I sit by the side of the road. Around me in all directions stretches the African plain. It's vast, flat expanse allows one to see miles in every direction broken only by the occasional tree and smoke from a cooking fire. Ahead and behind the single lane road stretches into infinity, swallowed up in the haze of the Harmatan winds off the Sahara.
My neck is burned, my hands are caked with grease, and the smell of diesel clings to my plain, tan-colored Arabic robes. My mouth is parched, my lips are cracked, my nose is filled with thick, black tinged snot, and my eyes are dry.
I lean against the hood of the truck as a small crowd of kids on foot and adults on bikes alternately stares and whispers among themselves in Arabic and a variety of local languages.
Sarah has left to fill our water bottles in the little cluster of huts off to the left. It is 3pm. We left B�r� at 7:30am and Bongor at 11am. Bongor is 24km, one toll booth, and a long day filled with experiences away...
....Coming out of Bongor I start to notice a problem with power and acceleration. As we approach the toll booth outside of town, the car stalls as I clutch and brake, I pop the clutch and the truck roars to life only to die again as I try to juggle braking, hitting the gas and pulling the emergency brake to stop and pay our toll. We try in vain to start it. Finally, the toll guys give us a push through the gate and we try to start it that way, but nothing.
With my wrenches in hand, I open the hood and remove the diesel return valve bolt from the injection pump. It is filthy. I ask some of the bystanding gawkers if they have any kerosene. One guy with a shortened upper arm brings me a plastic capfull. I clean out the tiny filter with the kerosene, a match, and blowing with my own mouth. I replace the part and the car starts right up.
I'm feeling really good about myself until 5km later when the pickup finds its closest point to our destination for the day. The time is 11am. We pull up under a tiny tree providing the only shade around. A few meters ahead a "road" turns off to a school built out of woven mats. The kids are outside playing some game. A medium-sized man with a rare Tchadian paunch sidles up, his hands deep in the pockets of his pants pulled up to his belly button with a tight white tank top tucked in.
He says we need a mechanic. A classic Tchadian introduction of stating the obvious. At the same moment, he yells to a passing motorcycle driven by a blue-robed Arab with curly, nappy hair and a short moustache. He immediately starts messing around with the engine by taking off the fuel filter and hand fuel pump. He says the problem is with the hand pump. I think it's maybe the filter, which looks a little crushed.
He calls someone in town and I climb on behind. We tear off down the tarmac, the wind stinging my eyes. The thought crosses my head that if the tire blows out, or we hit a goat or something that I'm dead. I grasp a 5 liter bottle in one hand and the old filter with hand pump attached in the other. I promptly upend the filter spilling diesel all over my lap. The unchanging African plain whirs by in a blur as my eyes sting and tear from the wind and dust.
We arrive in Bongor at a little shop with different sizes and shapes of glass bottles filled with a variety of fuels out front. Inside are an assortment of car parts old, new, and used piled haphazardly on shelves and all over the floor. We buy a new filter and a new pump which is obviously a cheap imitation. We haggle out the prices and I'm not satisfied but am desperate and know I will never get the same price as a local because of my skin color. A variety of "Al salaam alekums" and "al hamdullilahs" float around as I wait for our motorcycle friend to fill up the bike for our return trip.
The return is the same except I am doubly weighted down with filters and pumps, and the 5 liter jug is now full of gasoline.
The truck has been pushed down next to the school and Sarah is playing jumping games with the now out-of-school kids. We have now been reinforced with 3 more Arabs who all seem to know a little about engines but not much. They alternately open and close things pumping furiously and often on the new hand pump. Eventually, with a push we get the car started and our "friend" drives off down a dusty side road.
A half an hour later, Sarah and I are beginning to wonder if our truck has been hijacked to help out in the coup-d'�tat effort going on in parts of Tchad and whether we'll ever see it again. One of the other Arabs comes back on his motorcycle and takes us 100 meters up the paved road where the truck has stalled again.
Finally, at 3pm they leave for Bongor to find a mechanic and I find myself leaning against the hood waiting for Sarah to come back with water. All I can think about are the watermelons in Guelengdeng just 45 km up the road where we were planning to stop for refreshment. They are the best in the world, especially on a dry, hot, dusty Tchadian day.
I glance up and see four round green objects sitting on my side of the road just 50 feet ahead. I ask the locals hanging around what they are and to my unbelieving ears hear the word "watermelon"! I immediately buy two, borrow the ever-present, razor-sharp Arab knife from a boy standing by and slice into and devour one of the sweetest, crispest watermelons I've ever eaten!
As the juice runs down my face and chin and drops on my diesel stained robes, Sarah comes back to partake in the feast.
She then says she saw some horses back in the small village and wants to go back see if they'll let her ride them.
She arrives at the edge of the village where a marriage is being celebrated with the traditional spontaneous horse races up and down the dusty path in front of the wedding site. The men are hesitant to let a mere woman get on a horse as they are sure she will fall off and kill herself on their "wild" stallions.
As she mounts expertly and then challenges them to a race, they all smile condescendingly and the women turn to smile and cheer. They've never been given the privilege of riding and so are all on Sarah's side.
It is Sarah against two Arab men. Sarah's horse has obvious Arabian blood in it, is pale white with delicate feet and with Sarah mounting up like a jockey on the short stirrups she beats them hands down, not once but twice. As she rides up to where I am waiting there is a wildness and gleam in her eyes that reminds me again of what an amazing thing it was to have met and married a girl like her in a place like this.
The mechanic comes and promptly breaks the diesel intake valve. I had been warning them all day not to touch that as I'd broken that same part last year and knew how fragile it was. He leaves, promising to send a tow truck.
I'm frustrated and mad by now. I go to talk to his associate who's stayed behind and tell him we'll just stay here in the bush tonight and they can bring us the part in the morning and put it on and we'll go from there.
He cancels the tow-truck and it's not until the darkness descends that I regret my decision. The associate says he'll flag down a car that'll pull us into Bongor for at most 5000 francs. The next truck is a tiny Peugeot piled so high with baggage and people prickling out from on top of the cargo that the bumper is almost touching the ground. They stop and the turbaned chauffeur offers to tow us for 25,000 francs. After negotiation we get it down to 10,000 francs but in my state of mind I'm so angry with the whole situation that I refuse.
I continue to regret my decisions until a tiny, old toyota car pulls up equally weighted down. A tall, commanding Arab with a goatee pulls out and finally talks sense into me that we need to go to Bongor for our own safety. He says his car is too weak to pull us, though. As I discuss with the mechanic's associate, the commanding Arab comes back and says he can't leave us stranded like that and will pull us for the same price, 10,000 francs that we refused the other truck. I accept.
We attach a cord to our bumper and to the other car with about 10 feet in between. He says that when we see his left uncovered brake light go on we should stop, as the other lights don't work. We limp into Bongor and are deposited next to the fluorescently lighted grilled chicken restaurants. Our tow man comes back to tell us he's called the chief mechanic to come meet us here himself. We pay him and he leaves.
We wait. Our tall Arab comes back to say the chief mechanic is sick but he will pull us to the garage where these other guys can help us. It is the main garage in Bongor, run by the "chinois".
I'm not reassured as a wobbly gate made of tin roofing is slid to the side revealing what looks more like a junkyard than a garage. Another dude pulls up on a moto and they replace the broken part, fiddle with some things, start up the car, and take it out for a test run. It does great!...until they return and it loses power. They say they'll come back tomorrow at 5:30am. It's now 8:30pm.
I call Pastor Job in N'Djam�na and get the local pastors phone number to see if we can stay with him. I get no reply from the local pastor but I do get his name and know he lives somewhere near the Mayor's office. The mechanic on the moto takes us to the Mayor's. We ask around and finally a group of muslims lounging on some mats under a tree point us up the road to the Adventist church.
All is dark as we pull up behind the church. We call out "Al salaam alekum" and a groggy Pastor Issa emerges in shorts and a unbuttoned jacket to welcome us. He then wakes up his kids and moves them out of their mud hut so Sarah and I can sleep there. We stay up another half hour eating cold chicken and bread Sarah had bought on arrival in Bongor and hearing stories of how our hospital came into existence and the adventures of early missionaries like Armin Krakolinig, who built our hospital and most of the Adventist churches in Tchad including this one next door here in Bongor.
Sarah and I finally crash on a thin foam pad surrounded by piles of cassette tapes, simple notebooks, and clothes hanging on a string over the bed. With no mosquito net we sleep fitfully as the malaria vectors buzz our ears all night. At 6 a.m. I am up and have to pee but can't find a latrine. We walk back to the garage with Pastor Issa as our guide.
The mechanics are already at work. We sit around eating peanut oil-flavored beans Sarah has bought just outside, and wait as they clean the fuel tank and putter around adjusting and cleaning the injectors and the rest of the diesel circulation system. The "chinois" has arrived, the "Chef de Garage" and he helps fine tune things. While waiting for some new, clean diesel to arrive I strike up a conversation with the "chinois".
Then, he is about to send off someone to the pharmacy to buy him some meds. I tell him to wait as I'm a doctor, maybe I can find out what's really wrong and get him a better prescription. He gives me the classic joint pains, headache, and intermittent fevers of Malaria. I prescribe some good anti-malarials and the guys finally finish.
We head out for the last test run. I'm in the back of the pickup with one of the mechanics while the other one drives with Sarah inside. We accelerate well and fly out of Bongor back towards K�lo. About 10 km en route I sit up a little and the wind catches my glasses sending them tumbling onto the road. I bang frantically on the roof for the driver to stop. Eventually, he does and we spend the next 45 minutes walking up and down the road looking desperately for my glasses and asking everyone we pass if they've seen them. As we were leaving B�r� I remember thinking maybe I should put my contacts in my toiletries bag but decided against it since the trip was so short.
We are about to give up when a bike that had passed us a few minutes ago returns with my smashed and twisted glasses. One lens is gone but the left is still there and with a little bending I make them fit my face. We are on the road again. The car runs fine, it stalls a few times but easily starts back up. After Guelengdeng I have Sarah take over as I'm getting a headache driving with only one lens in my glasses and keeping my right eye shut.
As I enter our room in N'Djam�na at 4:30 p.m. that night my first thought is to take a shower and wash the last two days off of me. As I open my toiletries bag I find my contacts and solution somehow there. I laugh and call Sarah and we rejoice together to have the privilege of living, working, and surviving in a place like Tchad.
Sunday, January 29, 2006
Saturday, January 14, 2006
Near death experiences...
I'm staring at the old bathroom tile. On its smooth surface sit four drops of blood in the form of a T. On each has been placed a drop of a different liquid: blue, yellow and two clear. In the dim, fluorescent light I search diligently for signs of agglutination. It is a matter of life or death.
It started with a call from the nurse...
"There's the doctor from Kélo who brought someone. He wants you to see them."
