Tuesday, June 12, 2018

Camp Hell

Sunday, 8pm: 

Nuts. Juniper’s awake. I can hear her crying. You don’t hear that? It’s coming from outside? How’d Juniper get outside at night? Wait. Listen for it. Hear that? You’re right. It’s outside. Oh… it’s the sheep.

Flashback to Thursday night:

Do you want to know what my happy face looks like? Do you? You do? Ok, here… look at my face now. See it? Yeah, this is not my happy face. This is so not my happy face. This is like the opposite of my happy face. Imagine my face upside down. That would be much closer to my happy face.

I am not happy.

I am driving around on a wild goose chase in the pitch black moonless night somewhere in some seventh level of Sahel. 

And I am sooooo taking this guy’s man card. In fact, I’m taking all this guy’s cards. So not impressed.

My lovely wife is… lovely. Much lovelier than I am. Both in physical appearance and in generosity. And I hate it. Well, the physical appearance part I'm willing to tolerate. But this generosity thing is killing me. She’s also wildly in love. And no, not with me. That fling is past. Her new passion, as of the last several years, is all things Fulani. She wants to dress Fulani, she wants to… well, she just wants to be Fulani.

The Fulani are the nomad tribe that criss cross the country and the continent driving their herds from here to there and from there to here in search of greener pastures, greener for the grazing. My wife wants to move in with them. Except there isn’t really any way to move in with nomads. So she just wants to live with them. In America, we call it camping.

The theme of my wife’s life for the past several years is we-are-going-to-live-with-the-fulani-for-a-month-before-we-leave-africa. I agree, it’s not a very catchy theme. Feels clumsy on a billboard. But it’s consistent.

When we drive somewhere, we drive past people wanting to catch a ride in the back of the pickup truck all the time. And we drive right on by. Kids going to a soccer game? Nope, no ride for you. Guys headed to the market? Who’s got time to give them a lift? Not us. Women carrying massive loads on their heads home from the market? Sorry, ladies, but this is the express. Old ladies having heart attacks needing a ride to the hospital? Call a taxi. Unconscious kid with cholera needing IV fluids? Gross, he may diarrhea in the back. Can’t he ride on a motorcycle? Blind guy lost and trying to find his way home from church on his hands and knees with chapped lips and a parched tongue? Surely he’ll be just fine on his own. He looks tough. Roll up the windows, turn down the AC and keep driving! Can I see your iPod?

But drive past a Fulani, and suddenly Danae is the Good Samaritan, no, the Better, no, The BEST Samaritan who ever Samaritized. Pull over, pull over, Pull OVER NOW!!! Then jump out of the car and run over and hug these Fulani women who clearly do not have hugging in their culture and are extraordinarily uncomfortable and start snapping selfies and load them all up against their will into the back of the pickup, donkeys included and then proceed to drive an hour out of our way, in circles, just so she can have that ever-satisfying knowledge that she has Fulani in the back of the pickup.

I agree with you. It’s weird. And borderline-diagnosable. And quite probably requiring medication. But it’s my wife and it was in the fine print in the for better or worses. So I just bite my tongue and drive.

But now this might be the last straw. And when you’re dealing with nomadic herd-driving Fulani, you can be sure there will always be a lot of straw. Still, finding the last one was remarkably simple.

Danae corrected a hernia on a young Fulani boy, and wanted to drive him back to his village, along with his father and mother, because, well, duh, it would give her that ever-satisfying knowledge that she has Fulani in the pickup as referenced above.

I learn of this plan halfway through my first adventure making calzones. I rush them so we can make it there before dark, but they still turn out awesome. So awesome, in fact, I will never again make them for fear it may just have been a fluke. Regardless, my calzones and I were not the last ones ready. Oh, no. Danae’s Fulani-itis is contagious and we decided to take volunteers with us. All. The. Volunteers. I love my volunteers. So thirteen non-Chadians and innumerable Chadians, along with their unquantifiable Chadian belongings, piled into the pickup. Except Chad (an awesome American volunteer named Chad, ironically), who drove my motorcycle, so he could hustle Sarah back early in case of an obstetrical emergency.

By now, I realize we will be getting there in the dark.

