Monday, June 16, 2014

Same old, same old...

Many of you know that I have a crush.  On Olen, yes.  But also on a group of people, the Fulani people.  I think that they are so interesting and cool.  

Someday I want to live with them.  Even just for a little while.  

Someday I want to have a camel here too, but I’m getting off of the subject.  Which was my day.  

My nice, restful Sabbath.  Teaching Sabbath School for the kids.  (not so restful).  Church with 3 kids.  (not so restful).  Potluck.  (getting more restful).  There aren’t that many of us because the Parkers and my parents are on vacation.  But we still had the 5 of us, Wendy and Cherise (Gary is in Kenya), David and Sarah, Jonathan and Melody and Gideon, Zach, Charis, Papa, Appo, John and Clemence (Antoine’s kids).  My favorite thing was Sarah’s pumpkin cookies.  Mmmmm…

I had planned to visit a patient’s Fulani village this afternoon, but he didn’t come back to guide me there like he told me he would.  We decided that we’d take off anyways and try to find one to visit.  

As I was walking back to our house, of course, a nurse came up to tell me that there was an accident.  I head over to urgence (the ER) and found a man with his testicles on the outside of his scrotal skin.  

Okay, fine. I’ll suture this up real quick.  I helped him walk to the OR.  Poor guy in his 60’s  I’m guessing (grey hair) had some sort of an accident while he was working outside today.  He had branch particles in his testicles.  

I inject some local anesthesia, irrigate him a LOT, and stuff his testicles back into place.  Then I quickly suture up the skin.  Nothing to it, except he probably would have benefited from having spinal anesthesia.  He was tough though.  And I really wanted to get on the road and didn’t want to wait for the OR team. 

Before leaving the hospital I saw another teenager in urgence who had fallen a “long ways” out of a mango tree around noon.  It was now 4 pm.  Nothing was broken, but he had some severe left upper quadrant pain.  I suspected splenic laceration or rupture or contusion if I was lucky.  His conjunctiva looked quite pink and his belly was soft, so I ordered a hemoglobin and lots of fluids, and a repeat one in 4 hours.  

And off I went in search of my Fulani village with my family, along with Wendy and Cherise.  

We drove off towards Lai and stopped along the side of the road when we saw some nomadic looking people camped.  Of course we don’t speak Fulani, but details, details.  

There were only a few people home.  Two women and a few kids.  They had a lot of cute little calves, so Olen brought the kids over to pet them.  It turns out that they weren’t actually Fulani and were instead Arabic.  But we still had fun trying to communicate in our 20 words of Arabic.  I did a cartwheel to try to get the kids to loosen up, but they were all very reserved.  I know they think we were crazy nasaras!  They enjoyed seeing our nasara kids though.  

On our way home we stopped to visit a lady named Merci, who had been our hydrocephalic baby’s mom before he died.  We had drained CSF from him for months (literally syringe into his head).  He had been doing much better before he turned for the worse and died (which had been expected).  

We got home and started to feed our starving kids.  Cherise hasn’t been feeling very well, so I ran up with Wendy to order a malaria and typhoid test.  A nurse found me with a bleeding miscarriage, so I told her to go get the patient for an ultrasound.  She had had a miscarriage 4 days before but started bleeding heavily today.  I found retained products with the ultrasound, so I pushed her wheelchair into the OR and helped her get onto the OR table.  My maternity nurse helped me get an IV, and I did a d&c under local anesthesia. 

We called in the lab and her hemoglobin was 5, but B negative.  I look in the blood bank.  No B negative.  Well, she’ll just have to be okay.  

Mango kid’s hemoglobin had been 10.7 at 5pm.

I run home to help finish feeding the kids, sing some songs with the kids, play a little before getting them into bed.  

9:30 pm.  Night nurse calls to say that mango kid’s hemoglobin was now 6.  

Oh, great.  But I don’t want to operate tonight!  I decide to go look at him.  He looks okay, but his belly seems more peritoneal.  I do a bedside ultrasound and can see that his belly is full of blood.  I poke it to verify with a syringe and out comes blood.

Okay, fine.  I’ll call the OR team in.  The pathway to the OR from urgence isn’t easy to navigate with a stretcher so I decide to carry him.  The kid isn’t big, so I grab half of him and make the dad grab the other half.  A student nurse grabs his feet.  We trudge over to the OR, bang through the doors, and finally into the OR before we drop the poor kid.  No, we didn’t drop him.  BEFORE we drop him!

Ndilbe and Alexis come in.  Alexis and I scrub and find a belly full of blood.  It’s a torn spleen.  I’m no general surgeon in America, nor have I had to do a splenectomy here yet, but I know enough about spleens to know that they aren’t nice to you!  We irrigate a lot.  There is a tiny amount of bleeding still after all of the irrigation.  I put a stitch in it, but it seems to cause more bleeding.  I hold pressure and irrigate more and can’t see any more active bleeding.  So...no bleeding, get out!  I put a drain.  He’s getting fluids and blood.  

The good news is that if someone survives making it to the hospital with a bleeding spleen in Chad, it usually has already stopped bleeding.  We finish the surgery at around 11:50 pm.  

