I feel lost in a story that seems to fly by. It's moving, intense, captivating, exhausting...and each page is turned so fast I can only catch enough glimpses to get the general idea of the what's going on...yet, each page once turned is permanently turned...you can't go back.
A woman in labor for 2 days. Seen last night by a retired health care worker. Sent to us this morning. Her baby's too big. The head is all molded and almost sticking out...but it's just skin on his head that has been squeezed out...the skull won't fit through.
I have been called from my egg and rice breakfast. I run to the OR. I grab a syringe, anesthetic, an instrument box, a scalpel, a urinary catheter and some gauze and gloves. I rush back. I shave, prep, and slice down to her pubic bone. I start to cut through the cartilage. The scalpel breaks inside. I can't find it. I yell for a flashlight and another scalpel. I mop up the blood with the gauze. I call for Lona and Rachel. They each grab a leg. I cut deeper, going by feel. I tell Lona and Rachel to pull her legs apart. I hear a crack and feel her pelvis widen at the front.
The baby slides out in a slippery bath of brownish green fluid. He's huge, has a slow heartbeat and a little muscle tone. He never breaths. Despite CPR and resuscitation for 10 minutes he never cries. He's dead.
Meanwhile Lona has delivered the placenta and casually says she's bleeding. As I'm pressing the baby's chest between my fingers and two thumbs to pump his blood I look and see that Lona has draped a gauze over the perineum which is soaked with strings of coagulated blood dripping down into the green basin as the entire area is bright red. I leave the baby. I pull off the gauze...the entire birth canal is filled with blood and a piece of tissue hanging out. I yell for more gauze...they run to get it. I cram gauze inside and pull them out so I can see what's going on. Nathan holds a flashlight over my shoulder.
It appears the cervix has completely torn itself off circumferentially and is literally hanging by a thread. I clamp the base. Then, I soak up the blood in the wound where I cut her pelvis and with the flashlight try to find the piece of broken off scalpel. No where to be seen. I fish around with a needle driver and bang against something. I dab up blood and look again. I see it and pull it out. Then I wash out and suture up. I then suture up a tear around her urethra and a small posterior perineal tear. I cut off the dangling strip of cervix, take off the clamps, see there's no bleeding and an hour and a half after starting head off for rounds.
What part do I have to play? Why am I even in this story called H�pital Adventiste de Béré? My character being in the tale, much less one of the protagonists, is as odd as Crush the turtle showing up in Blair Witch Project. I get this feeling sometimes of the other players whispering behind their backs, when they think I'm not looking, asking how did he get a part? And, doesn't he realize that his lines are totally out of place and poorly acted?
I'm called over to the TB ward. Someone's not doing well. I see one of our long-timers is in bad shape. He'd come from Kelo...had started to improve and put on weight. He has a congenitally deformed left arm where the hand faces the wrong way and the whole thing is too short. Yesterday, his cousin told me he had a fever...probably malaria. Sure enough the smear is positive. I write for Quinine and Fandsidar and forget about it.
Now, he's death warmed over. He's unconscious, gray, has a slow heart beat, his cheeks are sunken and his breathing is more like an occasional deep sigh out of reflex rather than a serious effort at obtaining oxygen. I expect him to die in front of me. I sit there and stare at him for ten minutes. If I'd only gone to see him yesterday maybe I'd have seen he was bad and been more aggressive with treatment. It's so easy to ignore the TB patients...there just there taking pills. I'm so busy, maybe I'll see them tomorrow...at least once a week...or now and then...
A little girl, also hospitalized with TB, is sitting at the foot of the bed weeping. She is the cutest, cheeriest, most helpful girl. She always yells, "James-uh", and waves as she passes by carrying laundry or water on her head. She's helped us this week trim the mango trees wanting to saw as much as she can even if it doesn't really do much. Now, as easily as she laughs, she cries for someone she wouldn't know except for their common disease...I feel useless...I want to cry too...I want to run home and hide...I want to be a little kid again...but I just stand and stare and then walk lamely off with a blank expression...
Yet, somehow, it works. Beyond all rational thought, the play goes on...the plot thickens...the suspense builds...the rivals grow to respect each other...love is found in the most unexpected of places...laughter pops up randomly...joy is found...
I see all three "James-uhs" today. I've had three kids born here since I've been here who are named for me. The first one is the Chaplain's grandson. He's also been treated for Malaria a couple times and just wandered in with his mom looking healthy. James-uh 2 was brought in when 3 days old with a strangulated umbilical hernia that we operated on urgently. He recovered, then developed a wound infection and came in daily for a while for antibiotic shots and dressing changes. He sees me today as one of the sutures has poked through the skin and is sticking out. He is a round, chubby, dark baby with a serious afro going on and a vigorous cry and kick as I cut the suture and pull it out.
James-uh 3 is weak and malnourished. He is the surviving twin of Yvonne, born of c-section to an HIV+ mom. David, his bro, died last week. He manages to barely hang on. We tried him on formula to protect him from mommy's HIV and almost killed him with the diarrhea and lactose-intolerance. He's somehow toughing it out and I see him stretch out his puny arms for mom's breast as I change her dressing. She pulls him close and he sucks vigorously as if his life depended on it...and it does...
Then, despite the time in the desert, thirsty, hot, baked, dried out, tongue sticking to the roof of the mouth, hot, unbearable...despite it coming to an end with refreshing rain and cool winds and pleasant evenings...the sleeplessness continues. The thoughts ramble. The feeling of hopelessness for change enters. The spirit isn't even willing and the flesh is very weak.
A well-groomed, stocky man walks into my office with jeans, a tucked-in flannel and alligator skin boots. He presents his dossier. He is the referring doctor for a patient I've just seen. I was surprised to get an official looking letter with a reference from a traditional healer that morning. He'd tried to treat her pelvic pain for 3 days without success and so now was referring to the hospital. How cool, I'd thought.
Now he's presenting me papers telling how he's met with other traditional healers from Benin and other African countries for an exchange of ideas and how they're researching traditional pharmaceuticals. I'm impressed. I ask him how he was trained. That's when things suddenly turned bizarre.
I notice he's holding a carved horn as if it was a newborn baby...tenderly and pressed against his chest. He calmly tells me that he was drowned as a child, 5 spirits entered him and revived him, and they now tell him which plants to use for which problems. I don't know what to say. We continue otherwise to chat as colleagues. I tell him we've found Shistosomes in his patient's urine and have prescribed treatment. He is gracious, polite, refined and the last way I'd expected to see my first witch doctor.
This is just the latest to confirm my suspicions of the heaviness of spiritual forces here. A few weeks ago, after morning report we somehow got on the topic and all the staff started recounting tales of the supernatural.
Rahama told of taking her husband into the bush to see a healer. He boiled water, made him stand in the vapor and then threw something at his eyes. Animal bones immediately flew out of her husband's eyes and fell to the ground. She was shocked but had presence of mind to gather them up. She showed them to me the next day.