First stop is the health center in Tamyo to drop off another patient and their family. Tamyo is twelve miles from Bere. Bere is the largest city and the capital of this district of almost 200,000 people. The family does not know the way to Tamyo from Bere. Neither does the nomad, who lives just a couple kilometers away. Fine, I have a vague notion and we make it there a bit before dusk.

As we roll into Tamyo, Chad’s motorcycle (well, my motorcycle) stops working. So we put that in the back too.

Now we need to find the way to the Fulani village. Except the Fulani dude has NO CLUE where his village is.

Wait. Wait. Wait. No. Wait, wait, wait wait wait. Hang on. No. Wait.

Ok. Ok. So… ok. So, ok. So, what you’re wanting to tell me… No. Wait. So… You mean to tell me that you don’t know how to get home.

Hang on. Wait. No. Ok, so… We are two kilometers from your house. You know that you live two kilometers from Tamyo, one of the four largest towns in a district of nearly 200,000 people. But you don’t know how to get there? Like, nothing? Anything? No?

Give me your Man Card.

I’m serious. Now. Right now. Hand it over. No Man Card for you.

Hang on. Wait. No. No, no, no. No, no nonononononononononono. You are a freaking Fulani. You’re a nomad. You know that, right? You walk, on foot, driving animals all across this continent. Hundreds of miles. Thousands. All the time. Every year. We are two kilometers from your house. You’re lost? Like, do you need me to take you a hundred miles away and drop you off with a goat? Then could you find your way home? Aren’t you people born with a GPS in your brains? Don’t you, like, navigate by the stars or something?

No. Give me your Nomad Card.

You know what? No. Just, screw it. Give me all your cards. Hand them over. Give me your wallet or purse or whatever you people carry your cards around in. Open it up. Turn it upside down. Shake it. Tap it on the bottom. No, smack it. Hard. Hard. You know what? Just… like turn the whole card carrying purse inside out. Yup. There you go. No more cards? Good. You don’t get any cards. None. No cards for you.

Flippin’ nomad lost two kilometers from his own dang house.

And this. Now this. You see this face? This is so NOT my happy face.

So we get the health center director, and he hops on his motorcycle and leads us to the Fulani village, all the while my dear Fulani friend, like he’s trying to prove to me that I was justified in stripping him of all his cards, is adamantly and angrily insisting his village is in the opposite direction of where we’re driving. Then the motorcycle in front of me turns right, off the single-track sandy wash that qualified as our road, and then drives a half mile across dry rice paddies. We stop in front of their village, which consists of a large grass dome built on a maize-stalk frame, a small grass dome built on a maize-stalk frame, and a small grass dome… but without any grass. Just the maize-stalk frame. And people. I don’t know where they come from, but there are a hundred people milling about, shaking our hands, thanking us.

I use the Fulani I know, ‘BAHR-kuh! DJAHM! OO-say! TOO-tuh!’ Which I think translates, ‘Peace! Health! Thanks! Vomiting!’ Because those are the only four Fulani words I know. Sometimes I smash 'BAHR-kuh-DJAHM!' together into one word, and then people act like it’s a whole new thing. So I’ll just go ahead and claim a five-word vocabulary. Well, I know ‘urinate’ too, but that clearly wouldn’t be appropriate in this setting, so I leave it out.

Danae, of course, is in seventh Heaven. She rushes off to mingle with all the Fulani women and tour their house. Naturally, she speaks none of the language, knows none of the culture, and the only house to tour is about 100 square feet. It doesn’t stop her from being gone for an hour in the pitch black night.

Meanwhile, I’m sitting on the ground with four hungry, tired and cranky children, clueless as to where the open well is, but quite certain there’s a toddler-swallowing hole in the ground somewhere nearby. And of course all the Fulani men come and sit with me. Juniper isn’t a huge fan of the dark, so she wants me to turn on my flashlight on my phone, which I do. Then she loses it completely because all the bugs for a hundred meters around are drawn to the sole source of illumination and we immediately find ourselves in a swarm of various flying and crawling critters.

To make a long story only marginally shorter, Danae finally returns and we find our way home Thursday night.

Sabbath Morning, way-too-early-for-the-weekend AM:

It’s official. Danae has lost it. She’s gone native. We are going to sleep with the Fulani tonight. We will become nomads. Danae has decided this. But yet she is the one still sleeping in bed. I am getting food and cooking implements together (we have no camp stove nor camp cookware), mattresses, mats, sun shelter, tent, mosquito tent, mosquito nets, diapers, wipes, changes of clothes, etc. The truck is now loaded. Danae wakes up. And we are off.