I walk quickly over from the house to the hospital. It is dusk and the shadows are gathering. I hear the roar as the generator begins its nightly two-hour vigil. The fluorescent lights fight flickeringly to overcome the resistance to their illumination. I round the corner of the OR and towards the yellow light of the one bed "ER".
The nurse on duty, Hortance, points me back outside where a father sits on a crude bench holding tightly to his 7 month old son while his wife sits at his side with fear, desperatation, and hopelessness in her eyes. Dr. Assane from Kélo is standing by in street clothes, a departure from his usual stylish sport coat and unbuttoned, tie-less dress shirt.
Assane quickly explains that he went to his home village to visit relatives and found this kid on death's door. Since our hospital is closer he brought them here.
Truly, the kid is not long for this world. His eyes are rolled back. His body is limp. His respirations come in gasps. I listen to his heart which is pounding furiously and desperately. I look at his eyelids...white as snow. Anemia. Severe malaria. Our bitter daily bread and butter.
In 2005 we saw 67 patients, over 90% of whom were kids 2 years and under, die of malaria. Of those 67, 25 died of severe anemia requiring blood transfusions (hemoglobins less than 5). As depressing as that is, in all we transfused 99 patients meaning despite the desperate condition of the patient which pushed us to transfuse (using whole blood donated from a family member), we were able to save 75% who would've surely died otherwise.
This baby has the look of not even making it long enough to test his blood much less transfuse. The father gazes at me, pleading in his eyes. I tell the night watchman to go get Anatole, our lab tech.
Meanwhile, I ask Hortance to try and find an IV on the child so we can be ready if and when the blood arrives. The father places the limp child on the exam table. His head flops to one side as he continues to stare up, uncomprehending. His arms and legs are like jelly.
Anatole is not at home and he hasn't left his key. I sit there helpless watching Hortance search in vain for a vein on this tiny baby who has lost probably at least 3/4 of his red blood cells to the Plasmodium parasites. I could probably do the blood typing, I've seen Anatole do it countless times. If only I had the key, as all the equipment is safely locked in the lab.
Adam, our newest student missionary, is standing by, so I ask him to go get the bag-valve-mask so we can at least help this tired baby breathe. He returns and I place the mask over the baby's nose and mouth and start pumping in air with every effort he makes. His mom starts crying behind me.
Hortance has used up two IVs already when Anatole's son arrives with the lab key. I pass the bag-valve-mask to Adam and hurry to the lab. I open the door, flip on the light, open the armoire, find the fridge key, and pull out four bottles with droppers: A, B, AB and D. I grab two bathroom tiles, two lancets, some cotton, some alcohol prep pads, and rush back to the baby.
I prick the baby's middle finger and squeeze out a drop of blood in four different spots on the tile. Three across for A, B, and AB and one underneath B for D. I drop one blue drop for A, one yellow drop for B and one clear drop for AB and a different clear drop for D. I use the bottom of the vials to mix the drops in with the blood (since I'd forgotten to bring mixers from the lab). I start rotating the tile so the liquid will move allowing me to see if small clots form (agglutination). After two minutes nothing has formed in A, B or AB but there are agglutinations in D. Baby's blood is O positive. I prick mom's finger and repeat the process. She is O positive as well. I hope I've done it right as a mistake could cause a life threatening reaction, but desperate times call for desperate measures.
We are also out of rapid HIV tests. The only test we have takes 45 minutes to an hour. I look over at the dad. He's holding the baby as Hortance has given up trying to find an IV. He is trying to close the eyes, saying that the baby is about to die. The mom is sobbing. I make a quick decision.
One of our government lab techs, Matthieu, has just showed up. He's on strike, but I ask him a favor. He agrees and takes the mom off to draw her blood for the blood transfusion. I take the child back to the exam table. I need an IV.
Sarah has arrived and she brings me a larger IV and a 2 mL syringe. I feel the baby's femoral pulse and stick the needle in to the inside of the pulse where I know the vein should be. I pull back on the syringe looking for that quick fill of dark blood indicating I'm in the vein. I search and search. Finally, on pulling out I hit a small flash. I try to advance and it goes in. I pull out the needle and see a little blood in the catheter.
Matthieu has just arrived with the blood. Adam continues to help the baby breathe. I attach the bag of blood and it drips slowly in. I breathe a sigh of relief.
After a couple minutes, Sarah points to the groin and asks if it isn't swelling. Sure enough, the IV isn't in the vein and the blood has been going in under the skin only. I ask for another IV and try the other vein. This time I find the vein easily and with the big flash I know I'm in. I attach the blood again and open it up to go in fast.
We watch a miracle take place before our eyes. First, the floppy baby's legs start to curl up. Then, he stretches his arms straight over his head as if he were Lance Armstrong celebrating yet another Tour de France win. Then he pees straight up in the air, a glorious clear fountain telling us his internal organs are waking up now too. Then, his blank stare transforms into an intelligent sparkle as he looks around at the world he thought he'd left.
Three days, one more transfusion, 8 IV infusions of quinine, and one unbelieving family later, the little boy goes home...
It started with a call from the nurse...
"There's the doctor from Kélo who brought someone. He wants you to see them."
I walk quickly over from the house to the hospital. It is dusk and the shadows are gathering. I hear the roar as the generator begins its nightly two-hour vigil. The fluorescent lights fight flickeringly to overcome the resistance to their illumination. I round the corner of the OR and towards the yellow light of the one bed "ER".
The nurse on duty, Hortance, points me back outside where a father sits on a crude bench holding tightly to his 7 month old son while his wife sits at his side with fear, desperatation, and hopelessness in her eyes. Dr. Assane from Kélo is standing by in street clothes, a departure from his usual stylish sport coat and unbuttoned, tie-less dress shirt.
Assane quickly explains that he went to his home village to visit relatives and found this kid on death's door. Since our hospital is closer he brought them here.
Truly, the kid is not long for this world. His eyes are rolled back. His body is limp. His respirations come in gasps. I listen to his heart which is pounding furiously and desperately. I look at his eyelids...white as snow. Anemia. Severe malaria. Our bitter daily bread and butter.
In 2005 we saw 67 patients, over 90% of whom were kids 2 years and under, die of malaria. Of those 67, 25 died of severe anemia requiring blood transfusions (hemoglobins less than 5). As depressing as that is, in all we transfused 99 patients meaning despite the desperate condition of the patient which pushed us to transfuse (using whole blood donated from a family member), we were able to save 75% who would've surely died otherwise.
This baby has the look of not even making it long enough to test his blood much less transfuse. The father gazes at me, pleading in his eyes. I tell the night watchman to go get Anatole, our lab tech.
Meanwhile, I ask Hortance to try and find an IV on the child so we can be ready if and when the blood arrives. The father places the limp child on the exam table. His head flops to one side as he continues to stare up, uncomprehending. His arms and legs are like jelly.
Anatole is not at home and he hasn't left his key. I sit there helpless watching Hortance search in vain for a vein on this tiny baby who has lost probably at least 3/4 of his red blood cells to the Plasmodium parasites. I could probably do the blood typing, I've seen Anatole do it countless times. If only I had the key, as all the equipment is safely locked in the lab.
Adam, our newest student missionary, is standing by, so I ask him to go get the bag-valve-mask so we can at least help this tired baby breathe. He returns and I place the mask over the baby's nose and mouth and start pumping in air with every effort he makes. His mom starts crying behind me.
Hortance has used up two IVs already when Anatole's son arrives with the lab key. I pass the bag-valve-mask to Adam and hurry to the lab. I open the door, flip on the light, open the armoire, find the fridge key, and pull out four bottles with droppers: A, B, AB and D. I grab two bathroom tiles, two lancets, some cotton, some alcohol prep pads, and rush back to the baby.
I prick the baby's middle finger and squeeze out a drop of blood in four different spots on the tile. Three across for A, B, and AB and one underneath B for D. I drop one blue drop for A, one yellow drop for B and one clear drop for AB and a different clear drop for D. I use the bottom of the vials to mix the drops in with the blood (since I'd forgotten to bring mixers from the lab). I start rotating the tile so the liquid will move allowing me to see if small clots form (agglutination). After two minutes nothing has formed in A, B or AB but there are agglutinations in D. Baby's blood is O positive. I prick mom's finger and repeat the process. She is O positive as well. I hope I've done it right as a mistake could cause a life threatening reaction, but desperate times call for desperate measures.
We are also out of rapid HIV tests. The only test we have takes 45 minutes to an hour. I look over at the dad. He's holding the baby as Hortance has given up trying to find an IV. He is trying to close the eyes, saying that the baby is about to die. The mom is sobbing. I make a quick decision.
One of our government lab techs, Matthieu, has just showed up. He's on strike, but I ask him a favor. He agrees and takes the mom off to draw her blood for the blood transfusion. I take the child back to the exam table. I need an IV.
Sarah has arrived and she brings me a larger IV and a 2 mL syringe. I feel the baby's femoral pulse and stick the needle in to the inside of the pulse where I know the vein should be. I pull back on the syringe looking for that quick fill of dark blood indicating I'm in the vein. I search and search. Finally, on pulling out I hit a small flash. I try to advance and it goes in. I pull out the needle and see a little blood in the catheter.
Matthieu has just arrived with the blood. Adam continues to help the baby breathe. I attach the bag of blood and it drips slowly in. I breathe a sigh of relief.
After a couple minutes, Sarah points to the groin and asks if it isn't swelling. Sure enough, the IV isn't in the vein and the blood has been going in under the skin only. I ask for another IV and try the other vein. This time I find the vein easily and with the big flash I know I'm in. I attach the blood again and open it up to go in fast.
We watch a miracle take place before our eyes. First, the floppy baby's legs start to curl up. Then, he stretches his arms straight over his head as if he were Lance Armstrong celebrating yet another Tour de France win. Then he pees straight up in the air, a glorious clear fountain telling us his internal organs are waking up now too. Then, his blank stare transforms into an intelligent sparkle as he looks around at the world he thought he'd left.
Three days, one more transfusion, 8 IV infusions of quinine, and one unbelieving family later, the little boy goes home...
Friday, December 30, 2005
Never travel from Bere to Yaounde
We are 10 km from Yaound�. We left Bere Friday morning. It is Tuesday noon. I'm exhausted...which may explain what happens next. We pull up to yet another military check point.
Sarah and I are in the back seat of a Toyota minibus modified to hold 20 passengers. That means we are crammed five across on barely padded benches with not nearly enough space for my knees to fit even if I sit up straight (which is impossible due to the low ceiling). I therefore have spent the last 8 hours with my knees and legs twisted into positions I had previously thought impossible for me. I'm thinking of quitting medicine and joining the circus as Flexible Man. Despite closing the windows, everyone is lightly dusted in fine red dust highlighting eyebrows and almost shaved heads in a rich earth tone.
