Wednesday, December 10, 2014

Firsts

It’s nice to have short-term volunteers to remind us of how unique our careers are.

We just got a group of two anesthesia students and one anesthesia professor. All of them have worked years in ICUs before going into anesthesia. And all of them got to see a case they’ve never seen before.

I was in the OR chatting with these fine people when Sabine came and got me from pediatrics. She told me a kid swallowed of bottle of chemicals used for growing cotton.

I’d seen this before and knew what to expect. I called to the anesthesia students and asked if they wanted a shot at saving a life. They eagerly responded in the affirmative, so off we went to pediatrics.

In pediatrics I found a classic organophosphate poisoning. A boy about ten years old. And he was wet. Just imagine every possible way to lose fluids, he was doing exactly that. The most dangerous part was the froth coming out of his mouth.

These kids die when the fluid in their lungs overwhelms them. This kid had lots of fluid in his lungs. I could hear it from ten feet away as I walked up.

I sent somebody off to get atropine and explained to the anesthesia students that the treatment was essentially atropine until the lungs are no longer wet.

Atropine is a ‘code’ drug, meaning, it’s a drug that’s given in a code, or when a patient’s heart stops. In fact, when a patient’s heart stops, atropine may be the first medicine you give in your attempts to restart the heart. So it’s considered pretty potent. We give 1mg IV for a newly-stopped heart. Or maybe 0.5mg IV for a heart that’s fixin’ to stop and is very slow, but hasn’t stopped yet.

Well, we gave this kid 5mg IV bolus to start. This is a higher-than-recommended dose, but he was quite clearly on his way out, so we went for broke. His lungs started drying ever so slightly, but he was still quite wet. So we repeated it. I didn’t measure his heart rate, but judging by the amount of atropine he got, it was probably well over 200 beats/minute.

Next we gave him glycopyrrolate to dry him out. The anesthetists had just brought a bunch over with them, so they gave a couple doses.

He was actually drying out nicely, so I left for a meeting and left them in charge, essentially to give a couple milligrams of atropine whenever his lungs got wet.

I returned about four hours later to some bad news.

The boy had been sent home to die.

Organophosphate poisonings usually happen inhaling stuff or getting stuff on your skin. This kid had swallowed a whole bunch of it for reasons unknown. By the shear volume in his body and calculating roughly how long we’d need to treat him… It was decided his odds of survival were very low anyway and we would risk using the entire hospital supply of atropine to treat him. As it was, he received 21mg of atropine. That’s 21 pushes of medicine usually reserved for restarting a stopped heart. Or preventing a heart from stopping. Or preventing a child from having too many airway secretions during surgery under ketamine anesthesia.

And so our visitors had another first. First time they sent a ten-year-old home to die, when there was still the possibility of fighting longer and continuing to give atropine in a likely futile attempt to save his life, but possibly at a huge expense of resource which could be spent on other patients.

That’s a really tough first. I know, because I still remember those firsts quite vividly. I remember all the newborns we gave up on, knowing neither the family nor the hospital could afford the resources to really go all out 100% saving lives, particularly when we are already quite certain of the outcome. It’s rare the Tchadian father willing to spend every last dime to fight for the life of his child if it’s unlikely the child will survive. It’s difficult to allocate limited hospital resources to likely futile cases.

But we are taught to provide the highest level of care at all times. We are taught death is the worst possible outcome. So our urge is to always fight.

Tchadians have us beat in some ways. Although they may often accept death too easily, when I’d rather see them fight to save life, they always accept death gracefully. There aren’t many things I would describe as graceful in this culture, but they know life, spirit, soul, what have you… They know there are some things which transcend mere breath.

And that realization, for most of us, even if we say it intellectually… To not just say it but believe it and live as though we believed it… It’s another first.

love
olen and danae

missionarydoctors.blogspot.com
danae.netteburg@gmail.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
Afrique

Tuesday, December 9, 2014

Overly Sweet

It’s 3AM. Danae and I are both awake and have been all day. One or the other of us have been in the hospital all day. She just had two C-sections. And I’ve been bouncing to the hospital and back repeatedly to check on a patient. Our kids are likely to wake up in less than three hours. So why not write something?

This morning at our morning report, I learned a diabetic came in comatose around midnight with a blood sugar near 600. The nurses knew he required aggressive fluid resuscitation, so they gave him a whole liter of fluids (sarcasm, one liter is not much, but nobody ever gets more than a half liter every six hours, so he was ahead of the curve) by 7AM. We’ve been over this before: Diabetics in comas needs lots of fluids. Oh, and they also crushed up a metformin and stuck it in his mouth. Awesome.