I have chosen my man-capris today, because they are awesome pants, and because one can wear one’s man-capris and still carry one’s Man Card in Europe. And even cross one’s legs knee-over-knee. I am simply that internationally-sophisticated and this is a francophone country, thereby, inherently more sophisticated than most and ready to embrace me, man-capris and all. Danae may hate my pants, but my man-capris have so many cargo pockets, she won’t even know where to start looking for my Man Card. It is safe.

First stop is Guissa Kalia. We’ve been coming here for several weeks now. It’s the village where the monkey forest is. One day, we told a Bible story. Then we started going every Sabbath morning to share some Bible stories, teach some songs, pray a little bit. It’s fun.

After ‘church’, we carry on southeast through a different forest, where we turn off the road and drive through the trees a little bit to park right behind a massive termite mound, hiding us from the road 50 meters away. Here we have a delicious lunch of soymeat sandwiches and other delicacies. It’s starting to get a bit warm. It’s April, the hottest month, and it’s coming up on noon. It can get as hot as 50 degrees here (122 Fahrenheit). Today it’s probably well over 40 Celsius already (104). Picnic weather.

The kids are beginning to complain it’s a bit hot, and I’m willing to admit there’s no chill in the air today. But fortunately, we have a massive cooler full of water bottles frozen solid, so we’re good. Drink up!

Without a herdsman in the pickup, we find our way to their ‘house’ much quicker this time. Along the way, we stop near a couple different isolated Fulani houses, where toddlers run screaming away from us and teenagers come running toward us. Once we start handing out mangos to children like lollipops from the back of the van of that creepy guy who lives down by the river, only the most timid stay away. They are grabbing mangos like presidents grab ladies.

Once at our destination, we exchange the same 4.5 words I know in Fulani, then stare at each in awkward silent confusion, but our eyes carry on the conversation:
His eyes: Ummm… dude, I see you have more stuff in the pickup than I own. ‘Sup?
My eyes: Ummm… yeah, so like my wife wants to sleep out here with y’all.
His eyes: LOL. You trippin’.
My eyes: Nope. I’m for reals for reals. Check it. Mattresses and whatnot.
His eyes: Dude. I’ve never seen a mattress before in my life. You soft and squishy. If my 7% fat body doesn’t need padding, why does your 20% fat body need it?
Both our eyes: Blink, blink, blink, blink, blink.
My eyes: So, ummm… yeah. Like, cool if I pitch a tent here?
His eyes: Do what you want, but you will be miserable.
My eyes: How do you know? Is there like some ancient Fulani prophecy about visitors coming and spending a horrible night among you and changing the course of all history?
His eyes: No. You’re wearing man-capris.
My eyes: Touché. But check out the cargo pockets and mid-calf drawstrings!
His eyes: Blink. Your wife must be so proud. Eye roll.
My eyes: Which reminds me… get lost walking ten feet away from your hut lately?
Both our eyes: Blink.

Danae, oblivious to our entire ocular repartee, strolls off to embrace the wife like a long-lost friend. The wife obviously thinks Danae has not been lost long enough.

Meanwhile, I set up a sun shelter and toss a plastic woven mat underneath it. The kids gather under it, so I toss out another one. They are both full of kids and men. So I stand. Because, you see dear reader, nomads drive their herds. And when they camp, they camp surrounded by their herds. And their herds graze. And after they graze, they digest. And once digested, they poo. As such, I find myself completely surrounded by bull poo. And my mats are full of nomad. So I stand.

Danae returns from her emotional reunion with her unwitting BFF and get out a couple Bible books we had brought to have church with the kids. She starts reading the stories to our kids, but it would appear the Fulani men around have deeper interest. My kids are both hot and distracted. Danae carries on as if the Fulani are following her every word, in English. Realizing we aren’t in Kansas anymore, or any anglophone place, she starts trying to translate the book from English into French for them, intellectually completely cognizant of the fact they couldn’t understand a word of French to save their souls, but also so intellectually aware they don’t speak English, so she naturally can’t just read it to them in English, but needs to find some middle language she doesn’t speak perfectly and they don’t understand a whit. It’s all perfectly logical.