Since entering southern Cameroun it seems we've been stopped every 15 minutes by the military. My hand reaches automatically for our passports velcroed safely in a side pants pocket. Sure enough, a soldier swaggers up with a lazy "bonjour" slipping out of his mouth as he asks for ID papers. I present them. He scans them quickly and hands them back. At least I have nothing to hide like the last time I came up from Yaound� when I had an expired visa. I twist around a little to relieve my numb right leg when another soldier sidles up and asks for our passports. I inform him politely that we've already been checked. He takes them, anyway. After a cursory glance, he asks for our yellow vaccination cards.
I hand him mine. Sarah has left hers in Bere. I explain that it's not needed except at international borders and we've already been checked. He says that this is the border of Yaound� so we need them. This is an old Camerounian trick I've seen before. They want money to let us pass. He saunters off with our passports across the road to his buddies sitting under a tree. I am livid and so tired my normally weak inhibitions are completely obliterated. I shove open the window, crawl out, and march angrily across the street. We are in the middle of nowhere and they all have guns and are wearing military fatigues. What I do next isn't well thought out.
I storm up to the one holding the passports and start yelling at him in French explaining why it's so stupid and unnecessary to be always bothering people and trying to extort money. One of them says that I should start by greeting them or saying "bonjour". I snap out a sarcastic "bonjooouuuur" and continue my tirade. Pastor Job and the guys from the North Cameroun Mission who've been traveling with us come up and intervene. Miraculously, they let us go without any more fuss. I am wasted now not only physically but emotionally. As I crawl back into the minivan I start to have brief flashbacks of events on this trip up to this point.
Sarah, Nellie, and I are sitting on a sandy beach by the Chari River. This is the border between Bongor, Chad and Yagoua, Cameroun. There is no bridge. There are 10 or so dugout canoes pulled up on the beach with some Chadians idling around waiting to transport customers. They offered to take us across for 1000 francs each. We refuse. To cross the river in Lai--which is twice as far across--costs 250 francs. We take our backpacks off, set them on the sand and sit down to chat. It is noon. We know we need to cross but we don't want to be just give in to their exploitation of foreigners. We periodically bargain with them till the price comes down to 500 francs per person.
Sarah is hard core and says "no." We continue to sit looking at the invitingly cool water rippling past as we swelter in the midday sun. Sarah suggests swimming to amuse ourselves. Then it hits me!
"Why don't you two swim across and I'll take the bags, pay the 500 francs, and transport them across?"
They like it and start taking off their shoes and walking towards the water.
The unexpected happens! The Chadian we'd been bargaining with gets a frightened look on his face and yells not to cross that he'll take us for 250 francs each! Sarah replies that they really want to swim but he's adamant saying the current is strong, there are hippos, you are girls who don't know how to swim, etc.
Slowly it dawns on me, in Chadian culture, if something happened to one of the girls crossing, they would be responsible and they couldn't live with that. They were suddenly obliged to take us across, even if for free! We pay up and cross, feeling the cool water refresh us temporarily as we drag our hands the few hundred meters to the opposite bank.
Immediately, guys on motorcycles pull up yelling for our business. It is 7 km to Yagoua and I've been told the price for a "clando-man" is 500 francs. I waltz up to the first one and say, "Yagoua, cinq-cent francs". He agrees but then his boss runs up and says "750 francs." He refuses to give in. Sarah, as tough as ever, says "Well, we'll just walk then", grabs her backpack and starts around the corner to the immigration "office".
The "office" is in an old, abandoned carcass of a steel motor home with rickety wooden steps. Out back is a shelter made of sticks stuck in the ground with woven straw mats laid on top to provide shade.
"Al-salaam alekum," I greet as I duck into the door at the top of the stairs.
"Wa alekum al-salaam" is the reply of the camo-wearing immigration officer. I present our three passports and he signs them quickly with plenty of rubber stamps making our passports very "official" looking.
Meanwhile, Sarah has been reasoning with the "clando-men" who've followed us. They argue that gas prices have gone up (an old excuse, nothing new here). Sarah just picks up her pack and takes a few steps down the road before they laughingly call out after her "�a va, 500 francs". Sarah's a very tough customer.
The wind whips into my face, stinging my eyes and causing tears to leave a streak back across my cheeks. It's nice and cool and free-feeling to be bouncing up and down on the sandy roads riding casually on the back of the "moto". We pull quickly into town and board the first of many buses.
Several hours, much reading, quite a few frozen yogurt baggies, and we are nearing Maroua. The man next to me heard me speaking English to Sarah and asked me where we were going in broken English. I told him the Koza Adventist Hospital. It is nearing sundown, Friday evening and we hope against hope to make the last bus to Mokolo where we can catch more "motos" to Koza. He suggests getting of the bus before Maroua as the road to Mokolo shoots off there. He says we may get lucky and catch a bus there.
Suddenly, after miles of no crossroads, a road veers off to the left. My friend points. We look for a bus and see nothing until we are past the turn off when we see a tiny minivan. He motions something to me. I don't understand. He yells and the bus screeches to a halt on the side of the road. We explain and the driver grudgingly sends his assistant to the top of the bus to take our luggage down. Meanwhile, I've sent Sarah back the 100 meters to the crossroads to make sure they don't leave.
We snag our bags off the asphalt as the bus scurries away and run awkwardly back to Sarah with our backpacks swaying back and forth. They have plenty of room and leave 30 seconds after we are on board! Nous avons la chance!
Sarah and Nellie are crammed in the back next to a Camerounian girl with an MP3 player! All the people on the bus are constantly checking their cell phones and commenting on whether or not the network is present! All the while, we pass small mud brick huts, herds of goats, and kids dressed in rags waving cheerfully as we chug by spewing out rich, black diesel smoke from our tailpipe.
Shortly after dark, we enter a darkly lit, smoky little town called Mokolo. The streets are rocky and steep, built on the side of a mountain shooting out of the surrounding desert. Small shops selling a little bit of everything are harshly lit with bare fluorescent bulbs. The bus stops on the steep part of a hill and once again we are surrounded by the "clando-men".
One of them says "Docteur, we haven't seen you in a while but we've been waiting for you." Since I've never been there before I can only assume they are confusing my army style buzzed blond hair, lanky frame, and clean-shaven face for Dr. Greg Shank's thick, dark curly hair, broad shoulders, and black goateed face. After all, according to them, all white people look the same (every time we watch a movie with the Chadians they think I am the main star...�a c'est toi, James, n'est-ce pas?).
The night is cool, the stars are out, the air is dry and dusty as only can be found in a desert night, and the road is windy, rocky, and steep. Once again I am hanging on the back of a small motorcycle and I have an hour to just let my weary, wandering thoughts focus on the simple beauty and joy of being in that moment...for an hour!
Arriving in Koza, I find Greg and Audrey in surgery. A young man was stabbed by his brother multiple times. He then showed up--after half an hour in a pushcart over mountain trails--with his intestines hanging out his side, one lung collapsed, and profusely bleeding wounds down to bone on his right arm and left posterior shoulder. When we get to the OR, Greg has the belly open, has sewn up the diaphragm and is controlling the bleeding on his liver wound. A blood transfusion is up and running and I ask how I can help. I change into scrubs, put on sterile gloves, and start cleaning out and suturing his shoulder and arm wounds. A piece of skin the size of a small plate has been sliced back off his arm and has rolled up into a scrunchy little mess at the medial border of the wound. I slowly stretch it back out and over the wound after washing out and closing the muscles. I leave the lower part open to drain and an hour later we both unscrub with the boy still alive. He has a urinary catheter sticking out of his chest (improvised by Greg since no chest tubes were available), a massive bandage on his abdomen and side, and two loosely wrapped dressings on his arm and shoulder.
We all head home (except Greg who has a few rounds he wants to make) to a never-better-tasting supper of cold beans and rice. I sleep till the next afternoon when we catch the "motos" to Mokolo, the bus to Maroua and sleep that night at the Catholic mission before catching the 7 am bus to N'Gaoundere.
On that bus we meet up with Job and Wangkel from the Chad Mission and the 3 administrators from Northern Cameroun Mission. 4pm finds us in N'Gaoundere where we hit town for some fried egg sandwiches in a hole-in-the-wall place showing English League soccer and serving the best papaya drinks ever. 6pm and we are on the train for Yaounde.
I stretch out on the bunk and strip down to my shorts in anticipation of a nice long sleep overnight with the cool air rushing in as we descend on Yaounde. An hour and a half later we still haven't moved until a man tells us that the cargo train ahead of us has derailed and the train won't be leaving tonight. The president of N. Cam. Mission calls and arranges for us to sleep with the vice-president of the court of appeal! She's a strong Christian and opens up her house to us.
The next day, after avocado sandwiches, we head out to the market to search for French Christian music. The head of a local Christian radio station had come over that morning and takes us to a small boutique blaring loud Christian Nigerian praise from some huge old, speakers with the bass totally shot.
We are supposed to catch the noon bus for Yaound� but our host says not to worry as she knows the owner and has told him to wait for us as long as it takes. Here in Africa, it's all about who you know!
11 hours and two buses later we find ourselves in Bertoua. We pull off the main route, around a corner, and into a small, poorly-lit courtyard with several other buses. A guy comes running up yelling "Yaound�! Yaound�" and tells us to put our bags over on a bus right next to ours. It's a tiny mini-bus. We unload and quickly reload our packs. The first bus drives off and soon we look around to find the place empty except for us and a few other passengers. We've been abandoned.
I sit on a bench. Then I get hungry. I walk out with Sarah to the street. We sit on a crude wooden bench in front of a table covered with different feast-preparing items. In one corner is a pile of French bread. Scattered across the table are piles of avocados, old tin plates, a cup full of random silverware, a cardboard egg crate half full of brown eggs, and a spatula. Underneath and behind is a metal can with some coals in it and a frying pan sizzling over it with the fresh smell of "fried" wafting across the cool night air.
Sarah has just bought some freshly baked French baguettes from a bakery that happens to be just at the back of the bus stop and we order egg and avocado sandwiches. Nothing has ever hit the spot like those sandwiches. The smell of charcoal mixed with muddy, African street odor and the sounds of frying, scraping, shuffling, distant shouting and the occasional roaring of a passing diesel cannot be described, only experienced.
My belly full, I pry open the window of one of the abandoned buses, crawl through and stretch out on a seat until Sarah wakes me at 2:30 am to cram into the back of a tiny minibus and bounce around over unpaved, red-dust covered mountain roads until 10:00 the next morning when we find ourselves 10 km from Yaounde at the last of many police check points...
Sarah and I are in the back seat of a Toyota minibus modified to hold 20 passengers. That means we are crammed five across on barely padded benches with not nearly enough space for my knees to fit even if I sit up straight (which is impossible due to the low ceiling). I therefore have spent the last 8 hours with my knees and legs twisted into positions I had previously thought impossible for me. I'm thinking of quitting medicine and joining the circus as Flexible Man. Despite closing the windows, everyone is lightly dusted in fine red dust highlighting eyebrows and almost shaved heads in a rich earth tone.