Samedi once saw two men who came by to show their powers. One took a sharp bush knife, suddenly turned, and whacked off the head of his companion. They all saw it fall to the ground. Then he picked it up and set it back on his friend's shoulders and he started talking and moving normally.
Andr� has seen people put curses on things that if you touch them you become frozen in place till the person comes back and sees it was you who was going to steal it. The others all confirmed that this is common.
Someone told the tale of our swimming hole by the bridge where Sarah and I like to jump off the cliffs. Apparently, a healthy young man was accused of adultery and was forced to swim across...which he did fine. But on swimming back he suddenly cried, lifted his arms out, and disappeared under the surface never to be seen again.
Then, there are the simple things like, when Pastor Job from N'Djam�na was here and said he's never heard goats and animals make so much noise or be so bothersome. He said they must be possessed. I'd thought the same thing but was afraid of sounding silly or paranoid if I mentioned it. Why else would they poop on our porch exclusively, pee right out side our windows, bleat uncontrollably for no reason just as we fall asleep and basically do as much as possible to assure we get no rest.
Spiritual forces are palpable here. I believe that God will protect me...but how to battle for the others? I've seen many patients I'm convinced should've lived except there was always some "sorcellerie" going on, or as the patients say, "he's been poisoned" meaning had a spell cast on him. What can I do? I feel helpless and inadequate...
I wonder like Sam Gamgee as he wanders the wilds near Mordor if they will write about me in the tales or am I way too insignificant...do I have an important part to play in this cosmic story? Will I have made a difference when the credits roll?
Somehow, I know that in the end, as I sit around the campfires of heaven, I will have stories to tell. People will say, tell me more about Samedi, and Lona, and Anatole and especially, about Sarah...did you really?...Are you serious?...No way!...That's what keeps me going...even though, or especially because, a place like this is beyond my wildest nightmares...it begins to take on a mythic quality. I feel detached at times, looking at myself, wondering if this is reality or just another movie, a story, a tale, something someone made up...and just maybe Someone did and the ending will be beyond my fondest dreams...
To be continued...
James
Thursday, May 5, 2005
Tuesday, April 26, 2005
Getting close
Kulluku,
Al-salam alekum...anina afe...al hamdu lillah...
It's kind of strange. I only really get close to patients if they have problems severe enough to keep them hospitalized for a long time. There's Marty, the fisherman bit by the hippo. We still keep in touch. It seems every time I go to swim at a certain spot I see him. Last Saturday, he stopped by to give Sarah and I some fish he'd caught. Apparently, he's back fishing the lake with the hippos. But that friendship was at the cost of excruciating daily dressing changes on a two-foot long, 6 inch deep wound on his derriere.
Gai, the tall, lanky young man with one lung also sees us often at another swimming hole we frequent. He's usually off hunting with his bush knife but stops to say hello. He stops by the hospital from time to time as well and we're always glad to see him. He became our friend because of living with a chest tube for weeks, undergoing a thoracotomy with second chest tube and being hooked up to a crude suction machine every night when the power came on.
Then there's Freddy whose father refused amputation, who we did deep dressing changes deep into his thigh on for months and who ended up dying but not before finding a place in our hearts.
The list could go on and on...people brought into our lives through painful circumstances and suffering who somehow change us and become part of us through the process.
Currently, there's Suzanne and Yvonne. After a year of virtually no wound infections we were faced with two consecutive c-sections that turned into catastrophic post-op pus nightmares. Suzanne came first. Hers was a simple routine c-section except that the child was difficult to resuscitate and died 2 days later. She had a normal post-op course but then came back a week later with a little pus coming out of her wound, diarrhea and a distended abdomen.
She was started on antibiotics by the nurse, found to have malaria, treated for malaria and started to improve. I saw her a day later and opened the wound up more as there appeared to be a little abscess inside. Overall, she was doing well, walking and eating.
15 minutes after I opened the wound her husband came running to find me and said she'd had a huge diarrheal episode. I came in to find her standing in a puddle of foul smelling fluid. When I asked her she said it'd come from her wound. I took off the dressing and saw some fluid coming out.
We went to the OR to explore and ended up having to open her up in the midline as we found her entire abdomen filled with pus and inflammatory debris. She was left with a huge inverted T-shaped wound with the skin open in the midline and the entire wound down to the uterus open at the base.
She's been here over 6 weeks and has recuperated nicely with only a small portion of her wound still to close. Unfortunately, she has developed a nasty bed sore on her sacrum. But she and I and her mom (named Sarah) and my Sarah have all become fast friends. They don't speak French and I don't speak Nangjere but our non-verbal communication is enough to show that we're happy to see each other and that she has grown as fond of us as we have of her. They joke that Sarah needs to give me more back rubs as I work to hard...both probably true.
Just a few days after Suzanne came in with her wound infection, Yvonne came in with almost exactly the same thing. You'll remember that she is the woman infected with HIV who gave birth to twins by c-section. Her wound wasn't as extensive so I put drains in and we're doing dressings on the existing wound.
We helped them get formula from the Catholics so they wouldn't get HIV from the mom's breast milk. They did fine for about a month and we grew quite fond of them. In fact, they named one James and when I told them my twin brother was named David they named the other one David. David was the stronger one. James developed some abscesses on his head and was treated with some antibiotics. He was smaller and frailer from the beginning.
Yvonne's 3 year old son has started hanging out with the kids at church and basically has made himself a regular on campus. Her ten year old daughter helped us cut tree limbs and cooks and cleans for Yvonne here at the hospital.
Yvonne had a couple of setbacks but has pulled through. She developed a partial bowel obstruction which was resolved with one day of antibiotics, IV fluids and a nasogastric tube. A second one was cured with watching, waiting and prayer. She came to church last week and gives God thanks that she's recovering. The past two days she was well enough to walk to the market and back.
Unfortunately, David and James developed diarrhea and got Malaria. In a strange parallel to my own life, David (the stronger one), died after two days while the weaker James pulled through and is doing fine. It has been truly a bizarre sort of d�j� vu all along with Yvonne, James and David...but it has been a joy as well. I guess now I have two twin Davids to look forward to seeing in heaven...
James
Al-salam alekum...anina afe...al hamdu lillah...
It's kind of strange. I only really get close to patients if they have problems severe enough to keep them hospitalized for a long time. There's Marty, the fisherman bit by the hippo. We still keep in touch. It seems every time I go to swim at a certain spot I see him. Last Saturday, he stopped by to give Sarah and I some fish he'd caught. Apparently, he's back fishing the lake with the hippos. But that friendship was at the cost of excruciating daily dressing changes on a two-foot long, 6 inch deep wound on his derriere.
Gai, the tall, lanky young man with one lung also sees us often at another swimming hole we frequent. He's usually off hunting with his bush knife but stops to say hello. He stops by the hospital from time to time as well and we're always glad to see him. He became our friend because of living with a chest tube for weeks, undergoing a thoracotomy with second chest tube and being hooked up to a crude suction machine every night when the power came on.