I’m home ready to go to bed, but just wanted to explain the craziness of the SAME OLD things here.  

But I am so excited!  This next week we are getting a CRNA and his wife and 2 kids to move here.  They are landing on Tuesday in NDJ!!!  

And Friday my Mom and Dad come back from vacation!!! 

Please keep mango kid in your prayers.  He’s 16 or 17 years old.  



Saturday, May 24, 2014

Entertainment


Things we do for entertainment in Tchad…..

Lyol’s flip flops broke a while back.  I couldn’t believe that GAP shoes would break so easily!  He was quite sad about it.  So mommy and daddy had a contest.  Since both shoes broke, we each took one to repair (something weird doctor missionary parents would do).

Mommy, repaired one with 2-0 silk.  (opened, half-used suture that we hadn’t thrown away) It’s nonabsorbable and black.  Nice to look at.  Her skills paid off!

Daddy, chose something stronger but absorbable.  0 vicryl.  Purple and thicker.  He’s also got skills.  

We presented both shoes to Lyol and asked which one he liked better.  

He chose wisely and said he liked them both the best!  He was so happy to have flip flops again.  

Only time will tell now who’s shoe will break first.  Rainy season is coming and that absorbable suture won’t last forever!  

Only in Tchad will you entertain yourselves by pretending to be shoe repairmen.  I’m pretty sure we would have just ran to the store and bought a new pair in America.  But then again, we are pretty cheap sometimes!


Bok


The Things We Do for a Bok

Two quick chicken stories:

My ideas on tithe and offerings and faith and love have evolved somewhat since arriving here. I have become accustomed to seeing new things in church. Goats walking in the back door. Passing around the communal cup of water from an urn in the back when it’s too hot. Hearing three translations of a sermon (and being lucky to understand one of them). Bizarre theology. A list that could fill a blog by itself.

At offering time, it doesn’t surprise me at all anymore to see sacks of rice or bowls full of maize or millet or cucumbers or any other garden produce in the front of church as part of the offering. The head elder once embarrassed these poor genuine offering-givers and insulted them, asking if anybody in the church wanted it, because after all, what’s he going to do with that. Now we just take in to the market, sell it, and send the cash to the association.

Well, for the first time, I saw a chicken in the offering plate. It was awwweeesome. Unfortunately, I was on the platform that Sabbath. I’m afraid I didn’t bless the offering very well, because I was trying to clandestinely snap a photo on my phone during prayer.

After prayer, they took the chicken in the back. Well, the poor fowl didn’t like being part of the ceremony. He bok-bok-bukaaah-ed a bit too much. Eventually, an elder went into the back room and the noises ceased.

We don’t have Children’s Story at our church, but I’ve been thinking about starting it for quite some time. I thought maybe this would be a good first story.

‘There was once a chicken who made too much noise in church. The head elder broke its neck. Ok, kids. It’s now time to walk quietly back to your seats.’

Second story: I had a patient come in with difficulty breathing and fever. I’ve seen so many of these now they are getting routine. I brought him into the operating room (for ease of access to supplies) and cut into his chest wall, shoving a large tube into his chest cavity behind his lung. Liters of pus spewed out all over the floor, some of it actually falling into the trash can we had placed there to catch it.

Suturing the tube into place, I reflected a bit on how much suffering this guy had gone through in the last few months. There were scratches all over his abdomen, chest and flank. These are very common. This is the traditional ways of healing pain. Make a series of cuts on the skin overlying the pain. This heals the sickness. Duh. So obvious, it’s a wonder the medical community hasn’t caught on. I suppose I should blame Obamacare, since everybody else does.

Well, I got more curious than normal, so I asked him about it. He told me he had paid nearly $500 for these cuts. This is astronomical amounts of money in a country where 65% live on less than a dollar a day. He had been going to the witch doctor, who would sacrifice a goat and a chicken, then take the chicken foot and make these deep cuts on the poor young man.

If I weren’t so vehemently opposed to the whole witch doctor thing, I would love to go get a receipt for something like this and turn it into my insurance company.

love
olen and danae

missionarydoctors.blogspot.com


Olen Tigo: +235 91 91 60 32
Danae Tigo: +235 90 19 30 38

Olen et Danae Netteburg
Hopital Adventiste de Bere
52 Boite Postale
Kelo, Tchad
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Saturday, May 10, 2014

Mom, Mom, Mom


Who are the people in your life who you owe eternal gratitude?  

Probably one of them is your Mother!  

She carried you for 9 miserable months.  She agonized with pain in childbirth.  She fed you.  She wiped your butt.  She fed you.  She wiped your butt.  She fed you.  She wiped your butt.  

She lost sleep every night while you were little….and then probably more after you became a teenager!

My mother is an important part of my life.  I love my Mom!

Your mother is an important part of your life.  You owe everything to her.  Without her, you wouldn’t have existed.  