Since entering southern Cameroun it seems we've been stopped every 15 minutes by the military. My hand reaches automatically for our passports velcroed safely in a side pants pocket. Sure enough, a soldier swaggers up with a lazy "bonjour" slipping out of his mouth as he asks for ID papers. I present them. He scans them quickly and hands them back. At least I have nothing to hide like the last time I came up from Yaound� when I had an expired visa. I twist around a little to relieve my numb right leg when another soldier sidles up and asks for our passports. I inform him politely that we've already been checked. He takes them, anyway. After a cursory glance, he asks for our yellow vaccination cards.
I hand him mine. Sarah has left hers in Bere. I explain that it's not needed except at international borders and we've already been checked. He says that this is the border of Yaound� so we need them. This is an old Camerounian trick I've seen before. They want money to let us pass. He saunters off with our passports across the road to his buddies sitting under a tree. I am livid and so tired my normally weak inhibitions are completely obliterated. I shove open the window, crawl out, and march angrily across the street. We are in the middle of nowhere and they all have guns and are wearing military fatigues. What I do next isn't well thought out.
I storm up to the one holding the passports and start yelling at him in French explaining why it's so stupid and unnecessary to be always bothering people and trying to extort money. One of them says that I should start by greeting them or saying "bonjour". I snap out a sarcastic "bonjooouuuur" and continue my tirade. Pastor Job and the guys from the North Cameroun Mission who've been traveling with us come up and intervene. Miraculously, they let us go without any more fuss. I am wasted now not only physically but emotionally. As I crawl back into the minivan I start to have brief flashbacks of events on this trip up to this point.
Sarah, Nellie, and I are sitting on a sandy beach by the Chari River. This is the border between Bongor, Chad and Yagoua, Cameroun. There is no bridge. There are 10 or so dugout canoes pulled up on the beach with some Chadians idling around waiting to transport customers. They offered to take us across for 1000 francs each. We refuse. To cross the river in Lai--which is twice as far across--costs 250 francs. We take our backpacks off, set them on the sand and sit down to chat. It is noon. We know we need to cross but we don't want to be just give in to their exploitation of foreigners. We periodically bargain with them till the price comes down to 500 francs per person.
Sarah is hard core and says "no." We continue to sit looking at the invitingly cool water rippling past as we swelter in the midday sun. Sarah suggests swimming to amuse ourselves. Then it hits me!
"Why don't you two swim across and I'll take the bags, pay the 500 francs, and transport them across?"
They like it and start taking off their shoes and walking towards the water.
The unexpected happens! The Chadian we'd been bargaining with gets a frightened look on his face and yells not to cross that he'll take us for 250 francs each! Sarah replies that they really want to swim but he's adamant saying the current is strong, there are hippos, you are girls who don't know how to swim, etc.
Slowly it dawns on me, in Chadian culture, if something happened to one of the girls crossing, they would be responsible and they couldn't live with that. They were suddenly obliged to take us across, even if for free! We pay up and cross, feeling the cool water refresh us temporarily as we drag our hands the few hundred meters to the opposite bank.
Immediately, guys on motorcycles pull up yelling for our business. It is 7 km to Yagoua and I've been told the price for a "clando-man" is 500 francs. I waltz up to the first one and say, "Yagoua, cinq-cent francs". He agrees but then his boss runs up and says "750 francs." He refuses to give in. Sarah, as tough as ever, says "Well, we'll just walk then", grabs her backpack and starts around the corner to the immigration "office".
The "office" is in an old, abandoned carcass of a steel motor home with rickety wooden steps. Out back is a shelter made of sticks stuck in the ground with woven straw mats laid on top to provide shade.
"Al-salaam alekum," I greet as I duck into the door at the top of the stairs.
"Wa alekum al-salaam" is the reply of the camo-wearing immigration officer. I present our three passports and he signs them quickly with plenty of rubber stamps making our passports very "official" looking.
Meanwhile, Sarah has been reasoning with the "clando-men" who've followed us. They argue that gas prices have gone up (an old excuse, nothing new here). Sarah just picks up her pack and takes a few steps down the road before they laughingly call out after her "�a va, 500 francs". Sarah's a very tough customer.
The wind whips into my face, stinging my eyes and causing tears to leave a streak back across my cheeks. It's nice and cool and free-feeling to be bouncing up and down on the sandy roads riding casually on the back of the "moto". We pull quickly into town and board the first of many buses.
Several hours, much reading, quite a few frozen yogurt baggies, and we are nearing Maroua. The man next to me heard me speaking English to Sarah and asked me where we were going in broken English. I told him the Koza Adventist Hospital. It is nearing sundown, Friday evening and we hope against hope to make the last bus to Mokolo where we can catch more "motos" to Koza. He suggests getting of the bus before Maroua as the road to Mokolo shoots off there. He says we may get lucky and catch a bus there.
Suddenly, after miles of no crossroads, a road veers off to the left. My friend points. We look for a bus and see nothing until we are past the turn off when we see a tiny minivan. He motions something to me. I don't understand. He yells and the bus screeches to a halt on the side of the road. We explain and the driver grudgingly sends his assistant to the top of the bus to take our luggage down. Meanwhile, I've sent Sarah back the 100 meters to the crossroads to make sure they don't leave.
We snag our bags off the asphalt as the bus scurries away and run awkwardly back to Sarah with our backpacks swaying back and forth. They have plenty of room and leave 30 seconds after we are on board! Nous avons la chance!
Sarah and Nellie are crammed in the back next to a Camerounian girl with an MP3 player! All the people on the bus are constantly checking their cell phones and commenting on whether or not the network is present! All the while, we pass small mud brick huts, herds of goats, and kids dressed in rags waving cheerfully as we chug by spewing out rich, black diesel smoke from our tailpipe.
Shortly after dark, we enter a darkly lit, smoky little town called Mokolo. The streets are rocky and steep, built on the side of a mountain shooting out of the surrounding desert. Small shops selling a little bit of everything are harshly lit with bare fluorescent bulbs. The bus stops on the steep part of a hill and once again we are surrounded by the "clando-men".
One of them says "Docteur, we haven't seen you in a while but we've been waiting for you." Since I've never been there before I can only assume they are confusing my army style buzzed blond hair, lanky frame, and clean-shaven face for Dr. Greg Shank's thick, dark curly hair, broad shoulders, and black goateed face. After all, according to them, all white people look the same (every time we watch a movie with the Chadians they think I am the main star...�a c'est toi, James, n'est-ce pas?).
The night is cool, the stars are out, the air is dry and dusty as only can be found in a desert night, and the road is windy, rocky, and steep. Once again I am hanging on the back of a small motorcycle and I have an hour to just let my weary, wandering thoughts focus on the simple beauty and joy of being in that moment...for an hour!
Arriving in Koza, I find Greg and Audrey in surgery. A young man was stabbed by his brother multiple times. He then showed up--after half an hour in a pushcart over mountain trails--with his intestines hanging out his side, one lung collapsed, and profusely bleeding wounds down to bone on his right arm and left posterior shoulder. When we get to the OR, Greg has the belly open, has sewn up the diaphragm and is controlling the bleeding on his liver wound. A blood transfusion is up and running and I ask how I can help. I change into scrubs, put on sterile gloves, and start cleaning out and suturing his shoulder and arm wounds. A piece of skin the size of a small plate has been sliced back off his arm and has rolled up into a scrunchy little mess at the medial border of the wound. I slowly stretch it back out and over the wound after washing out and closing the muscles. I leave the lower part open to drain and an hour later we both unscrub with the boy still alive. He has a urinary catheter sticking out of his chest (improvised by Greg since no chest tubes were available), a massive bandage on his abdomen and side, and two loosely wrapped dressings on his arm and shoulder.
We all head home (except Greg who has a few rounds he wants to make) to a never-better-tasting supper of cold beans and rice. I sleep till the next afternoon when we catch the "motos" to Mokolo, the bus to Maroua and sleep that night at the Catholic mission before catching the 7 am bus to N'Gaoundere.
On that bus we meet up with Job and Wangkel from the Chad Mission and the 3 administrators from Northern Cameroun Mission. 4pm finds us in N'Gaoundere where we hit town for some fried egg sandwiches in a hole-in-the-wall place showing English League soccer and serving the best papaya drinks ever. 6pm and we are on the train for Yaounde.
I stretch out on the bunk and strip down to my shorts in anticipation of a nice long sleep overnight with the cool air rushing in as we descend on Yaounde. An hour and a half later we still haven't moved until a man tells us that the cargo train ahead of us has derailed and the train won't be leaving tonight. The president of N. Cam. Mission calls and arranges for us to sleep with the vice-president of the court of appeal! She's a strong Christian and opens up her house to us.
The next day, after avocado sandwiches, we head out to the market to search for French Christian music. The head of a local Christian radio station had come over that morning and takes us to a small boutique blaring loud Christian Nigerian praise from some huge old, speakers with the bass totally shot.
We are supposed to catch the noon bus for Yaound� but our host says not to worry as she knows the owner and has told him to wait for us as long as it takes. Here in Africa, it's all about who you know!
11 hours and two buses later we find ourselves in Bertoua. We pull off the main route, around a corner, and into a small, poorly-lit courtyard with several other buses. A guy comes running up yelling "Yaound�! Yaound�" and tells us to put our bags over on a bus right next to ours. It's a tiny mini-bus. We unload and quickly reload our packs. The first bus drives off and soon we look around to find the place empty except for us and a few other passengers. We've been abandoned.
I sit on a bench. Then I get hungry. I walk out with Sarah to the street. We sit on a crude wooden bench in front of a table covered with different feast-preparing items. In one corner is a pile of French bread. Scattered across the table are piles of avocados, old tin plates, a cup full of random silverware, a cardboard egg crate half full of brown eggs, and a spatula. Underneath and behind is a metal can with some coals in it and a frying pan sizzling over it with the fresh smell of "fried" wafting across the cool night air.
Sarah has just bought some freshly baked French baguettes from a bakery that happens to be just at the back of the bus stop and we order egg and avocado sandwiches. Nothing has ever hit the spot like those sandwiches. The smell of charcoal mixed with muddy, African street odor and the sounds of frying, scraping, shuffling, distant shouting and the occasional roaring of a passing diesel cannot be described, only experienced.
My belly full, I pry open the window of one of the abandoned buses, crawl through and stretch out on a seat until Sarah wakes me at 2:30 am to cram into the back of a tiny minibus and bounce around over unpaved, red-dust covered mountain roads until 10:00 the next morning when we find ourselves 10 km from Yaounde at the last of many police check points...