Then there's Freddy whose father refused amputation, who we did deep dressing changes deep into his thigh on for months and who ended up dying but not before finding a place in our hearts.
The list could go on and on...people brought into our lives through painful circumstances and suffering who somehow change us and become part of us through the process.
Currently, there's Suzanne and Yvonne. After a year of virtually no wound infections we were faced with two consecutive c-sections that turned into catastrophic post-op pus nightmares. Suzanne came first. Hers was a simple routine c-section except that the child was difficult to resuscitate and died 2 days later. She had a normal post-op course but then came back a week later with a little pus coming out of her wound, diarrhea and a distended abdomen.
She was started on antibiotics by the nurse, found to have malaria, treated for malaria and started to improve. I saw her a day later and opened the wound up more as there appeared to be a little abscess inside. Overall, she was doing well, walking and eating.
15 minutes after I opened the wound her husband came running to find me and said she'd had a huge diarrheal episode. I came in to find her standing in a puddle of foul smelling fluid. When I asked her she said it'd come from her wound. I took off the dressing and saw some fluid coming out.
We went to the OR to explore and ended up having to open her up in the midline as we found her entire abdomen filled with pus and inflammatory debris. She was left with a huge inverted T-shaped wound with the skin open in the midline and the entire wound down to the uterus open at the base.
She's been here over 6 weeks and has recuperated nicely with only a small portion of her wound still to close. Unfortunately, she has developed a nasty bed sore on her sacrum. But she and I and her mom (named Sarah) and my Sarah have all become fast friends. They don't speak French and I don't speak Nangjere but our non-verbal communication is enough to show that we're happy to see each other and that she has grown as fond of us as we have of her. They joke that Sarah needs to give me more back rubs as I work to hard...both probably true.
Just a few days after Suzanne came in with her wound infection, Yvonne came in with almost exactly the same thing. You'll remember that she is the woman infected with HIV who gave birth to twins by c-section. Her wound wasn't as extensive so I put drains in and we're doing dressings on the existing wound.
We helped them get formula from the Catholics so they wouldn't get HIV from the mom's breast milk. They did fine for about a month and we grew quite fond of them. In fact, they named one James and when I told them my twin brother was named David they named the other one David. David was the stronger one. James developed some abscesses on his head and was treated with some antibiotics. He was smaller and frailer from the beginning.
Yvonne's 3 year old son has started hanging out with the kids at church and basically has made himself a regular on campus. Her ten year old daughter helped us cut tree limbs and cooks and cleans for Yvonne here at the hospital.
Yvonne had a couple of setbacks but has pulled through. She developed a partial bowel obstruction which was resolved with one day of antibiotics, IV fluids and a nasogastric tube. A second one was cured with watching, waiting and prayer. She came to church last week and gives God thanks that she's recovering. The past two days she was well enough to walk to the market and back.
Unfortunately, David and James developed diarrhea and got Malaria. In a strange parallel to my own life, David (the stronger one), died after two days while the weaker James pulled through and is doing fine. It has been truly a bizarre sort of d�j� vu all along with Yvonne, James and David...but it has been a joy as well. I guess now I have two twin Davids to look forward to seeing in heaven...
James
Friday, April 15, 2005
No title
My living room in Béré is simple. There are holes in the ceiling over the table in the corner. In the rainy season we put pots on the table to collect the drips. The table is covered with fake plants, a kerosene lantern, a laptop computer, a satellite phone, a calendar, a box with corks, a clay pot with notes inside from people who've borrowed money and a straw basket woven locally and filled with pens, rubber bands, paper clips and various other odds and ends.
A woven wicker wasted basket sits to the side. A metal file cabinet with no door and a few shelves has been converted into a bookshelf containing Christian books in French, a Tchadian Arabic dictionary and grammar book, CDs, DVDs, Surfing magazines and a few odds and ends like Don Quixote in the original Spanish, A Tale of Two Cities, Perspectives on the World Christian Movement, The Gospel According to Biff--Christ's Childhood Pal, and Spanish playing cards.
In the corner are three African drums of various sizes, a guitar case, a car battery, a rusty machete, a broom, sandals and a few odd clay pots. A wicker couch covered with a curtain, a small table in the other corner, 4 chairs and a coffee table complete the furnishings. Two bush knifes, a Safari hat and various postcards adorn the otherwise bare, white walls.
Out the front door comes the sounds of an old typewriter being painstakingly tapped by André on his porch across the courtyard. A metal, rebar frame on the verandah houses a sagging, limp mosquito net. The cement railing has chipped paint and many missing blocks leaving some suspended virtually in mid air.
Out the side window one hears the sounds of twittering birds, scratching chickens and the mumbling of kids at play. A bare dirt yard has piles of raked weeds and leaves ready for burning and smoldering piles and ashes from this morning's burnings. Several guava trees have cracked leftover bricks arranged in something resembling circles around their trunks so they can be watered. An old clothesline is currently bare of its usually brightly colored African clothes or drably colored hospital scrubs. A rooster and a hen with her chicks scratch at the base of the newly watered trees.
The recently constructed wall is made of locally fashioned and fired mud bricks with sand-heavy mortar up to about 3 feet high where a thick, chain-link fence takes over. The heads of children are barely visible on the other side where they have gathered to drink from the hose draped over the bricks and through the chain-link to the outside. Some sort of game with a small deformed ball is being played to the side. An older boy rides by on a rickety bike with a hundred pound sack of rice tied to the back.
Behind the kids is our neighbor's stack of newly fired bricks. The mud bricks were assembled in a rough pyramid with holes on the outside layer and underneath where sticks were shoved and lit. All night long the family and neighbors gathered around the warm glow until morning brought a blackened outside crust housing bright red fired bricks within. The neighbors' mud brick, thatched houses weathered by years of rain rest just behind almost seeming a part of the natural landscape unlike our cement and tin roofed behemoths and rude metal fencing.
The elementary school is a few hundred yards off the corner of our fence, abandoned now in the hot, 120 degree afternoon. Everything seems oppressed by the heat. Even the air seems afraid to move lest it start to sweat or expend too much energy in providing its wind. The only thing unrestrained by the heat is the universally boundless energy of the kids, one of whom hangs casually off the chain-link while the rest have changed games slightly, now tossing the ball in the air in a circle with who knows what objective.
A man walks out of the hole in the neighbors wall serving as a door, leading three cattle. The cattle have huge, floppy humps between their shoulders and 2-3 foot long curved horns. A chain or rope through the nose allows these otherwise unpredictable steers to be guided even by a child. The man leads them off for some undetermined task:� perhaps hauling wood, carrying bricks, pulling a cart, or just to be watered and grazed.
In the kitchen, Sarah sits at her desk with white lace curtains behind her. She is intently flipping through pages scratching her neck with a pen. Her hair has been pulled up tightly and she wears a tank top in a vain attempt to escape some of the heat. A rooster crows. Ephraim calls for his papa. A boy runs past the fence with a stick pushing a rolling metal lid. The briefest of winds evaporates the sweat running down my back providing temporary refreshment.