So I went to see the patient and I ordered fluids. Lots of IV fluids. And I kept cycling back throughout the day to keep hanging fresh bottles of IV fluids to replace the empty ones.

Now you may think my job is hard and HHNK (Hyperosmolar Hyperglycemic NonKetotic Acidosis, used to be HONK, which was an exceedingly cooler acronym) is difficult to treat. But Bere Adventist Hospital makes it simple. You see, my only blood test is a blood sugar. And I can only get that about every twelve hours.

Typically, DKA and HHNK patients have normal-appearing potassium levels, even though they’re quite potassium-depleted. They’re just so viciously volume-depleted that it looks more normal than it is. So as you start replacing their volume with IV fluids, the potassium level goes down. It’s fun to treat elevated blood sugars with insulin, but the thing is, insulin drives potassium into the cells and out of the blood stream. Then the heart starts receiving lots of blood without potassium. Then the heart stops. And I learned in residency that cessation of cardiac activity is rarely a desired outcome.

And being unable to check a potassium level, I was left to guess. I gave my patient lots of Lactated Ringer’s, which is an IV fluid with a little bit of potassium. So I figured (prayed) the patient had enough potassium to support a whiff of insulin without his heart stopping. Normally, I’d give this guy 7 units of insulin per hour, but I had no way of knowing his potassium level and I had no IV pump. I’m just running in half liter bottles as fast as I can. So I don’t really get excited about the prospect of giving him a 7 unit IV push blind.

So I wimp out and give him 10 subcutaneously, which may not help, but is unlikely to hurt, which I think is an oath I took at med school graduation. Maybe. Then I give 20 units. Then I give 20 more. Every few hours. Blind.

Oh, and his blood pressure has been 60/40.

And there’s the pesky question of why he got so out of control in the first place. He apparently stopped his meds a few weeks ago. He felt lousy the last couple days and started treating himself with unknown IV fluids at home, because he thought he had malaria.

So now I have him on ceftriaxone (for ?typhoid, ?UTI, ?pneumonia, ?meningitis, who knows!?!!? Don’t judge me, I have no xray, no… well, let’s just say I have very little) and quinine IM, which I’ve never given before. Quinine decreases the blood sugar and is the world’s greatest anti-malarial, and can be given IM, although it frequently causes painful muscle necrosis. I could give it IV, but I want to give fluids quickly. And I don’t want to bolus quinine, or else I’ll stretch out the patient’s QT interval and push him into torsades de points (which also ceases cardiac activity, see above under ‘undesirable result’).

I would ask for intense nursing care, but his current nurse has over 20 hospitalized patients, all receiving cardioactive IV drips and is also in charge of consulting all new patients coming in overnight. And busy season is picking up, so we usually consult at least 60 new patients each day, many at night as well.

I was just in the hospital and the patient has been here over 24 hours. And he JUST now peed. And he has received 13 liters of fluids. That’s 26 half-liter bottles of IV fluids. Thirteen liters. That’s three and a half gallons of IV fluids. That’s twice somebody’s normal blood volume. And 11 of those liters were given in about 17 hours. Three and a half gallons and he just now peed. Try this for fun: Drink three and half gallons of any liquid. Then don’t pee for a day.

Anyway, his tongue is not quite as dry as it was and he’s starting to move around a bit and open his eyes and make some noises and localize pain (which is medico-speak for ‘pinch him and see if he tries to push your hand away’). His blood pressure is up to 110/60, although he’s still not talking or filling out the Sudoku I left at his bedside. I probably should have started with an easier puzzle.

Anyway, just praying he survives, as HHNK carries up to a 25% mortality rate, even in the states.

love
olen and danae
missionarydoctors.blogspot.com

danae.netteburg@gmail.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
Afrique

Volunteers Welcome!!!

Monday, December 8, 2014

Part III The Futuroscope

Seeing so much good change through the retroscope (not to be confused with the rectoscope), we now look to the future of Bere Adventist Hospital here in Podunk, Tchad.


We do not do handouts. We do not create dependence. We do not replace local employment with foreign employment if the expertise exists or can be created locally. We do not diminish people, take away their pride or claim to be superior. We do not help where one can be expected to help themselves.


So what do we do? We create temporary projects which empower and generate independence and lead to self-sufficiency and pride. And we witness. With this in mind, we set bold plans for the future. With our volunteers and philanthropic partners (that’s YOU!!!) and through God’s grace, we will accomplish great things next year! Below are our top priorities and ways you can join us in making these most critical needs a reality for the people of Bere and throughout Tchad.