Sunday, November 27, 2005
Thanksgiving in Bere
Gobble gobble,
I am alone. The last Thursday in November and I am alone. Sarah left Tuesday to stay in an Arab village for a few days.
She made friends with a tiny Arab girl whose mother was hospitalized, pregnant, and with malaria. They are cattle herder nomads. Another member of their clan was diagnosed with AIDS and tuberculosis and had just finished his first two months of treatment in the hospital. He came in with draining tuberculous lymph nodes on his neck and was all skin and bones with no hair. Although a strong Muslim he insisted on joining us for "prayer" several evenings and was interested very much in the one true God who also loved him. So, Mahamat (as he is called), came to escort Sarah to his "village". I was to be without a wife for at least 3-4 days. She wasn't sure when she'd be back.
One of my biggest fears about being married was how I was going to sleep with someone else in the bed with me. About the only time in my life I'd ever shared a bed with someone was during family vacations when I was a child. My twin brother, David, and I had to often sleep in the same double bed and we spent most of the nights fighting for covers or sleeping fitfully in the cold. As a result, I was convinced I could never sleep well with someone else always wanting the blankets or kicking me or rolling over on me or pushing me to the edge of the bed. But, now I find that I have a hard time sleeping without Sarah there.
So I toss and turn all night and find myself awake and alone at 6:30 am on the last Thursday of November. The phone rings.
"Hallo"
"Oui, bonjour, c'est André, �a va?"
"Oui, �a va..."
"Vous allez f�ter ce soir?"
And it all comes back to me, today is Thanksgiving. André had also left me alone on Wednesday to take care of some money issues with the PASS project and for some reason calls me to ask me if we're celebrating this evening.
I'd forgotten. Now I feel even more alone as my family is so far away and one should be with one's family on Thanksgiving.
I go next door and ask Nellie and Rebecca if they would like to fix a dinner and invite the hospital staff to dine with us for Thanksgiving. They agree. We ask Salomon to buy three chickens and I go to the hospital.
It's André who's supposed to read the daily Bible chapter for staff worship. I take his place. At the end, as is our custom, we ask for prayer requests. I take the opportunity to thank God for Thanksgiving and to invite them all to have dinner with us at 5 pm. I say I'll talk more about it later, but they're all invited. As we discuss the cases from the evening, Thanksgiving slips my mind.
The day is thankfully slow. I had planned to do an open reduction and internal fixation of a mandible fracture but the girl never shows up. She had been hit with a stick in the jaw by her husband. By the time she went to the hospital in Lai, was referred to us, was sent by us to Kélo for an xray, returned the one day I was sick and so went to the traditional healer, came back with the xrays but not the patient, and finally returned...three weeks have passed. I hope she'll show up tomorrow.
Other than that, it's a routine day of rounds, clinic and minor procedures. I'm actually able to leave at 3 pm as scheduled. Nellie, Rebecca and I start to prepare Thanksgiving dinner.
I boil water and dump in half a can of mashed potato flakes...voila! an essential Thanksgiving dish! The gravy is made my Rebecca who unfortunately has no other oil but the local peanut brand...it tastes like peanut butter. We have a can and a half of green beans, a can of cranberry sauce, two cans of baked beans, Rebecca makes stuffing from Salomon's bread, Salomon boils the chickens in tomato sauce to be served over rice and we are set.
I set out the plastic chairs that came in the container out in the courtyard along with our two locally made couches. The sun is going down turning everything a glowing orange. Samedi is the first to arrive and the only one on time. Soon after Pierre and David show up. Then a cry arises from the street. I look up.
"Sarah! Sarah! Sarah!" The kids are screaming.
Next thing I know around the corner of the hospital comes a wild haired red head bouncing on a fine Arab stallion with dust on her face pierced by the widest smile imaginable. Behind her comes a robed and turbaned Arab on a donkey with a sheep tied behind his saddle. My joy is complete. I didn't expect her till tomorrow. As she swings down from the saddle I stride over to meet her and sweep her up in my arms. I can tell the trip has been good for her. She looks dirty but refreshed.
As the sun goes down most of the staff have arrived. Samedi and Anatole have been regaling us with stories from the hospital's past and all the missionaries of B�r� past. Degaulle insists on singing one of the only two songs he knows in English: "She'll be comin' 'round da mountain when she comes..." At least he thinks he's speaking English. I join in.
Everyone chows down and the food disappears fast. Even the team on duty breaks away for a few minutes to partake. The two Arabs accompanying Sarah (Mahamat and his father), also join in.
At the end, everyone goes around saying what they're thankful for. As usual, Degaulle flies off on a tangent and we all try to gently (and finally, roughly) to bring him back to the point. Anatole surprises me by being so thankful that God brought him to B�r� because his life has been saved and so much bettered by having been here. I am shocked as all he usually does is complain about things. Even Mahamat is thankful that his sickness brought him to B�r� where his "eyes were opened" and his body was cured. I, of course, am thankful that in the last year God found me a hot Danish nurse for a wife...even way out in Tchad.
Lazare says something bizarre, as usual, but says it with such enthusiasm and obvious joy that everyone bursts out in applause at the end. Finally, they all leave except Lona's two sons, Fambé and Henri, who spontaneously help bring in the two couches even though they are only 3 and 5 years old respectively.
While the generator is still on I show Sarah half of the best Thanksgiving movie ever, "Planes, Trains and Automobiles". Then the generator cuts off and we go back to our rooms in darkness.
All day I'd been trying to call my family to wish them a Happy Thanksgiving but the satellite phone wasn't connecting. Finally, late that night I get through just as they are finishing eating waiting for the apple pie to come out of the oven. Grandpa, Grandma, Aunt Jeannette, Mom, Dad, and Chelsey are all there. While I'm jealous of the apple pie and the family being together, I have to admit my Thanksgiving has been hard to beat!
I am alone. The last Thursday in November and I am alone. Sarah left Tuesday to stay in an Arab village for a few days.
She made friends with a tiny Arab girl whose mother was hospitalized, pregnant, and with malaria. They are cattle herder nomads. Another member of their clan was diagnosed with AIDS and tuberculosis and had just finished his first two months of treatment in the hospital. He came in with draining tuberculous lymph nodes on his neck and was all skin and bones with no hair. Although a strong Muslim he insisted on joining us for "prayer" several evenings and was interested very much in the one true God who also loved him. So, Mahamat (as he is called), came to escort Sarah to his "village". I was to be without a wife for at least 3-4 days. She wasn't sure when she'd be back.
One of my biggest fears about being married was how I was going to sleep with someone else in the bed with me. About the only time in my life I'd ever shared a bed with someone was during family vacations when I was a child. My twin brother, David, and I had to often sleep in the same double bed and we spent most of the nights fighting for covers or sleeping fitfully in the cold. As a result, I was convinced I could never sleep well with someone else always wanting the blankets or kicking me or rolling over on me or pushing me to the edge of the bed. But, now I find that I have a hard time sleeping without Sarah there.
So I toss and turn all night and find myself awake and alone at 6:30 am on the last Thursday of November. The phone rings.
"Hallo"
"Oui, bonjour, c'est André, �a va?"
"Oui, �a va..."
"Vous allez f�ter ce soir?"
And it all comes back to me, today is Thanksgiving. André had also left me alone on Wednesday to take care of some money issues with the PASS project and for some reason calls me to ask me if we're celebrating this evening.
I'd forgotten. Now I feel even more alone as my family is so far away and one should be with one's family on Thanksgiving.
I go next door and ask Nellie and Rebecca if they would like to fix a dinner and invite the hospital staff to dine with us for Thanksgiving. They agree. We ask Salomon to buy three chickens and I go to the hospital.
It's André who's supposed to read the daily Bible chapter for staff worship. I take his place. At the end, as is our custom, we ask for prayer requests. I take the opportunity to thank God for Thanksgiving and to invite them all to have dinner with us at 5 pm. I say I'll talk more about it later, but they're all invited. As we discuss the cases from the evening, Thanksgiving slips my mind.
The day is thankfully slow. I had planned to do an open reduction and internal fixation of a mandible fracture but the girl never shows up. She had been hit with a stick in the jaw by her husband. By the time she went to the hospital in Lai, was referred to us, was sent by us to Kélo for an xray, returned the one day I was sick and so went to the traditional healer, came back with the xrays but not the patient, and finally returned...three weeks have passed. I hope she'll show up tomorrow.
Other than that, it's a routine day of rounds, clinic and minor procedures. I'm actually able to leave at 3 pm as scheduled. Nellie, Rebecca and I start to prepare Thanksgiving dinner.
I boil water and dump in half a can of mashed potato flakes...voila! an essential Thanksgiving dish! The gravy is made my Rebecca who unfortunately has no other oil but the local peanut brand...it tastes like peanut butter. We have a can and a half of green beans, a can of cranberry sauce, two cans of baked beans, Rebecca makes stuffing from Salomon's bread, Salomon boils the chickens in tomato sauce to be served over rice and we are set.
I set out the plastic chairs that came in the container out in the courtyard along with our two locally made couches. The sun is going down turning everything a glowing orange. Samedi is the first to arrive and the only one on time. Soon after Pierre and David show up. Then a cry arises from the street. I look up.
"Sarah! Sarah! Sarah!" The kids are screaming.
Next thing I know around the corner of the hospital comes a wild haired red head bouncing on a fine Arab stallion with dust on her face pierced by the widest smile imaginable. Behind her comes a robed and turbaned Arab on a donkey with a sheep tied behind his saddle. My joy is complete. I didn't expect her till tomorrow. As she swings down from the saddle I stride over to meet her and sweep her up in my arms. I can tell the trip has been good for her. She looks dirty but refreshed.
As the sun goes down most of the staff have arrived. Samedi and Anatole have been regaling us with stories from the hospital's past and all the missionaries of B�r� past. Degaulle insists on singing one of the only two songs he knows in English: "She'll be comin' 'round da mountain when she comes..." At least he thinks he's speaking English. I join in.
Everyone chows down and the food disappears fast. Even the team on duty breaks away for a few minutes to partake. The two Arabs accompanying Sarah (Mahamat and his father), also join in.
At the end, everyone goes around saying what they're thankful for. As usual, Degaulle flies off on a tangent and we all try to gently (and finally, roughly) to bring him back to the point. Anatole surprises me by being so thankful that God brought him to B�r� because his life has been saved and so much bettered by having been here. I am shocked as all he usually does is complain about things. Even Mahamat is thankful that his sickness brought him to B�r� where his "eyes were opened" and his body was cured. I, of course, am thankful that in the last year God found me a hot Danish nurse for a wife...even way out in Tchad.
Lazare says something bizarre, as usual, but says it with such enthusiasm and obvious joy that everyone bursts out in applause at the end. Finally, they all leave except Lona's two sons, Fambé and Henri, who spontaneously help bring in the two couches even though they are only 3 and 5 years old respectively.