There are mothers here who face HUGE risks just for the chance to have a child like you.  We live in Chad.  To be pregnant here is probably riskier than walking down a dark ally alone next to a crime scene on CSI.  Chances are that you will die 1 out of 50 pregnancies (depending on which statistics you use, if you even believe them here).  One out of every eleven Chadian women die in childbirth.  And all this is to give birth to children who have a 21% chance of dying before the age of five.

I’ve had 7 maternal mortalities this year alone.  It’s only May.  

And we are the good hospital.  

Seriously.  It’s sobering.  

Just last night I had a uterine rupture.  She had been in labor since the morning on her eighth baby.  She came from a bush health center.  They referred her to the district hospital, Lai (20 km from us).  Lai put a foley in her, shaved her, and referred her to us.  

Bumpy roads.  

She arrived with a BP of 60/40 with an arm presentation of a dead baby.  I was planning on turning the baby and delivering vaginally when I touched her belly and could tell that she had a ruptured uterus.  I called in the OR team and we saved her life.  She had 2 liters of blood in her belly.  She had been ruptured for several hours.  She should have died.    

It’s sobering to be part of this fight for mothers.  

That’s why we are trying to improve things here.  Each time a mother comes to her prenatal visits here it improves her chances of survival.  Each time a mother delivers at our hospital, it improves her chances of survival.  Not because we are that good, but because care elsewhere is so bad, or simply not there.  

How do we get them to come?

Through day to day teaching in the village with our Project 21.  Zach and Charis are two Public Health organizers who are heading up this important project this year.  Loma Linda University’s Global Health Institute is helping them continue to stay here by paying a small stipend and part of their school loans.

Every delivery is free.  Every c-section is free.  

We give bribes for delivering at our hospital.  Every woman who delivers here gets baby clothes and a water bottle, if we have them.  It might seem like nothing, but it may be the only present she gets for her baby.  They don’t throw baby showers here! And I’ve never seen a diaper.  (Don’t believe that lie that all you need is boob and diapers.  Really, all you need is boob.)

So it’s time to finish what’s started!  We had some generous donors give money for a new maternity ward and delivery suite.  The shell is up and beautiful!  The inside walls are actually finished and painted inside.  

But I still can’t move in!  There’s still plumbing and electric to finish.  

While we wait for our plumber and electrician to return from his annual leave, we can finish the details.  He’s only one person, and we’ve kept him too busy with everything going on!

We need some tables, desks, shelving, curtains to separate the delivery beds, and benches.

It’s almost finished!!!  

For now we continue to do deliveries in a room the size of a master bathroom.  Often we have 2 or 3 mothers laboring in this tiny, sweaty enclosure, sometimes multiple mothers laboring on the floor.  But out this armpit, we help bring life.  We help save mothers’ lives.  We help save babies’ lives.  

Tell your mom you love her.  (Warning: Gratuitous plea for financial help coming…) Send a check to AHI.  Note the sidebar to our blog for donations to AHI, please mark "Bere Adventist Hospital."

HAWA


Imagine the wet feeling of urine always running down your leg as you get up to welcome your visitors into your home.  Imagine the stench that plagues your clothes and anywhere that you spend more than a few seconds.  You wrestle daily with the desire to not drink water so you don’t leak as much volume… but then your pee is more concentrated and smells more.  Your family may have money, but they refuse to spend it on you because you are worthless.  You are nothing.  You just stink. 

Literally.

That’s what it’s been like for Hawa for 8 years!  

Last year she was almost a success story after having had several surgeries here.  She was dry for a month.  I was so happy.  And then she leaked again.  

How do you measure success?  When do you just give up?  Why do some surgeries work and others don’t?  

I don’t know.  

I don’t know a lot.    

I don’t know why some surgeries work, and others don’t.  But I know I am persistent.  Sometimes that pays off too.  

And a lot of you are persistent.  

I posted on Facebook that I needed a little money to provide food for a fistula lady, and people wrote!  Money came in!  And I am so thankful for your prayers, encouragement, and every dollar that you sent.  

In the month of February we did 4 vesico-vaginal fistulas (google it).  Three were successes.  But not Hawa.   

Hawa came in originally with her bladder inside out.  The whole part that connects the bladder to the vagina under the pubic bone was gone.  Her left ureter was also gone.  She had a recto-vaginal fistula as well (an unnatural connecting tube between the rectum and the vagina, causing stool to leak into the vagina, which we have repaired).  

There were issues with all of her post-operative courses to say the least.  The first repair was a good one.  The tubing got kinked that goes from the foley to the bag.  Not good for fragile bladder/vaginal tissues.  The bladder fills with urine and the pressure on the surgical repair site causes breakdown of the surgical closure and leakage.  Still a lot of it took.  After this, her expired ureteral stent broke off in her one remaining ureter.  (We have since obtained some new ones from a generous company.)

The second surgery was another repair of her ever-present peri-urethral VVF openings.  We have done away with tubing by the way because of the kinking issue and lack of nursing.  Drip, drip, drip into a pan is the way to go.

Third and fourth more of the same.  Malaria with a post-operative course is no fun.  One of those times she developed a terrible cough, so that pretty much did us in.  Pressure (coughing) on fragile tissues is no good.  After her cough got better I repaired her 10 days post-operative (a no no because tissue is no good) to make number 5 because I was so annoyed the repair had broken.