Saturday night, 8pm:

Well, that was gross. It might be pitch black out, but that sound and the wet feeling on my shins, the part my man-capris don’t cover, tell me Addison just vomiting all over my legs. That ain’t cool. That means it’s all over my man-capris too, in all likelihood. Poor girl has malaria. Again. Like third time this bloomin’ month.

Oh well. It some how seems terribly apropos. We spent the day in the blistering sun. Late evening, some of our volunteers came out to join us. Then after it got dark, we decided to eat. With our new BFFs. Danae decided to make burritos and salad for everybody. The Fulani absolutely refused to eat anything prepared by a non-Muslim. Our bad. But they did want to cook for us. One of our nurses came out with the volunteers and translated our lousy French into Tchadian Arabic. Then there was one dude in the village who spoke some Arabic, and he in turn translated into Fulani. Via this highly efficient system, Danae let them know we are vegetarian. In reality, she and the kids are vegetarians, but we all became guilty by affiliation and had to eat vegetarian. When Danae showed her BFF a carrot, her BFF acted like Danae was a martian pulling a four-headed peacock from her chest. Apparently, she didn’t know what a carrot was. Or any vegetable for that matter. So we had rice. Plain rice. Although it was extra special, in that it had more grains of rice than grains of sand, which is not always the case. After this scrumptiousness, the volunteers and translator all left, save for two hardy women who stayed the night as well. 

So considering how the evening is going up until this moment, a little vomit on my legs doesn’t seem out of place. I figure it’s time to collapse into bed and sleep the sleep of the just.

Addison and Juniper and Lyol and Zane are tucked into their tent on sleeping pads. I have a sweet setup rigged with mosquito net under our sunshade. Danae lays down on the crib mattress, and I lay down on the hospital mattress, because, well, I’m such a gentleman. And it is super romantic. 

It is also super still. And it is hot. It is so hot in fact, even the air molecules do their best impression of Danae and all the girl air molecules say to all the boy air molecule, ‘Ewwww! Don’t touch me! It’s too hot! You’re all sticky! Gross!!!’ And so not even the air molecules twitch a single air molecule muscle. (And yes, I’m nerdy enough to know that typically air molecules start vibrating faster when their hot, but this is so hot, the whole thing is actually working in reverse. True story. That’s science. And you can’t argue with science.) That’s how still it is.

So I lie there. Danae lays there. The kids lay in the tent ten feet away. The volunteers lay on the far side of the pickup. The Fulani lay next to their hut fifty yards away. And Danae’s BFF has a hair that’s a little bit too long in her left nostril. I know this, because I can hear the wind going past it as she breathes. The air is just that still. And I can hear yet another drop of sweat coming out of Danae’s pore. That hot. That still. I’m laying there topless and spread eagle, listening to the cells of my epidermis weeping and begging for mercy.

A few minutes later, we hear the pitter-patter of little feet. Danae gets up and asks the volunteers to move a hair, so they don’t get trampled by the bulls walking a few feed from their heads.

The kids moan and fuss incessantly. We pull Lyol and Zane out, pop up their mosquito tent, stick them in, kindly ask them to shut up and stop their complaining, we’re all hot, what do you want me to do about it? We debate about withdrawing our entry for parents-of-the-year.

At the strike of midnight, my fairy godmother finally arrives, in the form of a sweet, slight breeze. Oh divine. It’s still hot, but there’s hope.

Oh, and looky over there. Is that hope too? Does hope flash like that? BOOOOM! Nope, I guess that was lightening. Well, fancy that. We are on the top of the highest rise for miles around, under a metal sunshade. I’m no Bear Grylls, but this might not be ideal.

And my fairy godmother turns the soft and gentle breeze into a tempest. The sunshade is now airborne. I grab the corner as it flies by my head, and I wonder if I’ll turn into Mary Poppins. Thankfully, all the rocks I just ate with my rice has given me sufficient mass to weigh down the sunshade just before it fully takes flight. Danae and the volunteers help me collapse the thing as the wind picks up further and the light show eliminates any need for headlamps (which we don’t have anyway). We dig the kids out of the tent and collapse it down. It gets shoved into the pickup cab, along with the cooler and everything else I packed into the cab.

We all move out to sleep on the carpet on the low side of the pickup, and we watch the light show.