The hospital is quiet but at any moment that dreaded clap-clap could appear on the porch in the form of a scrub-wearing, white-coated nurse calling me forth from my malaria-induced reverie back into the world of the Béré Adventist Hospital...
James
A woven wicker wasted basket sits to the side. A metal file cabinet with no door and a few shelves has been converted into a bookshelf containing Christian books in French, a Tchadian Arabic dictionary and grammar book, CDs, DVDs, Surfing magazines and a few odds and ends like Don Quixote in the original Spanish, A Tale of Two Cities, Perspectives on the World Christian Movement, The Gospel According to Biff--Christ's Childhood Pal, and Spanish playing cards.
In the corner are three African drums of various sizes, a guitar case, a car battery, a rusty machete, a broom, sandals and a few odd clay pots. A wicker couch covered with a curtain, a small table in the other corner, 4 chairs and a coffee table complete the furnishings. Two bush knifes, a Safari hat and various postcards adorn the otherwise bare, white walls.
Out the front door comes the sounds of an old typewriter being painstakingly tapped by André on his porch across the courtyard. A metal, rebar frame on the verandah houses a sagging, limp mosquito net. The cement railing has chipped paint and many missing blocks leaving some suspended virtually in mid air.
Out the side window one hears the sounds of twittering birds, scratching chickens and the mumbling of kids at play. A bare dirt yard has piles of raked weeds and leaves ready for burning and smoldering piles and ashes from this morning's burnings. Several guava trees have cracked leftover bricks arranged in something resembling circles around their trunks so they can be watered. An old clothesline is currently bare of its usually brightly colored African clothes or drably colored hospital scrubs. A rooster and a hen with her chicks scratch at the base of the newly watered trees.
The recently constructed wall is made of locally fashioned and fired mud bricks with sand-heavy mortar up to about 3 feet high where a thick, chain-link fence takes over. The heads of children are barely visible on the other side where they have gathered to drink from the hose draped over the bricks and through the chain-link to the outside. Some sort of game with a small deformed ball is being played to the side. An older boy rides by on a rickety bike with a hundred pound sack of rice tied to the back.
Behind the kids is our neighbor's stack of newly fired bricks. The mud bricks were assembled in a rough pyramid with holes on the outside layer and underneath where sticks were shoved and lit. All night long the family and neighbors gathered around the warm glow until morning brought a blackened outside crust housing bright red fired bricks within. The neighbors' mud brick, thatched houses weathered by years of rain rest just behind almost seeming a part of the natural landscape unlike our cement and tin roofed behemoths and rude metal fencing.
The elementary school is a few hundred yards off the corner of our fence, abandoned now in the hot, 120 degree afternoon. Everything seems oppressed by the heat. Even the air seems afraid to move lest it start to sweat or expend too much energy in providing its wind. The only thing unrestrained by the heat is the universally boundless energy of the kids, one of whom hangs casually off the chain-link while the rest have changed games slightly, now tossing the ball in the air in a circle with who knows what objective.
A man walks out of the hole in the neighbors wall serving as a door, leading three cattle. The cattle have huge, floppy humps between their shoulders and 2-3 foot long curved horns. A chain or rope through the nose allows these otherwise unpredictable steers to be guided even by a child. The man leads them off for some undetermined task:� perhaps hauling wood, carrying bricks, pulling a cart, or just to be watered and grazed.
In the kitchen, Sarah sits at her desk with white lace curtains behind her. She is intently flipping through pages scratching her neck with a pen. Her hair has been pulled up tightly and she wears a tank top in a vain attempt to escape some of the heat. A rooster crows. Ephraim calls for his papa. A boy runs past the fence with a stick pushing a rolling metal lid. The briefest of winds evaporates the sweat running down my back providing temporary refreshment.
The hospital is quiet but at any moment that dreaded clap-clap could appear on the porch in the form of a scrub-wearing, white-coated nurse calling me forth from my malaria-induced reverie back into the world of the Béré Adventist Hospital...
James
Saturday, April 9, 2005
More death... and darkness
Suddenly it's pitch black. Not a new occurrence, it happens every night around 8pm or so. Shortly thereafter there is also quiet as the generator shuts down. For some reason, though, it is darker than usual. Like being in a cave, turning off the flashlight and trying to see your hand in front of your face. We sit patiently waiting. Someone lights a match...
But what about the darkness in my soul, the blackness squeezing out any light from my soul?
Death has struck again. If you've wondered where that dark hooded guy with the sickle over his shoulder hangs out in his spare time...it's Béré.
I'm standing on the porch talking to two teenagers. They have come before seeking help with science homework. They've taken us to their church a few Sundays ago. They have come tonight just to talk. It's a Friday night. They wonder if I'll go to Lai tomorrow to see the President of the Republic who'll be there to inaugurate the bridge linking B�r� and Lai. Andre walks up. "Our president is dead." At first, I think he means the President we've just been talking about. He soon clarifies, "the president of our Mission."
I met Pastor Herimanana at an HIV conference last October in Bamenda, Cameroun. A down to earth guy, he had a real heart for the sick and hurting, especially those suffering from HIV/AIDS. At the time, we'd been half a year without a leader of our Mission here in Tchad. I couldn't help but think how cool it'd be if he could come to Tchad. I knew he'd be supportive of our hospital and provide honest, strong leadership. To my happy surprise, a few months ago he was named as the president of the Tchad Mission.
Thursday, he finished his visa paperwork in Yaound� and was on his way to Douala to catch his flight to Tchad when the driver lost control and he was killed on the highway.
Andre kept hitting his hand with his other hand crying out "c'est pas possible, c'est pas possible!" Looking at me he said, "the devil really must hate us here in Tchad." I had to agree.
The darkness descends.
I hear in morning report today that the little Arab boy with the burn on his chest wasn't doing well. His mom "bugged" the night nurse three times to go get the "Nasara" meaning me. We all had a good laugh.
On rounds, Sarah comes up and says the boy is yellow all over...jaundice...and his belly is hard. I'll be to see him in 5-10 minutes when I finish with the other patients.
5 minutes later I hear a small child scream and wail. I look outside. The cute little sister of our young patient is running around, throwing her self on the ground with the most heart-rending cries. A nurse comes to say the boy has died.
He's been with us for weeks. He'd been recovering. He'd come in dehydrated after a month of home treatment for burns on his chest, arms, hands and feet. Friday, he was a chubby, happy baby. His two little sisters are the cutest ever and love to play with Sarah and hang all over their doting dad. He always brings crackers in his pockets where even the littlest one knows to find them before he can even get his ritual Arabic greetings over with.
A large group of brightly clad Arab women in veils cry--sometimes sounding like laughter but one look at the face makes the distinction--and prepare to take away the corpse. The oldest little sister bangs her head on the ground tears streaming down her cheeks as a nurse tries to keep her from hurting herself by placing her head in the absorbent lap of an aunt...