Sixth surgery in February?  Went well.  Should have worked.  

She was dry for a week and a half.  But now she’s still got one tiny little hole to the right of her urethra.  It’s way better than it was, true.  But not dry yet!   

How do we measure success?  Do we say, “Well, she is way better than she was!” ?

When do we give up?  

I don’t want to give up because I know it will work the next time.

So… we will do it again.  But this time more severe.  I will open her up abdominally, do a supra-cervical hysterectomy (to take away her menstrual cycle), repair her fistula vaginally, and close her vagina to take away tension on the urethral area (have done lots of vaginal flaps that have helped her but not good enough).  

Unless someone else has any bright ideas!  : )  Or unless one of my Uro-gyn friends wants to come visit and help!  

I’m making her wait two months for the next surgery.  Book your tickets now!

In the mean time, she’s “my daughter.”  You who have sent money support her.  Every Sunday I give her $10 for the week to feed herself and her little boy.  For now she just hangs out at the hospital on her mat.  The hospital supports her because every VVF surgery we do is for free.

So thank you all for supporting Hawa.  She’s your daughter too.  Thank you for being part of her success story.  

It’s just not finished yet! 

Stay tuned in June and July.

Thursday, April 24, 2014

Local


We aren’t very frequent blog writers anymore.  Sorry for that.  I guess it’s because after a while everything ends up being same old, same old.  

But believe me, there is still lots going on.  Lots of surgeries still, even though it’s slow season.  Problems with administration.  The accountant who “lost” a ton of money under our old administrator, who admittedly stole money, is refusing to sign his resignation.  So now Olen has to take him to the justice.  Seriously dude, we’re letting you get away with just saying you’re incompetent, not even that you stole money.  Because clearly you are incompetent.  So just accept it!  

Problems with nursing staff.  Yesterday I had my 5th maternal mortality of the year (I had 3 in January so was off to a bad start).  She shouldn’t have died.  A lovely postpartum Fulani mother with a living baby girl.  I’m sure she died of hypoglycemia.  She was completely fine that morning, just a little anemic and not eating much.  She was hospitalized on oral quinine for several days already.  I went to do rounds this morning and was told that she died.  No one came to say, ”Doctor, she’s getting worse.”  “Doctor, please come help.”  Nothing.  Just…”She died at 20:00.” 

“From what?” I asked during rounds this morning.
“I don’t know, it was the night staff, it just says here that she died.”  

Frustrating when you live 50 feet from the hospital and are always available to help if needed.  

So tonight I went in to see my complicated pregnant patient when the nurse came to tell me she was worse.  

G10P9 admitted in a coma yesterday at unknown gestation.  She had been sick for 5 days, but in a coma for a day-ish.  She had a raging fever and was jaundice.  Her BP was a little elevated, but then the next few were normal.  I did an ultrasound that put her at 26+6 weeks (just under 1 kg).  I put her on quinine for cerebral malaria, gave ceftriaxone, and started steroids for the baby just in case my dates were off in case I needed to deliver the baby (babies don’t live under 1.5kg here usually).  She got a foley.  She got blood for her anemia of 6.  I asked for BP’s every 6 hours so I could have more information whether it was eclampsia or not.  

This morning on rounds.  Oh, come on guys, why hasn’t she gotten ANY BP’s during the night?  (We only usually ask for one set of vitals every day because more than that just doesn’t get done.  This takes place at 5 or 6 am usually.) 

Okay, well, she’s still comatose.  Her eyes are yellow.  Her pee is really concentrated in the foley bag.  The BP at 5am was 150/90.  I retake it during rounds.  It’s 120/70.  Hmm...did someone take it right this morning, or is she really elevated?  I ask for more BP’s to be taken.  The patient responds a little to sternal rub and and during the day opens her eyes but is not really with it.  We continue the quinine drip for cerebral malaria.  I explain to the family (about 15-20 people crowded in when they are not all supposed to be in our tiny room) that we are doing what’s best.  I’m paying for the patient now, so don’t even think about taking her home!  Nice long conversation with the family, including the husband.  It takes several days to recover, and they had her at home for 5-6 days before coming here.  One doesn’t recover quickly from something like this.  I told them she had a 50% chance of living, but in reality it’s less than that.

Several hours later.  Husband demands to take her home.  He sees no change in her state after less than 1 day in our hospital, so he wants to go home.  

Seriously!?  We went over this already!  The family convinces him to listen to me.  

Tonight the nurse comes to get me that she’s doing worse.  

I go to look at her.  She’s not really doing worse, (it’s hard to do worse than coma) but now has a BP of 160/90.  I retake her BP.  The first automatic BP cuff doesn’t work.  The second automatic BP cuff doesn’t work.  Was it really elevated or the machine just didn’t work?  I ask for a manual cuff and miraculously after 5 minutes one appears.  

I take the BP myself and get 160/90 again.  