Oh dear. Well, it’s no big deal. It will pass. It’s just a drop. It’s just a couple drops. It’s just a few drops. It’s just… screw it, that’s alotta drops. 

Danae’s BFF comes out to save her and the two volunteers. I pile the four kids into the pickup. Along with the tent and the backpacks and the… sheesh… there’s a lotta junk in this car. The kids are situated and soon fall asleep, with me staring in the window.

I pull the mattress back out of the pickup and throw it on the ground and wrap up in a fitted sheet. By now there’s some serious wind and rain and lightening. At some point, there’s a mini-stampede right by my noggin. But I’m actually the most comfortable I’ve been in a long time. I might not be sleeping, but I’m finally comfortable. I love being cold.

Danae knocks on the… on my head… to see if I’m sleeping. Well, I wasn’t, but if I had been, that wouldn’t have helped.

We’re now three hours into this storm, it’s 3AM. Danae takes Lyol and Addison and retreats to the hut, where everybody is apparently dry and warm. I take my sopping self and slog into the driver’s seat, with two-year-old Juniper as my copilot and Zane sprawled out in the back. They are blissfully asleep as the wind buffets the pickup. I try to hunker down in the driver’s seat and do the little dance every man (or woman) must do to fall asleep in the driver’s seat. 

Put the steering wheel up, tip the seat back, but not so much you squish the six-year-old in the back, make sure the car is in gear, roll left. Don’t move for a few minutes and maniacally tell yourself, ‘I can fall asleep. I can do this. I am sooooo comfortable. I am most definitely not uncomfortable. Yep, I’m drifting off blissfully to sleep. I’m practically asleep already. I’m like 90% asleep. I can feel my body being refreshed and getting ready so I will be completely rested and bright-eyed and bushy-tailed in just a couple hours, that’s how good I’m sleeping right now. Curses. Dang it. This isn’t working. I’m so wide awake.’

Roll right. Repeat mantra. Lay on back, repeat mantra. Sit up straight. Stare at the windshield blankly. Put the steering wheel all the way down. Scoot your butt to the bottom of the seat. Fold up your knees like you’re still a young man and then put your feet up on the dash. Repeat mantra. Fold the knees back. Turn left. Turn right. Try to pile up something between the driver’s seat and the passenger’s seat. Hear your two-year-old start squirming and moaning and realize you’re about to wake her up, which is guaranteed to make your night much, much worse, so immediately abort that effort. Realize the rain on your clothes has evaporated and been replaced by sweat. Crack a window. Feel the rain pour in on your clothes so the sweat gets rinsed out to be replaced by rainwater again. Repeat ad nauseam.

Sunday, 5AM:

No, thank you. I do not want more rocky rice. I’m good. I swear. I promise. I just want to go home. A sheep? Seriously? You’re giving us a sheep? No, we’re good. I promise. I swear. Remember, she’s a vegetarian. I know the sheep eats vegetables. Doesn’t make it vegetarian to eat it. Doesn’t work that way. Really? You’re just gonna tie up in the back of the pickup like that? We go home.

Sunday, 8PM:

Nuts. Juniper’s awake. I can hear her crying. You don’t hear that? It’s coming from outside? How’d Juniper get outside at night? Wait. Listen for it. Hear that? You’re right. It’s outside. Oh… it’s the sheep.

Saturday, June 2, 2018


People used to ask us, “How long are you going to stay in Chad?”  

We always responded, “Until we were no longer having fun!”  That was the easy answer.  We knew we wanted to stay for several years.  Even though we had a contract for 6 years, we never felt bound to this.  

Now we’ve been here 7 ½ years and we are getting an itch.  I’m not sure what it is.  Sadly for the people who visit us, they get to hear our complainings about this or that.  But also, people realize that it is truly a hard place to live.  

I just had a visiting doctor plan to come for a month.  All of our visitors must visit the local authorities.  She visited the local authorities along with 3 other volunteers, one who was seasoned.  The meeting included a lot of yelling and screaming, pointing fingers in the face of Diana (the seasoned volunteer).  The local authorities wanted their bribe.  Diana wasn’t going to give it.  My poor volunteers who had just arrived had no idea why there was so much yelling going on.  Diana called Olen, who got involved and said they would have to come put him in Jail because we were not paying their bribe.  