We have virtually all the supplies necessary to finish construction. What we’re missing now is the expertise. In this entire district, there is no plumbing or electricity. So you can’t very well expect our local laborers to know what they’re doing along those lines. We are fervently praying for God to send us a volunteer, be it short-term or even long-term, who can help us complete the construction and perform the hospital maintenance Jamie so faithfully did.


But we’re open to all comers, including administration, accounting, pharmacy, evangelism, agriculture, medical, etc. We’re convinced everybody has something to give here. French is obviously a desirable skill (or Arabic), but is no prerequisite. The most important service one can render here is leading a life of Christian example.


We will continue to support the 17 students we have already taken on in medical and nursing school.


We are deciding to move forward in faith on our nursing school. The pieces are slowly falling into place. We have the shells of the buildings. The government provides a curriculum for private schools, which we will obviously improve upon. We have three Tchadian nurses with advanced degrees, plus a fourth finishing next year, plus Mason McDowell, our anesthetist with a doctor in nurse anesthesia. This school would save us the $24,000+ we paid this year sending other students to school. It will also allow us to create a better culture of quality nursing and spiritual care for our patients and to eventually send nurses out into the countryside. Another need is somebody to be the leader at our new nursing school. The ideal person would be a francophone nurse practitioner or physician's assistant. I don't know if they even exist in the French medical system. Or somebody with a masters. Or a physician, if he or she is interested in teaching nurses.


We are also deciding to move forward in faith building health centers. We have received dozens of requests to open health centers and hospitals. We will start with one and see how it goes. Typically, health centers are self-sustaining. And now we will have quality nurses to staff it and provide a good witness. While there is purpose in having a large training facility like Bere, where we can train, nurses, midwives, anesthetists and surgeons, the real work and witness is in rural health centers.


We will also be starting mobile clinics. We will load a Land Cruiser with supplies and head out to rural underserved villages and put on week-long public health programs. While teaching general public health, we will also be bringing members of our nutrition center to screen kids for malnutrition. We will also bring evangelists to preach the Gospel. We will also be sending out nurses and doctors to consult patients.


There are a few things which have possessed us to move forward now. Mostly, it’s a great guy named Mason McDowell and his wife Kim. Mason has taken over my anesthesia and pediatric responsibilities and Kim has taken over the school. I now finally have the time and energy to attend to the administrative and expansion responsibilities as well as my medical responsibilities. And there are other volunteers ready to either take on some of my responsibilities or help in these new projects.


So besides even more volunteers, what are we lacking?


Well, I’m proud to say we’re broke. AHI-Bere is officially broke. Zero money. AHI-Bere used to have loads of money. Historically, Bere has been the most financially-blessed AHI institution. However, we have spent all of it to get to where we are. I’m proud to say we’re broke, because we have spent all your donations on extremely important and productive projects and not just buried our talent in the ground. You can see all we’ve accomplished above. Much of it has gone to projects which further our goal of a financially-independent hospital. Your donation dollars have never gone to routine costs like nursing salaries. In fact, our hospital has made money, repaid debts, put money in the bank and made further investments this year. Oh how I wish you could come visit to see how much has changed! We have really done a TON with your contributions.


So there you have it, you who ask how you can help. You can come be a part of what we’re doing by the labor of your own hands. You can share this link on your Facebook page with a note that you would trust us to be good stewards of your tax-deductible donation dollars. Or be a part of what we do by making it financially possible.


AHI can take donations in many ways. You can pay by PayPal, check, phone, credit card, etc. Just mark it as Bere or send them an email indicating you made a donation and wish it to go to Bere. Another option is to shop through smile.amazon.com and list your preferred charity as Adventist Health International. Then 0.5% of your purchase price is donated to AHI. I don’t think there’s any specific way to make it go to Bere as opposed to the Global Fund at AHI, but we really love AHI and their Global Fund needs to be fed too.


Visit ahiglobal.org/main/donate-now/ for information on donating or click the PayPal link on our blog. And it’s tax-deductible, if you’re into that sort of thing in December.


You choose:
ahiglobal.org/main/donate-now/
909-558-4540
ahi@llu.edu or bbrewster@llu.edu
Adventist Health International
11060 Anderson Street
Loma Linda, CA 92350


Thank you once again for keeping us going long after we thought possible, be it via prayers, kind words or donations. We appreciate how you help shoulder the burden when we are taxed and hurt. We hope you feel proud sharing in our triumphs and trials. And we pray you share our hope for the future. Thank you immensely for spending your free time reading our blog. And thank you for partnering with us and trusting us with your hard-earned donations. We daily strive to please our Heavenly Father and be worthy of the faith both He and you have put in us.