While the generator is still on I show Sarah half of the best Thanksgiving movie ever, "Planes, Trains and Automobiles". Then the generator cuts off and we go back to our rooms in darkness.
All day I'd been trying to call my family to wish them a Happy Thanksgiving but the satellite phone wasn't connecting. Finally, late that night I get through just as they are finishing eating waiting for the apple pie to come out of the oven. Grandpa, Grandma, Aunt Jeannette, Mom, Dad, and Chelsey are all there. While I'm jealous of the apple pie and the family being together, I have to admit my Thanksgiving has been hard to beat!
Thursday, November 17, 2005
N'Djamena police chase
It was during my first month in Chad. I was stuck in N'Djam�na, trying to get a long term visa without knowing French, without knowing which offices to go to, without knowing whose signatures and stamps to get (and in which order!), and especially without knowing my way around.....
.....For almost two weeks I have just waited. A pastor and his wife have taken me into their home, assuming that it would only be a few days before I can go out to B�r� hospital and finally start learning the languages and to work. But my tourist visa only lasts for one month. A government official has promised to help me, but then an important journey came up and he had to leave.
Concerning the language, I do wonder what in the world I was thinking (or rather, not thinking) in going to a place by myself, where I don't know the languages or anybody. But in His mercy, God has come to my rescue: The pastor and his wife are from Brazil and speak Portuguese. Not that I do, but it somewhat reminds me of Spanish that I learned a bit of while 6 months in Peru, two years earlier. So they speak Portuguese to me, and I answer in Spanish. And dread the day I will end up in B�r�, with only French, Arabic and the local dialect to choose from.
Each day I go with the pastor's wife to the school where she is teaching. I sit 5 hours in the nearby church and read and go back home with her afterwards. I go to bed early, and am woken up every morning at 4 am by the minaret nearby loudly praising Allah and inviting to Morning Prayer. I find it hard to want to praise anybody, brutally being wakened up like that at the only time of day when it's actually cool enough to get some rest!
At last the government official is back. He has something for me to do while still waiting for the visa: there's a clinic near the main market and the big mosque. There is a dentist, and I can go help him pull teeth. The first day the pastor's wife shows me which minivan to squeeze into, and where to get off. She explains to me how to get back, too. So instead of going with her in the mornings, I now go to the clinic. I bring my dictionary and spend most of the time trying to learn more French.
The dentist has a cup that the patients sip from in between his twisting and pulling their teeth. Blood runs off its sides, along with saliva and rotten stumps of teeth. I hardly believe my own eyes when the first patient is done and another quickly takes his place in the chair. And sips from the same cup, not noticing it's only half full (since it has not been changed out or even emptied or cleaned after the first patient.) I am so perplexed and lacking words (of course), I mostly just feel like pointing to the bloody, slimy cup and screaming!!
The dentist likes to talk. Especially about the terrible situation his country is in, with both tuberculosis and AIDS all over. While he talks, I come up with something to say. Somehow I get the words together and ask: "What would happen, if a patient with, for example, AIDS or tuberculosis comes in here, drinks from the cup and bleeds on it, and then right after that someone else comes in and drinks from the bloody cup again?" He answers right away that it would not be good. Next day he has bought a couple of new cups that once in a while get dipped in a bucket with soap water.
The government official arrives at the clinic to tell me he needs two pass port photos from me, and then the visa can be issued. Thrilled, I ask the dentist where to get photos taken. He explains which minivan to get on, and when I see a certain shop on my right hand, then to ask to be dropped off. I go to the big public bus stop, near the main mosque. I get in, and as usual we have to wait to go till the bus is full. Because of the heat, the side door is still open, and I sit right next to it to get most possible of a possible breeze. Someone has opened the back door to load stuff, when suddenly the driver jumps in behind the wheel and takes off! While pressing the horn and pushing the speeder he gets everyone to jump to the side and other vehicles to leave him space on the road. The back door is still open, and I hold on to the frame of the car to not fall out the open side door! "Geez", I think," that's so rare to see anyone here in a hurry!" I want to close the door, but the driver does not slow down over the uneven and bumpy road, so I can't let go of my grip. I get a feeling he's not just in a hurry. I look back and see a jeep filled with armed military in the back, trying hard to catch up with us!
Turning to the front window, I see how the driver takes a narrow street to the left. I'm sure the chase will soon be over, because the street is packed with people selling their vegetables, chickens or other goods at both sides of the street, and I can't believe the driver will run over someone on purpose. Well, he doesn't, but people have to jump for their lives! Women with heavy baskets on their heads throw everything to jump to security; others push people in front of them to not get run over. The driver turns another corner without looking to his sides, speeds up, and tries another little ally. I try to figure out how to fold my arms around my head, so when we do drive into another vehicle I won't break my neck! But we are all bouncing around inside the car and have to hold on to whatever is closest.
Finally the driver ends up in a big area with other minibuses, and before the bus has come to stop he's out and running towards a market set up of several tents. Everybody else gets out of the minibus as fast as possible and are soon scattered. I guess this ride was for free! But I find myself in this unknown market, surrounded by Arabic speaking businessmen and heavily veiled women that all look down and hurry in whatever direction they are headed. I look around. I don't even know the name of the place I was going, just to get off when I see a certain shop on the right. I have lost all sense of direction, and nobody understands anything I say. Not that I actually try to get the attention of the Arab men, who, in my experience, could easily misunderstand my "interest" in them.
I have looked around for a while. I see people get into smaller taxies, and I recognize a lady who was also in the minibus. I get in the same taxi. I don't even ask where we are going. After all, how can this turn out to be a greater adventure than the previous?
Sarah
.....For almost two weeks I have just waited. A pastor and his wife have taken me into their home, assuming that it would only be a few days before I can go out to B�r� hospital and finally start learning the languages and to work. But my tourist visa only lasts for one month. A government official has promised to help me, but then an important journey came up and he had to leave.
Concerning the language, I do wonder what in the world I was thinking (or rather, not thinking) in going to a place by myself, where I don't know the languages or anybody. But in His mercy, God has come to my rescue: The pastor and his wife are from Brazil and speak Portuguese. Not that I do, but it somewhat reminds me of Spanish that I learned a bit of while 6 months in Peru, two years earlier. So they speak Portuguese to me, and I answer in Spanish. And dread the day I will end up in B�r�, with only French, Arabic and the local dialect to choose from.
Each day I go with the pastor's wife to the school where she is teaching. I sit 5 hours in the nearby church and read and go back home with her afterwards. I go to bed early, and am woken up every morning at 4 am by the minaret nearby loudly praising Allah and inviting to Morning Prayer. I find it hard to want to praise anybody, brutally being wakened up like that at the only time of day when it's actually cool enough to get some rest!
At last the government official is back. He has something for me to do while still waiting for the visa: there's a clinic near the main market and the big mosque. There is a dentist, and I can go help him pull teeth. The first day the pastor's wife shows me which minivan to squeeze into, and where to get off. She explains to me how to get back, too. So instead of going with her in the mornings, I now go to the clinic. I bring my dictionary and spend most of the time trying to learn more French.
The dentist has a cup that the patients sip from in between his twisting and pulling their teeth. Blood runs off its sides, along with saliva and rotten stumps of teeth. I hardly believe my own eyes when the first patient is done and another quickly takes his place in the chair. And sips from the same cup, not noticing it's only half full (since it has not been changed out or even emptied or cleaned after the first patient.) I am so perplexed and lacking words (of course), I mostly just feel like pointing to the bloody, slimy cup and screaming!!
The dentist likes to talk. Especially about the terrible situation his country is in, with both tuberculosis and AIDS all over. While he talks, I come up with something to say. Somehow I get the words together and ask: "What would happen, if a patient with, for example, AIDS or tuberculosis comes in here, drinks from the cup and bleeds on it, and then right after that someone else comes in and drinks from the bloody cup again?" He answers right away that it would not be good. Next day he has bought a couple of new cups that once in a while get dipped in a bucket with soap water.
The government official arrives at the clinic to tell me he needs two pass port photos from me, and then the visa can be issued. Thrilled, I ask the dentist where to get photos taken. He explains which minivan to get on, and when I see a certain shop on my right hand, then to ask to be dropped off. I go to the big public bus stop, near the main mosque. I get in, and as usual we have to wait to go till the bus is full. Because of the heat, the side door is still open, and I sit right next to it to get most possible of a possible breeze. Someone has opened the back door to load stuff, when suddenly the driver jumps in behind the wheel and takes off! While pressing the horn and pushing the speeder he gets everyone to jump to the side and other vehicles to leave him space on the road. The back door is still open, and I hold on to the frame of the car to not fall out the open side door! "Geez", I think," that's so rare to see anyone here in a hurry!" I want to close the door, but the driver does not slow down over the uneven and bumpy road, so I can't let go of my grip. I get a feeling he's not just in a hurry. I look back and see a jeep filled with armed military in the back, trying hard to catch up with us!
Turning to the front window, I see how the driver takes a narrow street to the left. I'm sure the chase will soon be over, because the street is packed with people selling their vegetables, chickens or other goods at both sides of the street, and I can't believe the driver will run over someone on purpose. Well, he doesn't, but people have to jump for their lives! Women with heavy baskets on their heads throw everything to jump to security; others push people in front of them to not get run over. The driver turns another corner without looking to his sides, speeds up, and tries another little ally. I try to figure out how to fold my arms around my head, so when we do drive into another vehicle I won't break my neck! But we are all bouncing around inside the car and have to hold on to whatever is closest.
Finally the driver ends up in a big area with other minibuses, and before the bus has come to stop he's out and running towards a market set up of several tents. Everybody else gets out of the minibus as fast as possible and are soon scattered. I guess this ride was for free! But I find myself in this unknown market, surrounded by Arabic speaking businessmen and heavily veiled women that all look down and hurry in whatever direction they are headed. I look around. I don't even know the name of the place I was going, just to get off when I see a certain shop on the right. I have lost all sense of direction, and nobody understands anything I say. Not that I actually try to get the attention of the Arab men, who, in my experience, could easily misunderstand my "interest" in them.
I have looked around for a while. I see people get into smaller taxies, and I recognize a lady who was also in the minibus. I get in the same taxi. I don't even ask where we are going. After all, how can this turn out to be a greater adventure than the previous?
Sarah
Wednesday, November 2, 2005
Miscellaneous experiences...