Unfortunately that’s just how it is here.  The Prefet later called to apologize to Olen because he realized the authorities were just wanting a bribe and not a real payment. 

One of the new volunteers has been to over 60 countries.  She said she has never been to a country that made her feel so unwelcome as that office.  They were downright rude and scary.  She wasn’t sure if she was going to be put in jail or not.  And she hadn’t even done anything wrong.  She just came here to help out with obstetrics since I was supposed to be gone.  And Sarah is gone.  

That’s just one example of how it’s rough here.  And that wasn’t even a big deal, to us.  It was a big deal to our new volunteers though.  

I can’t really describe it.  But lately I just don’t want to go into work.  Maybe I’m just plain lazy.  Maybe it’s because I would rather be with my kids.  Maybe I’m tired of people asking me for things ALL THE TIME.  Maybe I’m tired of infections.  So many postoperative infections.  Maybe, despite our best efforts, people still die.  ALL THE TIME.  

Maybe I’m ready to travel.  There is nowhere to go here.  Maybe I’m tired of compound life.  Maybe I’m tired of the heat.  Maybe I’m tired of being available 24/7.  Maybe I miss the rest of my family in America.  Maybe I’m tired of my kids being sick and half the time not knowing what they are really sick with.  And malaria could always kill them.  

I don’t know what it is.  It’s rewarding to know how to care for a patient.  Today I ran up to help a mother with a breech baby that had been stuck for over an hour as she had started the delivery process at home.  The midwife couldn’t get the baby out.  I like knowing what to do to get the baby out.  It’s rewarding.  

I like knowing how to diagnose GYN issues.  Today I did a vaginal exam and discovered the patient had a cyst or maybe a fallopian tube poking through a vaginal cuff from a previous hysterectomy.  The previous doctor that had seen her thought she still had a cervix.  I like knowing how to take care of her.  I scheduled her for surgery.  I want her to get good care.  

I want our excellence in care to continue.  I want good obstetrical care.  I want good surgical care.  Today I counseled a patient that her next delivery would need to be induced early, even with her history of c section because this baby (c section) and her last baby had died during the process.  Life is sad here.  But we can provide good care still.  Her next baby needs to be induced or maybe just a repeat c section.  I need to know that the next doctor will provide good care for her.  

We are not that awesome.  We are no different than your next doctor in America.  But it is leaps and bounds better than the surrounding care here.  The stuff that gets referred here.  The stuff that stays at home here.  Until it is too late.  It’s astounding.  It’s astoundingly sad.  

Who will replace us?  We are not that proud to think that nobody can replace us. 

When you think you are so irreplaceable, then it is time to leave.  For you have replaced God.  But still I can’t help to think of who is coming.  Who is coming?  How much longer can we stay here?  How good are we here if we are not cheerfully doing our work everyday?  If people see us as just working?  What good is it if you save a few lives if you are grumpy doing it?  I must argue not much good.  

My children are getting older.  I want to take care of them when they are small.  I can’t make it 3 more years until the next scheduled surgeon is maybe going to be ready to come out here.  Many of the surgeons who are graduating are deciding on going to fellowship first.  As if fellowship is going to train them better to come here.  The best training is to come here and work for 6 months while an experienced doctor is still here. 

I think I’m just ready for a change.  

I recently asked another missionary who is visiting us, how do you know when it’s time to leave?  His response was , “I always said I could leave when there was a replacement for me.”  

Well, there’s certainly no replacement yet.  But I’m feeling like I wish there was one.  

There’s also the, If you are unhappy in one place in life, and you move somewhere else to get happier, you never find your happiness.  You need to find your happiness wherever you are, and then you will always be happy.  

At the moment, I don’t have answers.  Only questions.  Only complaints it seems.  



Palestine wanted a new pagne, a fabric cloth that is so versatile you use it for everything.  It’s not so easy to go shopping in Chad.  You can’t just jump in your car and head to the store.  Even 10 km takes a long time when you have to walk it.  

Palestine decided to take the family vehicle.  The ox cart.  

But one oxen wasn’t so happy to go along.  Before Palestine knew it, she had been pinned against the fence by one of those big horns.  “I’m going to die,” she cried out loud.  

Her mother soon ran out of the thatched mud-brick hut and chased the angry bull away.  

