300 men to fight off an army of 135,000; Elijah taking on 400 prophets of Baal on a mountain and God burning up the wet wood, bull, stone and earth with fire from the sky; and Daniel's three friends being saved from a fiery furnace heated up seven times hotter.
In a surprising lack of African hospitality, Stefan and I are allowed to escape the usually obligatory millet paste and slime sauce meal and head back to Bere. Just outside of Dabegue, we come across three young boys bareback on tiny ponies herding cattle. As we trot past, one of them turns and starts running alongside heading towards the road. He wants to race! I cluck loudly and give a big kick to Libby's flanks and she almost shoots out from under me as she pushes to catch the pony. Within seconds we pull even and leave the surprisingly fast pony in the dust. Entering Dabegue we tear around puddles of water, under trees and around people scampering to get out of the way. I'd seen Stefan gunning Bob and was sure he'd catch us by now. I quickly over my shoulder and he's nowhere to be found. A commanding "whoa", a sharp pull on the reins and a lean back with all my force and Libby stops dead in her tracks.
Stefan finally catches up explaining that he lost his hat as Bob sprung forward to enter the race. We continue trotting and walking until we are about 5 kilometers from Bere.
"Let's race Bob and Libby. I want to really see what she can do. See that tree to the left just beyond that puddle? It'll be a walk up start. As soon as we enter the shadow of the tree, the race starts."
I feel my heart beat pick up as the tree approaches and we try to keep the horses even. It's a slow walk up. We're only a few feet away. The horses start to sense our excitement...and...we're there. Libby seems to have been expecting it as she rockets forward almost pulling my feet out of the stirrups. I'm holding on for dear life. We're ahead! I then see Bob cut around a little to the left where a side path goes around some bushes. He's picking up speed. At the same time I feel Libby fading, she's just not in shape and running out of energy. Bob leaves us way behind as we continue a slow gallop to the entrance to Bere and do a cool-down walk the rest of the way home.
As i finally pull myself out of the saddle, I can't believe how tired I am. I'm so wobbly I cna barely stay a foot. I'm covered with sweat and fine dust. The horses slurp up bucketfuls of water and then go for a roll as soon as their saddles are off. I take a quick shower and fall into a deep sleep before being awakened shortly by the nurse on duty.
"There's a woman with high blood pressure and seizures. She's seven months pregnant. The cervix is completely dilated."
I give some instructions and go back down to lay down, but then think better of it and get up, put on scrubs and head to the hospital.
The woman is thrashing around on the bed moaning and whining. The cervix is only at three centimeters. We start an oxytocin drip to give her better contractions and I go to see some other patients. The nurse runs to get me.
"She's having a crisis again!"
I enter the labor and delivery room. The husband is at the bed side and the woman is hysterical. It's not a seizure, though, and she quickly calms down when the husband leaves. I order some pain medication and then she has a grand mal seizure. We hurry her to the OR. Luckily Simeon is there and Samedi lives right next door. The woman is combative and agitated and difficult to get on the OR table. We tie her arms and legs down good, prep the abdomen, scrub and gown and drape.
We pray and Simeon gives one milliliter of Ketamine and I slice down to fascia, rip the fascia and muscles open, lift up a bladder flap, slice into the uterus, poke into the amniotic sac and squeeze out a full term baby boy who after a little rubbing and slapping starts to give a healthy cry. I suture up the uterus and skin and head home to finally rest.
James
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