Friends,
Random experiences:
1. The baby has one normal leg. He is two days old brought in by his arab nomad parents. The second leg is cut off halfway up the shin with something like a floppy foot with toes with no bones. Oh, he also doesn't have an anus which is why he was brought in. We take him to the OR, an IV started by Samedi sticking out from his good foot. Sarah administers the Ketamine anesthetic and the baby sleeps. I know I will have to do one of two things--one easy and the other hard. The most difficult will be to open his stomach, find his colon, cut a hole in it, attach it to his abdominal wall and let him poop out of there until his is old enough to try and create an anus for him. The easiest is what I try first. I heard about this a few weeks ago when I was with my surgeon friend, Greg Shank, at Koza Hospital in northern Cameroon. I grab a needle and a syringe and I poke it into his butt skin where his anus should be. I aspirate and fortunately, about 2cm in I hit meconium (baby's first poop). I leave the needle in to guide me and slice through his skin. I grab a clamp and dissect down until I pop into his rectum where black meconium and brown, stinky, regular poop pours out. I leave a piece of rubber catheter in and he wakes up to a new experience...defecation!
2. Angeline is well known at the hospital. She came in last year with osteomyelitis and ended up having to have the middle part of her left tibia taken out and her wound dressed with diluted Chlorox in order to get rid of the infection. Of course, that took months. We saw her grow up (and fatten up) before our eyes. She was always wary of us, though, and would often cry just seeing Sarah or I. Unfortunately, her bone never reformed and she was left with a floppy left lower leg that was left in a cast. When my orthopedic surgeon friend, Troy Dickson, was here we tried to contact her to come and have some sort of transplant procedure. We couldn't find her, however, so Troy told me what to do and left. Now she is before me.
Her leg is still floppy but the joints are also still moving normally and the fibula is intact. She is fat and healthy and yes looks at me with suspicion. I decide that her only chance of walking again is to do what Troy suggested and I've read about but never seen: a fibula transplant.
Sarah puts Angeline to sleep. Both legs have been scrubbed and now prepped with Betadine. My heart is in my throat. I know I'm in way over my head. I scrub and drape. I grab the scalpel and cut into the lateral side of her good leg and down to her fibula. I'd measured the defect on xray to be 7cm. I separated the middle part of the fibula from its attachments to the tibia and then with a tiny, Swiss Army Knike-like saw I cut out her tiny, chicken bone-like fibula. I put it in a dish of saline, close the defect in layers, staple her skin shut and cover it with a sterile dressing.
I go to the other side of the table and cut into her old scar and down to the two stubs of bone. I clean them up by munching on the ends of them with an instrument called a Rongeur, pull out some of the spongy bone from the knee end of the tibia, pull out the fibula and find it too short.
I split it in half and jam it into the two ends of tibia and surround the three fracture sites with pieces of spongy tibia. I close the fascia over the graft and staple the skin shut. I put on a dressing and a fiberglass cast with her leg in as close to normal position as I can guess without access to intraoperative x-ray.
I take off my gloves and gown, Angeline wakes up and my heart finally descends to its normal place in my chest. It was thanks to last year's SM, Jennie Norton, that her surgery is paid for but it will be only through supernatural intervention that it will actually heal and allow her to walk.
3. The baby has what sounds like asthma on listening with the stethescope, but as Dr. Ken points out, the baby's only one month old so it's probably bronchiolitis. In either case the only thing to do is treat with nebulized albuterol and oxygen. We have albuterol but no oxygen...wait, didn't we get one in the container? We search in our storehouse and find the oxygen extractor which we've never tried. Micky, the visiting ER nurse, is administering the neb. The lights are on because the sun has just gone down and our 2 hours of programmed electricity is just beginning so we find a transformer and plug in the O2 extractor. It works and the baby seems to be doing well on it as we watch its oxygen saturation rise (on the O2 sat machine given us 3 years ago by Erling Oksenholt the night I visited him in Oregon on the spur of the moment before going to Chad to visit for the second time on a trip that lasted only 2 days and didn't include a visit to B�r�). It started at 85% and is now up to 93-95%.
I'm called to see a 12-year-old boy with a swollen stomach and no stool or gas for a day. He needs a laparotomy. We go to the OR. His thin body is in contrast to his firm, bloated belly. Sarah finds an IV fast and gives him his Ketamine. I scrub and drape and quickly cut him open from sternum to pelvis around his belly button as his intestines pop out and spill across the abdomen. I don't see anything obvious at first but there are red patches all over the intestines with little darker areas. Something is weird. I think maybe Typhoid fever at first at the point of perforating.
Then, as I run the intestines I discover that part of it has twisted on itself. I untwist it and quickly the dark areas become normal covered except for those patches that look almost dead. I know I can't leave them.
I put on bowel clamps, clamp and cut through the mesentery on the bad looking section and once all the blood vessels are tied off I cut the dead intestine out and then suture the two cut ends back together in two layers of running sutures. I release the clamps, there is no leakage. I leave in a drain and close the fascia with sutures and the skin with staples.
I go back to check on the one month old. I see a dead bat in the trash can by the door. The nurses look up mischievously. The baby is stable but still wheezing. Apparently, a bat entered the room, hit the fan, and landed directly on the baby's face, dead as a doornail! The baby lives through the night and the next day and the next and goes home the third day.
The boy recovers normally and by the 5th day post op is eating, walking, pooping, and passing gas. He goes home, comes back 3 days later to have his staples out and looks fine.
4. The baby is one month old and has a circular wound around the back of its head. Over the course of the next few days of antibiotics and dressing changes the whole part of his scalp that is inside the circle comes off leaving his skull exposed in the center. We continue antibiotics, he nurses normally and to all other appearances is totally healthy. We do dressings with diluted Chlorox and his wound starts to turn beefy red. He is still hospitalized.
5. A 1 1/2-year-old comes in. She'd been seen by me in April 2004 when she was a few months old and had an abscess on her left arm incised. Apparently she did well and I never saw her again until today. Now she has a bone sticking out of her forearm. It is jagged and rotten. Her hand and arm move and function normally. A centimeter from the bone is another wound draining pus. The radius and ulna appear intact but there's this third bone sticking out. It seems her bone got infected last year but since she's so young and otherwise healthy a new bone formed pushing the infected part out until it came out the skin. Sarah gives her an IM shot of Ketamine and I grab the bone with a clamp and pull out a 3 cm long piece! That's it. She comes back two days later and the two wounds are all but closed and her hand and arm continue to function normally...
6. Today, a woman comes in with a change in bowel habits and a big hard mass right under her sternum that is pulsating. I can only think of very bad things that I couldn't do anything about like cancers and aneurysms and such. I say she should go to N'Djam�na. The husband says he doesn't have the money. I say maybe and x-ray would help, but our machine is down one week after our friends from Florida got it up and running. Finally, I say we can try and ultrasound but I don't think I'll be able to see much.
I pull out the portable, laptop-sized ultrasound just donated by GE and brought by the Florida team. It runs on batteries, so I can use it without the generator. I turn it on, put in her name and place the probe over the mass. To my pleasant surprise, it appears that it is in her liver and that it is either a cyst or an abscess. After looking in some books I am convinced that it is an amebic liver abscess so I hospitalize her and put her on Metronidazole. I will be able to check on her in a few days again and see if it's going down in size. If not I can use the ultrasound to help me put a needle in it! Technology comes to B�r�! Above all, I thank God that He made me think to use the ultrasound. Sometimes, I am so used to hopeless situations that it's hard to get used to having more options around now.
James
Random experiences:
1. The baby has one normal leg. He is two days old brought in by his arab nomad parents. The second leg is cut off halfway up the shin with something like a floppy foot with toes with no bones. Oh, he also doesn't have an anus which is why he was brought in. We take him to the OR, an IV started by Samedi sticking out from his good foot. Sarah administers the Ketamine anesthetic and the baby sleeps. I know I will have to do one of two things--one easy and the other hard. The most difficult will be to open his stomach, find his colon, cut a hole in it, attach it to his abdominal wall and let him poop out of there until his is old enough to try and create an anus for him. The easiest is what I try first. I heard about this a few weeks ago when I was with my surgeon friend, Greg Shank, at Koza Hospital in northern Cameroon. I grab a needle and a syringe and I poke it into his butt skin where his anus should be. I aspirate and fortunately, about 2cm in I hit meconium (baby's first poop). I leave the needle in to guide me and slice through his skin. I grab a clamp and dissect down until I pop into his rectum where black meconium and brown, stinky, regular poop pours out. I leave a piece of rubber catheter in and he wakes up to a new experience...defecation!
2. Angeline is well known at the hospital. She came in last year with osteomyelitis and ended up having to have the middle part of her left tibia taken out and her wound dressed with diluted Chlorox in order to get rid of the infection. Of course, that took months. We saw her grow up (and fatten up) before our eyes. She was always wary of us, though, and would often cry just seeing Sarah or I. Unfortunately, her bone never reformed and she was left with a floppy left lower leg that was left in a cast. When my orthopedic surgeon friend, Troy Dickson, was here we tried to contact her to come and have some sort of transplant procedure. We couldn't find her, however, so Troy told me what to do and left. Now she is before me.
Her leg is still floppy but the joints are also still moving normally and the fibula is intact. She is fat and healthy and yes looks at me with suspicion. I decide that her only chance of walking again is to do what Troy suggested and I've read about but never seen: a fibula transplant.
Sarah puts Angeline to sleep. Both legs have been scrubbed and now prepped with Betadine. My heart is in my throat. I know I'm in way over my head. I scrub and drape. I grab the scalpel and cut into the lateral side of her good leg and down to her fibula. I'd measured the defect on xray to be 7cm. I separated the middle part of the fibula from its attachments to the tibia and then with a tiny, Swiss Army Knike-like saw I cut out her tiny, chicken bone-like fibula. I put it in a dish of saline, close the defect in layers, staple her skin shut and cover it with a sterile dressing.
I go to the other side of the table and cut into her old scar and down to the two stubs of bone. I clean them up by munching on the ends of them with an instrument called a Rongeur, pull out some of the spongy bone from the knee end of the tibia, pull out the fibula and find it too short.
I split it in half and jam it into the two ends of tibia and surround the three fracture sites with pieces of spongy tibia. I close the fascia over the graft and staple the skin shut. I put on a dressing and a fiberglass cast with her leg in as close to normal position as I can guess without access to intraoperative x-ray.
I take off my gloves and gown, Angeline wakes up and my heart finally descends to its normal place in my chest. It was thanks to last year's SM, Jennie Norton, that her surgery is paid for but it will be only through supernatural intervention that it will actually heal and allow her to walk.
3. The baby has what sounds like asthma on listening with the stethescope, but as Dr. Ken points out, the baby's only one month old so it's probably bronchiolitis. In either case the only thing to do is treat with nebulized albuterol and oxygen. We have albuterol but no oxygen...wait, didn't we get one in the container? We search in our storehouse and find the oxygen extractor which we've never tried. Micky, the visiting ER nurse, is administering the neb. The lights are on because the sun has just gone down and our 2 hours of programmed electricity is just beginning so we find a transformer and plug in the O2 extractor. It works and the baby seems to be doing well on it as we watch its oxygen saturation rise (on the O2 sat machine given us 3 years ago by Erling Oksenholt the night I visited him in Oregon on the spur of the moment before going to Chad to visit for the second time on a trip that lasted only 2 days and didn't include a visit to B�r�). It started at 85% and is now up to 93-95%.