I decide that it is probably eclampsia with malaria and to operate to increase her chances of living.  It’s a risk.  Her jaundice means that her liver is sick and she has a higher chance of bleeding when I cut her.  (Her jaundice is either from malaria or eclampsia).  I don’t have working exams to test her liver function.  It wouldn’t change anything anyways.  You just learn to do without here.  The only tests she has gotten are hemoglobin, blood type, and malaria smear.  

So, back to the operation.  We carry her to a stretcher because the stretcher won’t fit in the room she’s in.  We push the stretcher to the operating room.  

Ndilbe and I discuss anesthesia.  I pinch her legs, she doesn’t move.  Ketamine not possible with her BP.  Spinal is risky if she has an increased chance for bleeding (sick liver) and, plus, she’s really sick.  We decide on local.  This was actually my first time to use ONLY local for a c-section that I can remember.  I’ve started them and then done ketamine once the baby is close, but haven’t done one exactly like this before.  

Alexis and I prep the patient and scrub.  I inject 10cc of lidocaine just under her skin along the incision area.  She doesn’t budge.  My blade doesn’t have the right knife handle so I just pick up the blade with no handle and cut down to the fascia.  Her fascia is yellow.  Normally it’s white.

I cut down to the uterus and take the baby out.  There is a lot of meconium like the baby was already in distress.  The baby dies a few minutes after delivery.  It weighed about 1 kg.  

I suture the uterus.  It’s extremely atonic (not contracted).  The oxytocin is going in intravenously.  I ask Ndilbe to inject oxytocin directly into her uterus.  It firms up some, but not completely.  I ask for my suture to manually contract the uterus like I seem to do 50% of the time I do a c-section here.  I place sutures through the uterus and cinch down the uterus so it can’t fill with blood once she goes to the floor if the nurses forget about her and she gets worse uterine atony.  

I do a tubal ligation without asking.  Something I would have never done when I first got here.  I’ll tell them if she lives.

I close fascia, then skin.  

All of this with no anesthesia.  Okay, I mean all of this with ONLY LOCAL anesthesia.  

She didn’t budge from pain.  

For those of you that don’t know, the treatment for eclampsia is delivery of the baby.  So at least that part is done now.

She’s really sick.  She probably has eclampsia with cerebral malaria also.  Either way, she needs your prayers.  I restarted the quinine when I got to the floor.  The maternity nurse was in with a delivery.  There was a nursing student helping her.  She doesn’t have a clue.  

I told her to watch the drip and make sure it doesn’t go in faster than 4 hours.  She started translating all of this to the family.  

I said, “No, you are the nurse.  You need to watch it and make sure it doesn’t go in too fast or too slow.”  

I told her to press on the fundus of the uterus and if she bleeds too much, look for the other nurse.  It’s like telling at kid to watch this patient and make sure she doesn’t die.  

That’s what it’s like here.  And I’m sure if I hadn’t been here for 3 years already, there would be a million other details that you would never believe of the things that go on here every day that would never happen in a first world country.  

Please pray for her.  Her name is Berthe (probably Bertha in English).

Danae


Wednesday, March 26, 2014

Crazy Pants


Crazy Pants

I swear we could make a movie of the craziness that happens here. It just doesn’t get any crazier than this past week, however. And this we can write about.

How’s a girl gonna get out of school in Chad where there’s no such thing as a snow day?

It better be something good!

You gotta fake out your teacher. You gotta fake out your classmates. You gotta fake out your parents. You gotta fake out the nurses at the hospital.
I’ve always hated fakers in the medical field. Somehow I attract them. Fake seizure here, fake seizure there….. In America. In Africa. They’re everywhere!

In the medical field there are a few tell tale signs to know when someone’s faking it. Once you get that one little sign. It’s over. You know they are a faker. It takes less than a minute usually.

Then comes the process of the PATIENT accepting it and telling everyone else that they were faking it too. That’s the part that takes a while. In America, we don’t usually get the luxury of this second part even though we know the truth.
It started a week or so ago. A teenage girl came in here. A teenage girl came in there. Same story. She was at school (usually) and started acting weird.

She had some sort of a seizure. She would act crazy, shaking her arms and body parts depending on the girl. She would stare and look at you weird. Some people thought it was medical. Some people thought it was devil possession. In reality, they were just faking it.

A girl fell ill with the sickness. Everyone got all hyped up about her. Crowds gathered. She got lots of attention. Another girl thought she’d try it in another school. Same sort of thing.

The drums of Bere started beating. They passed it on to Kelo. They passed it on to Moundou. The drums even got to N’DJamena.

I had heard Olen complaining of these girls on and off for a week or so. There hadn’t been very many at one time though.

Then…

I heard the commotion at urgence. A pick-up truck had brought in a teenage girl acting like a rabid dog. There were 20 people trying to hold her down and carry her into urgence.

Seriously people!? “Get away. All of the family has to get out! Everyone get out!” (Fakers love a good crowd.)

At the same time 2 other girls came in. All 3 of them were from different schools in Bere. Since they all came from different schools, people thought they had to be telling the truth and were really sick. Oh, so it must be an epidemic of crazy pants girls then!