Wow that hurt, thought the 20 year old girl.  Did his horns actually go right through me?  Are my insides falling out?  She fell to the ground in agony.  Her mother checked her out, brought her inside the compound to lay her on a brightly colored mat.  For now she was okay.  Her skin had not been punctured, thank God.  

Palestine was still in quite a bit of pain.  The family decided to take her to the health center.  They prescribed pain meds and antibiotics.  

The next day her abdomen grew bigger.  Hmm…the doctors at the health center didn’t do any good, so maybe we should take her to the Marabou, the local witch doctor.  Maybe someone put a curse on her, and is causing her to have continued pain.  

The witch doctor just asks for a small nominal fee.  A chicken and 5000 cfa (10 dollars).  He kills the chicken and uses the feet to scratch over the point of her abdomen with the most pain, the part that is bulging out.  He promises health and recovery and a removal of all curses placed on her.  

She goes home, happy that she will soon be healed.  

No healing comes.  In fact, she gets worse!  

Four days from the angry bull incident, the family has no other choice.  They have to bring her to the little Christian mission hospital.  They have heard stories that sometimes miracles happen there.  Maybe it was possible that they could heal her there.  Doing nothing sure wasn’t helping.  The witch doctor’s chantings sure weren’t helping.  Maybe the mission hospital could help.  

Palestine presented to our hospital with an acute abdomen (a very painful abdomen that requires surgery).  She was quite distended.  She also had a bulging 4cm hernia in her left abdomen.  It was squishy, full of liquid.  Like a big water balloon attached to the left side of her abdomen.  I wasn’t sure if the liquid was in her intestines or outside of her intestines.  Whatever it was, it had to be opened.  

I looked carefully to see if the skin had been punctured, but it had not.  She just had a couple of scratches in the skin made from the witch doctor.  

With the history of her bull-goring, I knew it couldn’t be good.  If it was blood in her belly, she would probably be dead by now four days later.  It was either old blood, poop, pus, or intestinal necrosis from blunt trauma.  

We were full swing in busy season at the end of February, but this was an urgent case and had to be operated on.  I add her on to my already full day of cases.  

After obtaining spinal anesthesia, I make a midline incision to cut through her taught abdomen.  Liquid poop comes pouring out.  We do our best to suction it up, but much of it pours to the side of her and onto the floor, my scrubs, my legs.  

After exploring her abdomen and evacuating liters of liquid poop, I found a 2cm perforation in her small intestine in her upper abdomen.  

So apparently the bull’s horn did NOT perforate her skin.  But DID perforate her fascia, about 4cm of it.  The tip of the horn continued on to perforate her intestine, 2cm of it.  Either that, or the witch doctor healed her skin… unlikely.  So this was a blunt trauma case, with a very sharp bull horn.  

I would like to say that this is the end of the story.  I fixed her and she got better in a few days.  Nope.  Ha ha.  That would be too easy.  Since when is being a mission doctor easy?  

Palestine was my patient for almost two months!  Initially I closed her intestinal perforation.  I irrigated her a LOT, then I closed her fascia and put in a couple drains.  I also cut open the skin over the hernia since it had become a pocket full of poop.  There was poop infiltrated into her subcutaneous tissue (the part between the skin and the fascia).  It was a set up for infection.  I closed the fascia of the hernia and packed the skin open.  

But she got infected.  She kept leaking poop out of her subcutaneous tissue (the fat below the skin) of her hernia area.  The poop seeped out of her tissue for days.  

After a few more days I had to open her fascia and leave her open because of her infection.  I remember her mother commenting to me several days after the surgery as I was doing her massive dressing changes of her abdomen, “Is it possible that she is going to live?”  

I nodded to her, “Yes, by God’s grace, she will get better.”

Slowly, slowly Palestine’s pus that had been leaking from her abdomen cleared up.  I quit doing her dressing changes and left her in the capable hands of my post-op nurse on surgery, Emmanuel.  

I took her back to the operating room several times to re-approximate her skin and fascia with anesthesia.  Every week for the past month I let Palestine’s mother pick up mangos under our trees so they could have a little more to eat.  If I forgot, she would soon remind me that she would love some more mangos!

This week Palestine went home!  She went home in good health.  She went home very much so not dead.  I do hope she eventually makes it to the market to buy a new piece of fabric!  And that they sold that naughty bull.  