And the baby? Now, he's a cooling body lying on his back, eyes staring into nowhere...into the darkness...
I return to rounds and stare blankly at the floor for awhile. None of the patients or staff says a word. They must wonder what's the problem, people die all the time, it's a part of life...a part I just can't get used to.
A few minutes later, the Financial Manager of our Health District comes in. He pulls me aside to inform me that our newly appointed "Chef" of the infant vaccination program died yesterday of AIDS. Also, Dagal, the nurse in charge of supervision of the health centers on my arrival who'd recently been relocated to Lai, also died of AIDS. Two of our colleagues in the same day. Yeah, I'd had my run-ins with Dagal, but at the same time I'd hear him occasionally mention God as if his life was a tug of war between two warring factions for his life...who knows who won in the end...it would appear the darkness of his reckless lifestyle...but God only knows...
I stumble on, groping, in the darkness...I find a little light, enough to finish rounds and head to the office where a letter awaits me in the hands of Andre.
Rahama has asked for a 5 day leave of absence to take her husband to see one of the more powerful witch doctors in the area for his eye problem. After some discussions with Rahama and Samedi I find myself walking through the dusty streets, past the mud brick houses of Anatole and Samedi, around the corner near the big mango tree, through the hole in the mud wall and onto the mat under the large shade tree in Rahama's courtyard.
Kemkoye invites us to sit. We do. Samedi and I are wearing matching light blue scrubs and Kemkoye has a brightly colored shirt on. His face is an expressionless puzzle. Thinking back, I wonder if I've ever seen anything not approaching a blank stare on that face. I start the conversation.
I tell him I must warn him that not only is he unlikely to find a lasting solution to his problem, but that he is messing with dangerous, and real, forces of darkness. Is it worth it, even to find a little relief? Or as Someone said years ago, to gain the world and lose one's soul? The mask stares past me. The red, cloudy eye pierces into some corner far away. He hedges and bets never changing the expressionless tone of his voice.
He says he can't afford to go to the Ophthalmologist. I offer to have him come with us in two days to N'Djaména...free of charge. Then, I mention having just seen that Doctors Without Borders has some Ophthalmologists in Kousseri, Cameroun, just across the border. I'll take him there personally I say. He doesn't want to be convinced. Samedi says a few words. Half an hour later we leave with him at least "considering it".
At 2pm, I see Rahama. She enters the office, face a storm cloud of darkness. Abruptly, she spurts it all out. He insists on going to the witchdoctor. She must go with him. She rises to go. She says she's at the breaking point of discouragement...her face shows it. She is hopeless. She says I should pray "beaucoup". As the door is about to close behind her she turns and says, "C'est entre vos mains, maintenant" (it's in your hands now) and without a look behind her she heads off into the increasing darkness of a sunny day.
I find myself that afternoon curled up in a ball on my mattress on the floor in the corner of my room. Music coming from the computer across the room tries to soothe my mind...in vain. The pillow is wet...not just sweat this time...but tears flowing from sobs of an uncomprehending soul desperately seeking answers from the one spot he's at least got a few in the past...Tossing and turning, I cry out in the midst of this present darkness...
James
But what about the darkness in my soul, the blackness squeezing out any light from my soul?
Death has struck again. If you've wondered where that dark hooded guy with the sickle over his shoulder hangs out in his spare time...it's Béré.
I'm standing on the porch talking to two teenagers. They have come before seeking help with science homework. They've taken us to their church a few Sundays ago. They have come tonight just to talk. It's a Friday night. They wonder if I'll go to Lai tomorrow to see the President of the Republic who'll be there to inaugurate the bridge linking B�r� and Lai. Andre walks up. "Our president is dead." At first, I think he means the President we've just been talking about. He soon clarifies, "the president of our Mission."
I met Pastor Herimanana at an HIV conference last October in Bamenda, Cameroun. A down to earth guy, he had a real heart for the sick and hurting, especially those suffering from HIV/AIDS. At the time, we'd been half a year without a leader of our Mission here in Tchad. I couldn't help but think how cool it'd be if he could come to Tchad. I knew he'd be supportive of our hospital and provide honest, strong leadership. To my happy surprise, a few months ago he was named as the president of the Tchad Mission.
Thursday, he finished his visa paperwork in Yaound� and was on his way to Douala to catch his flight to Tchad when the driver lost control and he was killed on the highway.
Andre kept hitting his hand with his other hand crying out "c'est pas possible, c'est pas possible!" Looking at me he said, "the devil really must hate us here in Tchad." I had to agree.
The darkness descends.
I hear in morning report today that the little Arab boy with the burn on his chest wasn't doing well. His mom "bugged" the night nurse three times to go get the "Nasara" meaning me. We all had a good laugh.
On rounds, Sarah comes up and says the boy is yellow all over...jaundice...and his belly is hard. I'll be to see him in 5-10 minutes when I finish with the other patients.
5 minutes later I hear a small child scream and wail. I look outside. The cute little sister of our young patient is running around, throwing her self on the ground with the most heart-rending cries. A nurse comes to say the boy has died.
He's been with us for weeks. He'd been recovering. He'd come in dehydrated after a month of home treatment for burns on his chest, arms, hands and feet. Friday, he was a chubby, happy baby. His two little sisters are the cutest ever and love to play with Sarah and hang all over their doting dad. He always brings crackers in his pockets where even the littlest one knows to find them before he can even get his ritual Arabic greetings over with.
A large group of brightly clad Arab women in veils cry--sometimes sounding like laughter but one look at the face makes the distinction--and prepare to take away the corpse. The oldest little sister bangs her head on the ground tears streaming down her cheeks as a nurse tries to keep her from hurting herself by placing her head in the absorbent lap of an aunt...
And the baby? Now, he's a cooling body lying on his back, eyes staring into nowhere...into the darkness...
I return to rounds and stare blankly at the floor for awhile. None of the patients or staff says a word. They must wonder what's the problem, people die all the time, it's a part of life...a part I just can't get used to.
A few minutes later, the Financial Manager of our Health District comes in. He pulls me aside to inform me that our newly appointed "Chef" of the infant vaccination program died yesterday of AIDS. Also, Dagal, the nurse in charge of supervision of the health centers on my arrival who'd recently been relocated to Lai, also died of AIDS. Two of our colleagues in the same day. Yeah, I'd had my run-ins with Dagal, but at the same time I'd hear him occasionally mention God as if his life was a tug of war between two warring factions for his life...who knows who won in the end...it would appear the darkness of his reckless lifestyle...but God only knows...
I stumble on, groping, in the darkness...I find a little light, enough to finish rounds and head to the office where a letter awaits me in the hands of Andre.
Rahama has asked for a 5 day leave of absence to take her husband to see one of the more powerful witch doctors in the area for his eye problem. After some discussions with Rahama and Samedi I find myself walking through the dusty streets, past the mud brick houses of Anatole and Samedi, around the corner near the big mango tree, through the hole in the mud wall and onto the mat under the large shade tree in Rahama's courtyard.