I had 10 seconds with the first girl before I knew she was faking it. It’s all in the eyes.

Immediately, I brought the other 2 girls in the same holding area as the first girl. There was some wrestling I must admit. There was some yelling. There was a lot of, “Why don’t you want to be equal with the men in this country?” “Why don’t you want to go to school? Didn’t we just celebrate Mar. 8 (women’s independence day)?” There were a few pen to nail bed pressures (trust me you don’t want this.). There was even a little of me acting crazy to show them I could do it also.

In the end, each girl walked out of urgence on her own standing next to me. She told the crowd she was sorry.

We had 8 total crazy pants teenage girls come in that same day. Each one got the same treatment.

“Are you going to admit you are faking it now?, Or do you want to spend the week in pediatrics with us?” They all chose to be difficult and become hospitalized. Olen and I paired up a few times when several came in at once.

Each girl had to say sorry to the crowd of gawking onlookers who had just struggled to get this thrashing girl to the hospital.

Each girl was then hospitalized in pediatrics with all of the screaming babies.

They all hated me at first. But I promise that we were BFF’s (best friends forever) by the time she left the hospital.

You see, starting with the most stubborn girl, I made them follow me around on rounds, consulting patients, and operating on patients (observation only). By the end of the day she was my friend whether she wanted to be or not.

These girls needed attention. And they needed hope for the future. They needed to know that their life mattered. That they could BE someone. And they needed discipline.

I didn’t want them to EVER forget this week. They messed with the wrong girl here! The first day I took 2 girls. The second hospitalized day I took 2, and Olen took 2. The third day I took 2 and Olen took 1. They actually liked it after the first few minutes of us ignoring their stubbornness.

Well I tell you that we’d never get away with this in America...Wrestling the patient to the floor, humiliating her in front of all of the on-lookers, publicly declaring that she was faking it, and then bringing her into the hospital to learn about medical things!?

The girls’ eyes were opened by what they could learn if they just stay in school. They saw intelligent female nurses working equally with men. They saw the suffering of the female patients here. They saw the sadness in the eyes of the parents of very sick children with malaria. They saw rude men refuse to pay for care for family members.
You could see the change in their eyes, little by little. They wanted to be different now. They wanted to be an intelligent female.
The epidemic finished with a 3 day vacation from school for the WHOLE COUNTRY. Seriously. For fakers. Official government line: “We are suspending all academic activities for 72 hours in the hopes the evil spirits will pass by in that period of time.”
But our girls didn’t really get a vacation. However, they will never forget it. They soooo hated me at first. And then they loved me. Oh, it was a great week! And we discharged them after only 3 days because they were on such good behavior!
(As an aside: We do actually believe in demon-possession. And we believe we see it here. However, this was not that. This was voluntary crazy-pants.

Friday, March 14, 2014

The Desk


I am no good at my job. Since I arrived three years ago (and a year and a half before that), around $80,000 has disappeared from this hospital. The number has yet to be determined. It was probably all or mostly removed by one man, my administrator, whom I trusted too much. I have no administration experience or education and have never even taken so much as high school accounting. The hospital was making money and the hospital was growing and we were slowly making strides in our organizational structure, quality of care and infrastructure. I thought everything was going well. Now I know better.

So I am learning as I go. And I am hating it. I am the all-time reluctant administrator. I don’t like politics. I’m no good at it. I’m no good at inter-personal relations when I am the boss. I’m not organized enough. I’m not motivated enough. I don’t set a good example. I’m only the administrator because my wife refuses (unhappy wife makes unhappy husband) and my father-in-law doesn’t speak enough French.

Oh, and I’m overworked too. That might decrease my efficiency. I need to see the pediatric and medicine patients, handle radiology questions, see private consults, consult any complicated emergency room patients, do any potentially-tricky anesthesia, oversee construction (although Jamie handles 99% of this), make the nursing schedule, arrange for employees’ time off, handle any issues which arise (which is several times a day), govern meetings, fundraise, collect donations of money and equipment, find projects suiting the needs of donors, start a nursing school, a midwifery school, an anesthesia school and a surgical training program from scratch, get all my volunteers short-term and long-term visas, build proper local and national government and church relations, etc.

Oh, and I’m also AHI Director for Tchad/Cameroon. So in theory I need to oversee Moundou, Abougoudam, Buea, Koza and Batouri. For the most part, I have very little to do with them. But if I did my job well, I’d be much more helpful in getting Batouri and Koza more supplies and staff. And I’d be recruiting more. Oh, and I’m responsible for getting volunteers here, which involves getting them from airport to N’Djamena lodging, then to police station, then to change money, then on a bus to Bere, then arrange food and lodging in Bere (although I have help finishing the food and lodging). Then return them back home. We had over fifty volunteers in January. I’m in charge of taking care of all Tchadian nursing and medical students sent through school by AHI, which is 17 this year. I need to get them their monthly stipend, pay their tuition and ensure they are actually enrolled in the school they say they are. I also oversee our public health project (although I have good help here), govern more meetings, handle incoming containers, make sure all paperwork between AHI and the government and our institutions and the government are in order, etc.