I'm called to see a 12-year-old boy with a swollen stomach and no stool or gas for a day. He needs a laparotomy. We go to the OR. His thin body is in contrast to his firm, bloated belly. Sarah finds an IV fast and gives him his Ketamine. I scrub and drape and quickly cut him open from sternum to pelvis around his belly button as his intestines pop out and spill across the abdomen. I don't see anything obvious at first but there are red patches all over the intestines with little darker areas. Something is weird. I think maybe Typhoid fever at first at the point of perforating.
Then, as I run the intestines I discover that part of it has twisted on itself. I untwist it and quickly the dark areas become normal covered except for those patches that look almost dead. I know I can't leave them.
I put on bowel clamps, clamp and cut through the mesentery on the bad looking section and once all the blood vessels are tied off I cut the dead intestine out and then suture the two cut ends back together in two layers of running sutures. I release the clamps, there is no leakage. I leave in a drain and close the fascia with sutures and the skin with staples.
I go back to check on the one month old. I see a dead bat in the trash can by the door. The nurses look up mischievously. The baby is stable but still wheezing. Apparently, a bat entered the room, hit the fan, and landed directly on the baby's face, dead as a doornail! The baby lives through the night and the next day and the next and goes home the third day.
The boy recovers normally and by the 5th day post op is eating, walking, pooping, and passing gas. He goes home, comes back 3 days later to have his staples out and looks fine.
4. The baby is one month old and has a circular wound around the back of its head. Over the course of the next few days of antibiotics and dressing changes the whole part of his scalp that is inside the circle comes off leaving his skull exposed in the center. We continue antibiotics, he nurses normally and to all other appearances is totally healthy. We do dressings with diluted Chlorox and his wound starts to turn beefy red. He is still hospitalized.
5. A 1 1/2-year-old comes in. She'd been seen by me in April 2004 when she was a few months old and had an abscess on her left arm incised. Apparently she did well and I never saw her again until today. Now she has a bone sticking out of her forearm. It is jagged and rotten. Her hand and arm move and function normally. A centimeter from the bone is another wound draining pus. The radius and ulna appear intact but there's this third bone sticking out. It seems her bone got infected last year but since she's so young and otherwise healthy a new bone formed pushing the infected part out until it came out the skin. Sarah gives her an IM shot of Ketamine and I grab the bone with a clamp and pull out a 3 cm long piece! That's it. She comes back two days later and the two wounds are all but closed and her hand and arm continue to function normally...
6. Today, a woman comes in with a change in bowel habits and a big hard mass right under her sternum that is pulsating. I can only think of very bad things that I couldn't do anything about like cancers and aneurysms and such. I say she should go to N'Djam�na. The husband says he doesn't have the money. I say maybe and x-ray would help, but our machine is down one week after our friends from Florida got it up and running. Finally, I say we can try and ultrasound but I don't think I'll be able to see much.
I pull out the portable, laptop-sized ultrasound just donated by GE and brought by the Florida team. It runs on batteries, so I can use it without the generator. I turn it on, put in her name and place the probe over the mass. To my pleasant surprise, it appears that it is in her liver and that it is either a cyst or an abscess. After looking in some books I am convinced that it is an amebic liver abscess so I hospitalize her and put her on Metronidazole. I will be able to check on her in a few days again and see if it's going down in size. If not I can use the ultrasound to help me put a needle in it! Technology comes to B�r�! Above all, I thank God that He made me think to use the ultrasound. Sometimes, I am so used to hopeless situations that it's hard to get used to having more options around now.
James
Monday, October 24, 2005
Frogs, Mud, and Barges
Hallo,
I step outside. The buzzing hits my ears. A million insects like microscopic cockroaches fall as if they were small kamikaze pilots trying to demolish the big toads hopping gingerly away from my feet. Unfortunately, they mostly hit my back and neck. I walk out into a foggy, full-moonlit night. The drums pound in the background. A chant wafts on the air softly numbing the senses like the unceasing pounding of the ocean on the shore.
My chest burns as my lungs suck in the hot, searing air. It is Saturday and everyone has left church on march to the river for a baptism. The young guys have taken up my challenge. I began to walk fast and they soon felt I couldn't keep it up. They said, aren't you taking the car. I said of course not. I haven't exercised in weeks. I change from my Arab robes into some long shorts and a plain white t-shirt with sandals.
We pass the mud puddle in front of the hospital's main gate. The ducks waddle off quacking and swaying as if drunk. We round the corner at a fast pace. I am surrounded by young guys ranging in age from 6 years to late teens. We pass through the remnants of a millet field which, like a ghost town, has just a few reminders of the past prosperity left standing. Past the night watchmen's hut and through a few more mud puddles we hit the main "road."
Red clay stretching off into the African plain surrounded by yellow tipped rice in paddies as far as the eye can see. A few boys fish with homemade sticks and twine in the standing water that houses the rice. The red road is pocked with massive mudholes and deep grooves from the large transporters. We are still keeping up a brisk pace and already I'm wishing I'd brought water as the sun bakes my head making even sweating to keep cool seem almost like spitting in the wind.
A small Peugot truck is stuck between a rice paddy and the road where it tried to skirt a mud puddle. The mud is over the tires and into the chassis. I call the boys over, take off my sandals and step into the muck as I begin to discuss a plan of action with the turbaned driver. The back of the truck is piled with four barrels of diesel and a ton of miscellaneous sacks and plastic containers. I call all the boys over as they pass.
We attach a rope to the back and some pull while others lift and push on the side facing the rice paddy. I look over and see a well dressed man hit some slick clay and fall on his back off the bike like a Three Stooges movie. He's ok but getting the truck out has been put on hold as everyone stops to have a belly rolling laugh as his expense. Soon, we are to follow as the rope breaks and our boys end up also on their butts.
We change strategies and unload all the bags, plastic containers, and one barrel. Then with coordinated heaves and ho's and many manly grunts, and with much soiling of clothes, the truck backs out of the hole and back on the "road." With many "Que Dieu vous guide" following us we take off again with mud between our toes.
I suddenly feel very energized and I take off running at a determined pace. The boys gladly fall in line bragging of how they'll run me off the road and how they could run all the way to Kelo if they had to. Unfortunately, I don't last long but end up having to slow to a fast walk which fortunately opens up the time to many questions. Most of them are to be baptized today and they pound me with questions about Sorcery and Ogres and stuff that is a part of their everyday lives and how that relates now to believing and serving one God. They are smart and with such stimulating and intelligent conversation we arrive quickly at the river where I dive in, barely missing the fishing net.
I baptize for the first time and couldn't imagine a better place or way: a muddy river, after pulling a truck out of the mud, in shorts and a plain t-shirt with guys I've just been running and having deep spiritual conversations with...it's my first time and I wouldn't trade it for anything.
The drums pound, the long metal cylinder is pounded and clanged, the rattles are in full roll, and the chanting brings each person into and out of the water where we wait waist deep. Laughs and swaying and dancing abounds. People drink water straight from the river from one plastic water bottle that one person has thought to bring. Pierre fetches the water, wading out with his shirt off showing off his ample gut rolling over his trousers.
It's probably one of the best days I've ever had...
James
I step outside. The buzzing hits my ears. A million insects like microscopic cockroaches fall as if they were small kamikaze pilots trying to demolish the big toads hopping gingerly away from my feet. Unfortunately, they mostly hit my back and neck. I walk out into a foggy, full-moonlit night. The drums pound in the background. A chant wafts on the air softly numbing the senses like the unceasing pounding of the ocean on the shore.
My chest burns as my lungs suck in the hot, searing air. It is Saturday and everyone has left church on march to the river for a baptism. The young guys have taken up my challenge. I began to walk fast and they soon felt I couldn't keep it up. They said, aren't you taking the car. I said of course not. I haven't exercised in weeks. I change from my Arab robes into some long shorts and a plain white t-shirt with sandals.
We pass the mud puddle in front of the hospital's main gate. The ducks waddle off quacking and swaying as if drunk. We round the corner at a fast pace. I am surrounded by young guys ranging in age from 6 years to late teens. We pass through the remnants of a millet field which, like a ghost town, has just a few reminders of the past prosperity left standing. Past the night watchmen's hut and through a few more mud puddles we hit the main "road."
Red clay stretching off into the African plain surrounded by yellow tipped rice in paddies as far as the eye can see. A few boys fish with homemade sticks and twine in the standing water that houses the rice. The red road is pocked with massive mudholes and deep grooves from the large transporters. We are still keeping up a brisk pace and already I'm wishing I'd brought water as the sun bakes my head making even sweating to keep cool seem almost like spitting in the wind.
A small Peugot truck is stuck between a rice paddy and the road where it tried to skirt a mud puddle. The mud is over the tires and into the chassis. I call the boys over, take off my sandals and step into the muck as I begin to discuss a plan of action with the turbaned driver. The back of the truck is piled with four barrels of diesel and a ton of miscellaneous sacks and plastic containers. I call all the boys over as they pass.
We attach a rope to the back and some pull while others lift and push on the side facing the rice paddy. I look over and see a well dressed man hit some slick clay and fall on his back off the bike like a Three Stooges movie. He's ok but getting the truck out has been put on hold as everyone stops to have a belly rolling laugh as his expense. Soon, we are to follow as the rope breaks and our boys end up also on their butts.
We change strategies and unload all the bags, plastic containers, and one barrel. Then with coordinated heaves and ho's and many manly grunts, and with much soiling of clothes, the truck backs out of the hole and back on the "road." With many "Que Dieu vous guide" following us we take off again with mud between our toes.
I suddenly feel very energized and I take off running at a determined pace. The boys gladly fall in line bragging of how they'll run me off the road and how they could run all the way to Kelo if they had to. Unfortunately, I don't last long but end up having to slow to a fast walk which fortunately opens up the time to many questions. Most of them are to be baptized today and they pound me with questions about Sorcery and Ogres and stuff that is a part of their everyday lives and how that relates now to believing and serving one God. They are smart and with such stimulating and intelligent conversation we arrive quickly at the river where I dive in, barely missing the fishing net.
I baptize for the first time and couldn't imagine a better place or way: a muddy river, after pulling a truck out of the mud, in shorts and a plain t-shirt with guys I've just been running and having deep spiritual conversations with...it's my first time and I wouldn't trade it for anything.
The drums pound, the long metal cylinder is pounded and clanged, the rattles are in full roll, and the chanting brings each person into and out of the water where we wait waist deep. Laughs and swaying and dancing abounds. People drink water straight from the river from one plastic water bottle that one person has thought to bring. Pierre fetches the water, wading out with his shirt off showing off his ample gut rolling over his trousers.
It's probably one of the best days I've ever had...
James
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