Kemkoye invites us to sit. We do. Samedi and I are wearing matching light blue scrubs and Kemkoye has a brightly colored shirt on. His face is an expressionless puzzle. Thinking back, I wonder if I've ever seen anything not approaching a blank stare on that face. I start the conversation.
I tell him I must warn him that not only is he unlikely to find a lasting solution to his problem, but that he is messing with dangerous, and real, forces of darkness. Is it worth it, even to find a little relief? Or as Someone said years ago, to gain the world and lose one's soul? The mask stares past me. The red, cloudy eye pierces into some corner far away. He hedges and bets never changing the expressionless tone of his voice.
He says he can't afford to go to the Ophthalmologist. I offer to have him come with us in two days to N'Djaména...free of charge. Then, I mention having just seen that Doctors Without Borders has some Ophthalmologists in Kousseri, Cameroun, just across the border. I'll take him there personally I say. He doesn't want to be convinced. Samedi says a few words. Half an hour later we leave with him at least "considering it".
At 2pm, I see Rahama. She enters the office, face a storm cloud of darkness. Abruptly, she spurts it all out. He insists on going to the witchdoctor. She must go with him. She rises to go. She says she's at the breaking point of discouragement...her face shows it. She is hopeless. She says I should pray "beaucoup". As the door is about to close behind her she turns and says, "C'est entre vos mains, maintenant" (it's in your hands now) and without a look behind her she heads off into the increasing darkness of a sunny day.
I find myself that afternoon curled up in a ball on my mattress on the floor in the corner of my room. Music coming from the computer across the room tries to soothe my mind...in vain. The pillow is wet...not just sweat this time...but tears flowing from sobs of an uncomprehending soul desperately seeking answers from the one spot he's at least got a few in the past...Tossing and turning, I cry out in the midst of this present darkness...
James
Friday, April 8, 2005
Scroti
"I just don't get it, why would anyone want to keep something like that at home?" Lona echoed all our thoughts. I mean, really, I ask you, how could one let one's scrotum get like that. Maybe a little bulge, but 3 liters!!!
I was called in as usual in the middle of the night for the emergency. It just started hurting yesterday. You never had any problems before? No, it just came on suddenly. No vomiting? No. What then? Pain, it hurts.
There is something strange about a man lying on an exam table wearing nothing but a wrap around skirt looking like he's hiding a small animal between his legs. As he gingerly lifts up his skirt I see a two-football sized scrotum emerge into view.
The first trick is to figure out if it's a hernia with intestines and other abdominal stuff inside or if it's just a hydrocele (a collection, often massive, of liquid around the teste that doesn't usually communicate with the abdomen) caused mostly by small parasites called filaria. I just stared in awe. I mean, we often make jokes about the size of the hydroceles that we see here, but this one takes the cake! Obviously, this didn't happen over the last few days. In fact, on further questioning he says it's been years! I ask you, would you...I don't get it...
We hospitalize him and schedule surgery during which we remove 3 liters of straw colored fluid then hack off a 10 inch hunk of scrotal skin with hydrocele attached, suture the rest around back of the testicule and somehow manage to get the rest sewed back together. Afterwards, it is far from aesthetically pleasing, but at least he can wear his skirt without bulging and walk without waddling bowlegged.
The next guy I wished was a hydrocele. His scrotum was only about a football size. This had been sudden...at least this episode. It all came out and he started vomiting and writhing in pain. He's had a hernia operated on years ago on the same side that had recurred over the last two years. He'd always been able to get it back in before but not now.
The scrotum was bulging at the inguinal area with bowel sounds audible and even the shape of the intestines visible through the skin. We knocked him out with Ketamine and Valium but soon realized it wasn't going back in. We rushed him to the OR and slashed a diagonal down across the mass, dissected into the hernia sac and found small intestine, cecum (large bowel) and appendix inside. All of them were looking a little dusky from being strangulated. Even then it wouldn't go back in. Finally, we had to cut the hernia bigger which pinked up the intestine and allowed it to finally be pushed inside after which the hole was closed.
For our third sac of the week, we have a young man with only a small half a football sized hernia suddenly that evening at 6pm. He came to us at 11pm. I was exhausted already and didn't want to have to operate that night. I gave him many good drugs. I pushed, I manipulated, I massaged, I wrung, I forced, I dripped great, big piles of sweat all over him, I twisted and pried and prodded until my hands, arms and fingers were cramping. I didn't see any progress after an hour. I prayed. I continued in desperations. I didn't feel I had the strength. Slowly, I felt wiggling and heard some gurgling. It started to go in. I persisted 20 more minutes and with the help of the nurse it finally went in. What joy to feel that final sucking in and see the scrotum normal (a rare site here)!
A running joke here is my famous saying, "that's the beauty of the scrotum". Kind of sarcastic in a way, but even something as gnarly and nasty as the scrotum does have its amazing qualities. When one cuts into the scrotum, the skin and muscles contract up to close the wound almost making stitches superfluous. But in the face of the above cases, I ask you, is there really such a thing? And wouldn't you seek help sooner if it was you...seriously...wouldn't you?
James
I was called in as usual in the middle of the night for the emergency. It just started hurting yesterday. You never had any problems before? No, it just came on suddenly. No vomiting? No. What then? Pain, it hurts.
There is something strange about a man lying on an exam table wearing nothing but a wrap around skirt looking like he's hiding a small animal between his legs. As he gingerly lifts up his skirt I see a two-football sized scrotum emerge into view.
The first trick is to figure out if it's a hernia with intestines and other abdominal stuff inside or if it's just a hydrocele (a collection, often massive, of liquid around the teste that doesn't usually communicate with the abdomen) caused mostly by small parasites called filaria. I just stared in awe. I mean, we often make jokes about the size of the hydroceles that we see here, but this one takes the cake! Obviously, this didn't happen over the last few days. In fact, on further questioning he says it's been years! I ask you, would you...I don't get it...
We hospitalize him and schedule surgery during which we remove 3 liters of straw colored fluid then hack off a 10 inch hunk of scrotal skin with hydrocele attached, suture the rest around back of the testicule and somehow manage to get the rest sewed back together. Afterwards, it is far from aesthetically pleasing, but at least he can wear his skirt without bulging and walk without waddling bowlegged.
The next guy I wished was a hydrocele. His scrotum was only about a football size. This had been sudden...at least this episode. It all came out and he started vomiting and writhing in pain. He's had a hernia operated on years ago on the same side that had recurred over the last two years. He'd always been able to get it back in before but not now.
The scrotum was bulging at the inguinal area with bowel sounds audible and even the shape of the intestines visible through the skin. We knocked him out with Ketamine and Valium but soon realized it wasn't going back in. We rushed him to the OR and slashed a diagonal down across the mass, dissected into the hernia sac and found small intestine, cecum (large bowel) and appendix inside. All of them were looking a little dusky from being strangulated. Even then it wouldn't go back in. Finally, we had to cut the hernia bigger which pinked up the intestine and allowed it to finally be pushed inside after which the hole was closed.