So now, after missing all this money, I also realize I must meet with my new administrator and new accountant daily to count and sign off on the previous day’s income and receipts, I must sign off on every expense, I must ensure daily store room status and I must make out our staff’s payroll. I also need to confirm retirement accounts for my employees and that they pay income tax properly.

Oh, and then I need to spend several hours a day responding to emails and working on the computer. When I work at the hospital, patients and staff are constantly coming to find me. When I work from home on the kitchen table, my children want to play. So it was decided I needed an office.

My loving wife cannibalized a guest bedroom in our house and Jamie made me a desk. Well, he actually found an old desk frame in really good shape and put a nice piece of American plywood on top, with the edges sanded to perfection. But it needed painted.

So Lyol and I painted it. Sort of.

Lyol grabbed a medium-sized paint brush and gave me a pencil-sized paint brush. He then proceeded to slop paint out of the bucket onto the desktop. Occasionally he would push the paint around a bit, not unlike you might see an octogenarian do on the senior’s professional shuffleboard circuit.

Handicapped though I was by the size of my brush and my desire to not merely use the brush to dip-and-drench, I still managed to keep pace with him on my side of the table. I helped paint the edges. As the desktop was nearing completion, I picked up the paint bucket so we could paint the last remaining corner of plywood. Each time he dipped into the paint bucket, Lyol managed to scrap half of his paint off on my hand. Lyol decided it might also be wise to paint the base supporting that new sheet of plywood, so he slashed a stroke across it. And then tired of his labors.

He stepped back from his handiwork and looked. I too stepped back from the desk and sized up my five-year-old son, trying to determine which had more paint, the desk or his skin. He pronounced his work good and moved on to play in the yard, but not before getting cleaned up with gasoline to wash off the paint, leaving behind only traces of gray as evidence of his hard, sloppy labor.

As he played in the yard 40 feet away from me, I tried to clean up his workmanship just a tad. I tried move the paint from places that seemed a quarter inch thick with it to places still brown and barren. I painted the edges. I finished the base, which I wasn’t intending to do, but needed done since he started it with a singular broad stroke.

I knew the entire time I could have done a better job and done it faster on my own. But I enjoyed doing it with him. I enjoyed spending time with him. I enjoyed watching him learn to do something. And I think the next desk he paints will be better off for it.

That was yesterday and I moved my desk into my office today. It now has the handprints of all three of my children on it. Is it composed of the greatest, highest-quality parts? No. Is it the craftsmanship that makes it valuable? By no means. Does it stand apart by virtue of it’s attention to detail? Certainly not.

But it’s my favorite desk in the world. It’s the perfect desk. Why? Because my son and I spent time together painting it. The two of us. Our project.

So now I sit down at my desk and work. And I think of my mountains of assignments. I think of my stress. I think of what a shoddy job I’m doing.

And I realize something.

I’m taking my medium-sized paint brush to this hospital and to AHI. And I’m just slopping paint all over the place, willy-nilly. Some places are way too thick. Other places I miss altogether. I forget. I don’t pay attention to detail. I’m painting things that shouldn’t be painted. I’ve started painting some things and I’m running out of steam to finish them. I’m getting myself very dirty. And I’m even slopping paint all over the Guy holding the bucket.

God is holding the bucket. He’s standing by observing, content to watch me do my miserable best. He’s patiently letting me cover Him with my lousy efforts to paint. He watching me get myself dirty. He’s seeing all the places I’ve overlooked. He sees how uneven I am, how I make neck-deep pools of paint where a sixteenth of an inch would have sufficed. He watches me paint things that were just fine without paint, then tire out. Then He patiently does His best to douse me with gasoline and scrub me clean, leaving behind only the traces.

And then, He ever so patiently takes the piddly pencil-sized brush I’ve left Him with and starts going over the places I’ve missed. Finishing what I couldn’t. Smoothing over all the irregularities. And without ever groaning, He merely bears the paint I’ve smeared on His hands by my clumsiness and shortcomings and inattention to detail. And He stands back and smiles.

Yes, the job could have been done better and faster without me. But you know what? He CHOSE to do this with somebody. And you know what? He CHOSE me! And when He sits down at His desk to work, He thinks back on spending time with me. He thinks about all my silly little efforts to do my best, tongue hanging out in concentration and everything. He sees the imperfections in my work, which are not hard to find. He runs His fingers over the places where He remembers me particularly messing up or where He remembers working hard to erase my mistakes.

And He smiles, saying to Himself, ‘This is my favorite desk. I made this with my son.












Friday, February 7, 2014

13.1

13.1

You know what it’s like to see that 13.1 mile marker while you’re running a marathon? Me neither. Marathon runners are crazy. Who wants to run for five hours just to be able to say you’re peeing blood the next day? But I can imagine what would be going through my head if I ever did see the 13.1 sign. Probably something totally upbeat and inspirational and self-motivating, say, ‘I think I’m going to vomit last night’s carb-loaded pasta dinner and this morning’s carb-ridden bagel on my fancy $120 marathon-running shoes now,’ or, ‘I wish I had put on bandaids to prevent the chafing,’ or, ‘I regret not going on that half-mile walk around the neighborhood to train for this,’ or, ‘So this is what my patient meant when he said he felt like there was an elephant sitting on his chest.’ Actually, I’d probably be thinking something like, ‘Man, I’m sure glad I decided to take a taxi for miles two to twelve. Where’s the next one?’