Wednesday, May 2, 2018

Oral Boards

Disclaimer. This was what I wrote the day before my boards in early January. One of the most traumatizing times in my life. We are posting a bunch of blogs we didn’t get posted. So sorry for the confusion. Welcome to our life!! The last 3 months have flown by. 

Oral boards

Describe your practice setting.  

I am a solo practitioner practicing in a rural hospital in Africa.  We have a 100 bed hospital with 3 physicians, myself, an ED trained physician, and an FP trained general surgeon.  We serve a region of a million people and have referrals from the surrounding areas. I am available 24/7 as I live on the hospital compound.  Our electricity is run with a generator, and I have minimal diagnostic equipment, no pathology, no specialists to refer to, and no NICU.

There.  That’s my shpeal.   I’m trying to keep it short and simple.  I’m trying to keep the two worlds separate.  For the boards, all they care about is how I will practice in america.  Will I be safe?  Do I know the standard of care?  

I have come back to America for 2 months to study for these dang oral boards, and it has come down to one day now.  I have left my family.  I have left my work.  I have done numerous mock orals.  I felt sort of ready last week (I had some awesome mockers who were very motivational).  I knew the answers.  I felt ok.  

Last night I had a mock that didn’t go so well.  There was a lot that I didn’t know on office.  Today I had a mock where the examiner wasn’t sure what to do with my list.  I feel like he was very hung up on the idea that my practice was so different.  It definitely did not make me more confident.  

In the past I have overcome this by separating my two worlds.  When the examiners ask a general question, I answer like I was in america practicing.  If they ask about a specific patient, then I explain why I did what I did while in Chad.  

But several people recently have encouraged me to “be myself.”  Show them who you are and where you practice.  I have always separated the two worlds.  In Chad for instance, a baby hardly ever lives less than 1500 grams or around 31 weeks.  In America the cut-off for viability can go down to even 23 weeks now.  There are these HUGE differences.  When I even stop to think about it, I get emotional.  It’s not fair.  It’s NOT normal the way I do what I do.  But it’s all I have in Chad.

Rant.  I don’t have diagnostic lab work like potasium, sodium, serum-Hcg, TSH, Prolactin, FSH, Estradiol, Testosterone, 17 OHP, ovarian tumor markers, urinary cultures, endometrial biopsies, pap smears.  I don’t even have X-ray at my hospital, let alone CT or MRI.  I don’t have ovulation predictor kits to see when my patients on Clomid are ovulating.  I don’t have pathology to evaluate the surgical specimens that I take out.  I don’t have blood cultures.  I don’t have mid-urethral slings.  My light on my cystoscope has been out for a long time.  I have NO aneuploidy screening.  I can’t even trust my RPR because I don’t have a confirmatory syphilis test, so why would I even order it since malaria causes false positives?  My prenatal care is crap.  Nobody gets the 28 week fasting blood glucose that I recommend.  In a postpartum hemorrhage, I stop the bleeding and replace blood.  Period.  I don’t have platelets or a coagulation profile like fibrinogen, PT, PTT.  Hmm…white as a ghost even though you are black…?, yes I think I’ll give blood.  

I don’t have so much.  I have no one to refer to.  I have no chemo or radiation.  IN THE COUNTRY.  I am a bad doctor.  According to my case list.  

BUT.  I am doing the best that I can.  And I just need to get the words out to show them that I am a good doctor.  I am a safe doctor.  And I am in no way trying to be a cowboy.

When I combine the worlds, it’s challenging.  It makes all of the death and sadness that I bottle up in Chad more real.  It makes it more unfair.  Somehow if I keep things separate, it’s easier.  That’s what I do in Chad….and this is what I would do in America.  Separate.  Much easier.  But to apply my standards of care in America to my case list in Chad is emotionally draining.  The world is an unfair place.  

I essentially have to answer two things in one answer.  In America I would do this, but in Chad I did this because of XYZ.  

Certainly God is leading.  I know He is.  I just have to rely on His providence.  He always provides whether I pass the test or not.  But I know He wants me to do my best. 

I am literally emotionally drained.  It didn’t help that I attract drama and realised that I lost my photo ID (maybe at the airport 2 weeks ago) today.  My test is tomorrow.  Michael (brother-in-law) has graciously flown to DC overnight to bring back my passport in the morning so that I will have a photo ID for the test.