For our third sac of the week, we have a young man with only a small half a football sized hernia suddenly that evening at 6pm. He came to us at 11pm. I was exhausted already and didn't want to have to operate that night. I gave him many good drugs. I pushed, I manipulated, I massaged, I wrung, I forced, I dripped great, big piles of sweat all over him, I twisted and pried and prodded until my hands, arms and fingers were cramping. I didn't see any progress after an hour. I prayed. I continued in desperations. I didn't feel I had the strength. Slowly, I felt wiggling and heard some gurgling. It started to go in. I persisted 20 more minutes and with the help of the nurse it finally went in. What joy to feel that final sucking in and see the scrotum normal (a rare site here)!
A running joke here is my famous saying, "that's the beauty of the scrotum". Kind of sarcastic in a way, but even something as gnarly and nasty as the scrotum does have its amazing qualities. When one cuts into the scrotum, the skin and muscles contract up to close the wound almost making stitches superfluous. But in the face of the above cases, I ask you, is there really such a thing? And wouldn't you seek help sooner if it was you...seriously...wouldn't you?
James
Heat
I have never known what heat was. I thought that maybe living in Florida qualified me as an expert. Maybe visiting the deserts of southern Cal or living on the Amazon. I imagined that maybe after a year in sub-Saharan Africa I had some kind of idea about being hot. But now, I know. There is a reason why Béré is in the part of Africa called the Sahell.
Imagine. Over 130 degrees Fahrenheit. A cool evening is 96 degrees inside. Sweat is your constant companion. In surgery, with the air conditioner running full blast you soak your scrubs and drip sweat onto your patient despite your best efforts at sterile technique. Drinking water becomes your obsession. You feel a strong desire to fall to all fours and join the goats at the salt lick. Sleeping is an impossibility as you must flip your pillow every half hour to let the soaked side dry out. The stillness of the night with its hanging heat and dust weighs you down.
The newly remodeled clinic building is a little cooler with its aluminum roof instead of galvanized steel. Running the generator during the day instead of at night lets us use the ceiling fans which bring a little relief. Amazingly, a hand crafted clay jar makes our drinking water at least not hot, and comparatively cool. No fridge means food doesn't last. But one doesn't feel like eating anyway.
Sarah manages to find some ice in the vaccine fridge today and I have a brief epiphany of joy as the ice cold water flows into me. The only other true ecstasy is the couple of minutes after a surgery of placing my sweat soaked face and hair in front of the air conditioner about 5 inches from the vents and letting the cool air pour over me until the generator is shut off...and it's back, suffocatingly, unrelieved by wind or night...the searing life that is the Sahel in Béré...
James
Imagine. Over 130 degrees Fahrenheit. A cool evening is 96 degrees inside. Sweat is your constant companion. In surgery, with the air conditioner running full blast you soak your scrubs and drip sweat onto your patient despite your best efforts at sterile technique. Drinking water becomes your obsession. You feel a strong desire to fall to all fours and join the goats at the salt lick. Sleeping is an impossibility as you must flip your pillow every half hour to let the soaked side dry out. The stillness of the night with its hanging heat and dust weighs you down.
The newly remodeled clinic building is a little cooler with its aluminum roof instead of galvanized steel. Running the generator during the day instead of at night lets us use the ceiling fans which bring a little relief. Amazingly, a hand crafted clay jar makes our drinking water at least not hot, and comparatively cool. No fridge means food doesn't last. But one doesn't feel like eating anyway.
Sarah manages to find some ice in the vaccine fridge today and I have a brief epiphany of joy as the ice cold water flows into me. The only other true ecstasy is the couple of minutes after a surgery of placing my sweat soaked face and hair in front of the air conditioner about 5 inches from the vents and letting the cool air pour over me until the generator is shut off...and it's back, suffocatingly, unrelieved by wind or night...the searing life that is the Sahel in Béré...
James
Thursday, March 31, 2005
Water
Water. 60% of the human body. Drink 5 liters a day and you can resist malaria. Dig down 15 feet by the side of your mud hut and you have a contaminated water source. Dig down 90 feet at your hospital and have pure water. A mango tree stays green in a dry, Tchadian wasteland by sending deep roots into that water reservoir producing the world's best fruit in the middle of literal hell on earth in sub-saharan African in March nourishing otherwise left-to-fend-for-themselves kids as long as they can throw stones at, climb precariously to pick without falling and breaking their jaw and femur, or pluck off the mangos using a bamboo rod with a hooked stick tied on the end.
Plip, plop. Can it be? Yes, rain. It never rains in March in Béré...except right before 16 foreigners arrive to camp out in your yard for 10 days having been assured by you that they don't have to worry about getting rained on...which they don't, having passed over a week surviving heat, dirt, packs of kids and limited food supplies. A hose, attached to the house, carries water half way to their building site allowing them to fill buckets and containers, put them in push carts and haul them off to mix with cement and sand to make mortar to place between home-fired mud bricks and start building a new church. After having all been diagnosed with Malaria in the last few days of their stay in Béré, all are overjoyed to have the water fall from the sky again--even if only for 10 minutes--the last night most of them will ever spend in a place like this.
(Is it any wonder God describes his presence as rain as I feel the influence of this group's dedication to prayer by a palpable lifting of the spiritual darkness in Béré...followed by a wakening from my sleep feeling a evil presence and sense of fear the night they leave...and at the exact time their plane leaves N'Djam�na...weird? Yes. True? Oui.)
During the three major operations performed during the group's visit sterile water mixed with salt flows through a tube and into a vein in the patients arm allowing him to be put to sleep for the surgery and survive it. The water then flows through his blood, is filtered in his kidneys and comes back out mixed with waste products in his urine. That same sterile salt water is poured into the wounds before closing, diluting the bacteria and preventing infections. The bloody, vomit covered OR floor is then doused with water and squeegyed down the drain. The instruments are washed with water and then sterilized with heated water under pressure in an autoclave.
I approach the river between Béré and Lai. I have 5 other foreigners inside the truck with me and 15 foreigners along with 3 locals outside in the back. They are covered from head to foot in red dust and diesel exhaust. We've just come from the bush church in Kalm� and are looking forward to refreshing ourselves with a swim in the water. As white bodies immerge in swimming suits to descend down the small cliffs to the tiny beaches along the river, we draw quite a crowd of gawkers...mostly children. I'm one of the first to crash down the sandy bank, rip off my shirt and plunge into the cool, flowing river. I feel it envelop me, cleanse me, cool me, free me, energize me. I pop to the surface and swim against the strong current the short distance to the shallow sandbar that is most of the river. I lay on the bottom with just my head sticking up fighting the swiftness of the water streaming past.