This summer, in fact, I did something quite similar. I let my brother-in-law sign me up for a ‘metric century’ bicycle ride. 62.2 miles, 100 kilometers. Roughly a week before the ride, we rode a half dozen miles or so around his neighborhood, then perhaps 15 miles the next day. I figured that was adequate training. After all, I rode all the time back in college. And it had only been 12 years since college graduation. You know what they say: ‘You never forget how to do it. It’s just like falling off of a bicycle.’ Something like that. Surely I hadn’t gotten that out of shape. Surely my muscle memory would kick in.

Surely I hadn’t really gained 40 pounds since then.

I think Shirley was actually the name of the person of ambiguous gender who passed me on his/her Wal-Mart mountain bike, grey hair flapping elegantly in the breeze. Meanwhile, I was really focused on not loosing my free-with-the-price-of-admission-I-paid-for-this-draconian-course-of-metric-pain-and-suffering lunch. Turns out the Appalachians have a wee bit more elevation change than the farm roads of Berrien County, Michigan. Of course, so does a pimple on a teenager.

Actually, back in college I wanted to take part in the Eco-Challenge, a 12-day, 24-hours-a-day race taking place in Patagonia, Argentina. And before college, I went on a six-day, 500-mile bicycle tour, as well as a six-day hiking trip. I even once dated a girl for four months. Like four months straight. In a row. No break. Same girl. Serious.

I have witnesses. Ok, it was like 3.5 months. I round up. And it was long-distance. I also traveled Europe for months with no shower, deodorant, change of underwear or expenditure on hotel rooms. All of this is just to demonstrate how I’m all about the long-term, endurance feats.

And so here we are, halfway through the longest commitment I’ve ever made. (Wait, no. I guess I actually committed a lifetime to Danae. But besides that. Oh, and baptism and having kids, I suppose. You know what I mean.) We agreed to serve six years in Tchad. December 12, 2010 was our arrival. We’re now past mile 13.1.

Without going into too much allegory of runner’s high, hitting the wall, cramping up, getting a second wind, etc, we can just say there have been ups and downs. The metaphor has probably been taken as far as it should go at this point.

Day by day, it seems as if nothing ever changes. We still have the same clashes of culture, differences of working styles, different priorities, difficulties motivating our staff, discipline challenges, health challenges, medical challenges, etc. When new volunteers arrive, full of energy and good intentions, but short on time, we are embarrassed to have them see what goes on at the hospital. It’s nothing that would pass for quality care in the states. There are so many short-comings in our system that it’s hard to adjust. And it’s hard to squash their good intentions by explaining the reasons why things are the way they are. Sometimes it’s for cultural reasons. Sometimes it’s for financial reasons. Sometimes it’s for infrastructural challenges. Sometimes it’s just because I’m tired and there’s only so much I can do. I won’t be that missionary who works himself into a burnout, I hope. It’s really easy to do.

But when we look back at what the hospital was a decade ago, it’s incredible. James Appel really changed the place from a run-down chicken coop of a health center on the verge of collapse into a respectable full-service referral hospital. We just tried to continue James’ momentum since our arrival three years ago.

And although God has really blessed Bere Adventist Hospital to prosper and triple our income, increase our staff, increase the number of patients we see, make us the leading surgical hospital in the country, triple our square footage… There’s still a long way to go. At least 13.1 miles.

Do marathon runners get tired thinking about the last half of a marathon? Sometimes it seems so far. There’s so much ground to cover.

We need to open a nursing school and graduate our first class of nurses and get them into the system. We need to get a midwifery school. We need to start our anesthesia program. We need to start our surgical training program. We need to get our new Tchadian doctors trained and on their feet. We need to finish this MASSIVE construction project. We need to do a better job at public health and evangelism. We need to get our system online with accounting, medication ordering, store room forecasting, lab orders/results, patient tracking, etc. We’d love to get a computer school and radio station running. We have so many invitations to open health centers and hospitals. We have so many relationships to build with the government. We have so many relationships to build with EVERYBODY. That’s why we’re here, right?

This is much more than 13.1 miles left to go. It can’t be done in three more years. It can’t be done in four more years. It will be at least eight or nine more years.

Marathons are daunting, intimidating. I don’t really enjoy running, although I’ve done it for exercise. It always struck me as such a loner sport, isolated. I’m much too sanguine.

They say during marathons you tend to find a person that is about at your pace. You stick with them, strike up a conversation between the gasps for the air and occasional flurry of emesis, encourage each other and eventually build that relationship to finish together.

Anybody up for a jog? I’m always looking for a jogging parter.

Does anybody get to the finish line of a marathon and say, ‘You know, that was fun.

Let’s turn around and run the course again backwards’?