The others soon join me with a football and two frisbees which quickly brings a swarm of naked boys who find it obligatory to place and hand over the privates when standing but are otherwise free to be one with nature. The sandbar drops sharply to about 10 feet allowing spectacular diving catches of appropriately thrown footballs. Soon kids are swarming, splashing, diving, thrashing, clambering, jumping, yelling, catching, tossing awkwardly, smiling, laughing. Two older boys arrive and ask to be given the frisbees. I say we'll see.
Suddenly, in the frenzy, I notice the football still being tossed but no frisbees to be seen. I stop and yell. The yellow frisbee is quickly produced by one of the older boys. No one claims the red one but they say it was probably buried under the sand to be dug up later when we've left. We talk a lot. I suspect the older boys. We're all in the middle of the river standing in 1-3 feet of water. Most are naked so they've no place to hide it.
I see that the soccer ball of one of the older boys is drifting downstream off the sandbar into the current. He's yelling for one of the small boys near by to get it. No one moves. I make my move. I splash through the shallow water and dive off the sandbar. Swimming powerfully through the crisp flow of water I grasp the deflated soccer ball and swim slowly back upstream to the sandbar. He says thanks and reaches out for it. I say thanks and say I'll keep it until he finds the red frisbee. Then begins a stand off of over 1/2 hour. Everyone wants me to give up. I'm surrounded by locals who say they just want their ball and they have no idea who stole it. I say we'll just take their ball and leave. When they find the frisbee they can come to B�r� and get their soccer ball back. They don't realize how stubborn I am.
They threaten to stop our car from leaving. I say go ahead and try...I'll take you to court and I know all the government officials (not exactly true...but a nice bluff). Suddenly, I see one of the older boys in the 3 foot area of the sandbar. A young boy 5 feet away holds up the red frisbee while the older boy shouts out look he's found it. I say thanks and take the frisbee. Then, without giving back the soccer ball I swim across the channel to the rest of the group.
The tall boy who owns the soccer ball calls out for it. I know now for sure it's they who have stolen it. I ask him to come get it. He smiles sheepishly and refuses. They beg for awhile and then walk off. The little boys surrounding us confirm that they are the thieves and tell me not to give the soccer ball back. I give it to the one who tells me that and still wet from the swim jump back in to drive back to dry, dusty Béré where just beneath the surface rests enough water to irrigate the entire area and keep it green and productive year round...instead, we appear to be in a desert...by definition and area without much water...
James
Plip, plop. Can it be? Yes, rain. It never rains in March in Béré...except right before 16 foreigners arrive to camp out in your yard for 10 days having been assured by you that they don't have to worry about getting rained on...which they don't, having passed over a week surviving heat, dirt, packs of kids and limited food supplies. A hose, attached to the house, carries water half way to their building site allowing them to fill buckets and containers, put them in push carts and haul them off to mix with cement and sand to make mortar to place between home-fired mud bricks and start building a new church. After having all been diagnosed with Malaria in the last few days of their stay in Béré, all are overjoyed to have the water fall from the sky again--even if only for 10 minutes--the last night most of them will ever spend in a place like this.
(Is it any wonder God describes his presence as rain as I feel the influence of this group's dedication to prayer by a palpable lifting of the spiritual darkness in Béré...followed by a wakening from my sleep feeling a evil presence and sense of fear the night they leave...and at the exact time their plane leaves N'Djam�na...weird? Yes. True? Oui.)
During the three major operations performed during the group's visit sterile water mixed with salt flows through a tube and into a vein in the patients arm allowing him to be put to sleep for the surgery and survive it. The water then flows through his blood, is filtered in his kidneys and comes back out mixed with waste products in his urine. That same sterile salt water is poured into the wounds before closing, diluting the bacteria and preventing infections. The bloody, vomit covered OR floor is then doused with water and squeegyed down the drain. The instruments are washed with water and then sterilized with heated water under pressure in an autoclave.
I approach the river between Béré and Lai. I have 5 other foreigners inside the truck with me and 15 foreigners along with 3 locals outside in the back. They are covered from head to foot in red dust and diesel exhaust. We've just come from the bush church in Kalm� and are looking forward to refreshing ourselves with a swim in the water. As white bodies immerge in swimming suits to descend down the small cliffs to the tiny beaches along the river, we draw quite a crowd of gawkers...mostly children. I'm one of the first to crash down the sandy bank, rip off my shirt and plunge into the cool, flowing river. I feel it envelop me, cleanse me, cool me, free me, energize me. I pop to the surface and swim against the strong current the short distance to the shallow sandbar that is most of the river. I lay on the bottom with just my head sticking up fighting the swiftness of the water streaming past.
The others soon join me with a football and two frisbees which quickly brings a swarm of naked boys who find it obligatory to place and hand over the privates when standing but are otherwise free to be one with nature. The sandbar drops sharply to about 10 feet allowing spectacular diving catches of appropriately thrown footballs. Soon kids are swarming, splashing, diving, thrashing, clambering, jumping, yelling, catching, tossing awkwardly, smiling, laughing. Two older boys arrive and ask to be given the frisbees. I say we'll see.
Suddenly, in the frenzy, I notice the football still being tossed but no frisbees to be seen. I stop and yell. The yellow frisbee is quickly produced by one of the older boys. No one claims the red one but they say it was probably buried under the sand to be dug up later when we've left. We talk a lot. I suspect the older boys. We're all in the middle of the river standing in 1-3 feet of water. Most are naked so they've no place to hide it.
I see that the soccer ball of one of the older boys is drifting downstream off the sandbar into the current. He's yelling for one of the small boys near by to get it. No one moves. I make my move. I splash through the shallow water and dive off the sandbar. Swimming powerfully through the crisp flow of water I grasp the deflated soccer ball and swim slowly back upstream to the sandbar. He says thanks and reaches out for it. I say thanks and say I'll keep it until he finds the red frisbee. Then begins a stand off of over 1/2 hour. Everyone wants me to give up. I'm surrounded by locals who say they just want their ball and they have no idea who stole it. I say we'll just take their ball and leave. When they find the frisbee they can come to B�r� and get their soccer ball back. They don't realize how stubborn I am.
They threaten to stop our car from leaving. I say go ahead and try...I'll take you to court and I know all the government officials (not exactly true...but a nice bluff). Suddenly, I see one of the older boys in the 3 foot area of the sandbar. A young boy 5 feet away holds up the red frisbee while the older boy shouts out look he's found it. I say thanks and take the frisbee. Then, without giving back the soccer ball I swim across the channel to the rest of the group.
The tall boy who owns the soccer ball calls out for it. I know now for sure it's they who have stolen it. I ask him to come get it. He smiles sheepishly and refuses. They beg for awhile and then walk off. The little boys surrounding us confirm that they are the thieves and tell me not to give the soccer ball back. I give it to the one who tells me that and still wet from the swim jump back in to drive back to dry, dusty Béré where just beneath the surface rests enough water to irrigate the entire area and keep it green and productive year round...instead, we appear to be in a desert...by definition and area without much water...
James
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