And as always, we can be reached at danae.netteburg@gmail.com

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
Afrique


Volunteers Welcome!!!

Sunday, December 7, 2014

Part II The Retroscope

Every once in a great while, we need to take off our myopic glasses and step back and take in the grand picture. And maybe even allow ourselves to be just the slightest bit proud.


We can get so focused on our short-term troubles we forget the blessings we’ve been fortunate enough to know.


Since our arrival four years ago, we have built…


3 large houses for expat staff.
5 small houses for expat staff.
4 hotel rooms for volunteers.
A waiting room in front of Urgence.
A lab/pharmacy/cashier complex.
A private ward in front of pediatrics.
A nursing office in front of pediatrics.
Sidewalks throughout the entire campus.
A new water tower.
A wall around the compound.
A new labor and delivery complex with four labor beds and private and public consultation areas.
A 14-bed maternity ward.
New toilets throughout.
A 16-bed private ward.
A four-building nursing school compound.
A chaplain's office.
A guard room.
A storage building.
A two-theater operating building.
A dental building.
An outpatient surgical office.
A public health building.
A post-op/ICU building.
A restaurant.
A kitchen.
Family sleeping quarters.


We have also recruited a full-time anesthetist from America.
We have also recruited three Masters in Public Health who are running great projects.
And we now have a third physician. Actually, even a fourth! Our first Adventist Tchadian physician in the country just finished school and started at Bere this week. (AHI paid for his medical school!)
We currently are supporting 17 Tchadians in nursing and medical school.
We have a program to deworm the entire region of a million people with albendazole.
We have a Burkitts tumor treatment program free of charge.
We have acquired more land for the hospital.
We manage a nutrition center.
In January we will install computerized medical record and physician order entry, the first of its kind in Tchad, which will also generate stock orders. We have already built the wireless network.
We are also starting TV public health and evangelistic programs we will be showing on TVs at our hospital.
We will start drilling wells and expanding the public health project next year.
We have planted a garden and hundreds of fruit trees for the patients.
We have started raising goats and chickens for patients.
We have a dozen church plants we are helping with.
We are helping with a lay evangelism school.
We have received two new 30kva generators.
We have received containers of equipment including oxygen concentrators and various other medical equipment.


Yes, we are tired, in case you were wondering. No, we are not yet burned out.


The reality, however, is many of these projects are just half-finished. We have the outside shells of the buildings, but they are empty inside. The last two Januarys, we had AMAZING teams come and construct all these buildings. The goal was Jamie Parker, our full-time maintenance man, would be able to finish these projects.


Jamie and Tammy left in March and Jamie had back surgery in July. Between health issues, family issues, and the fact they had spent five years on the battlefield, they made the decision to return in November, pack up shop and go home. It’s truly the end of an era. They had accomplished so much in their five years, it’s hard to believe they are only human and there are only two of them. We have been so blessed to have them. We’re grateful to all our volunteers, but there were never harder-working or more productive volunteers than the Parkers. (Incidentally, if anybody has $7000 burning a hole in their pocket, we need some money to buy Jamie’s tools and motorcycle and other items from him.)


I say ‘we’ have done this in the greater sense. Obviously, without God nothing is possible and even if it were, it would all be for naught. Danae and I have very little to do with these things except for providing vision and guidance, recruiting the volunteers to do the job and being blessed with financial and management partners. These things have been accomplished with Maranatha, ASI, One-Day Project, A Better World-Canada, Restore a Child, Gospel Outreach and many individuals who have chosen to be a part of what we do, either by volunteering personally or by participating financially.


To each and every one of you who have used your hands to lift a hammer, sign a check, or fold in prayer for our hospital… A most sincere thank you!!!


And stay tuned for yet another blog very soon to follow!


Saturday, December 6, 2014

The Coda and the Hook

We are at the four-year mark here in Tchad, and with the exception of fleeting fantasies, we have no real desire to leave just as of yet. Despite all the challenges, be they political, cultural, language, social, climate or sickness, we still feel blessed every day, knowing God is entrusting to us the care of some of His most precious children, because He loves us, not because He needs us. We are very grateful and humbled to be of use.


Our jobs are never boring. In fact, this is the most rewarding and interesting job I can imagine. It is never JUST a job. We don’t envy anybody anything (unless you’re reading this while eating at Taco Bell). However, in spite of the variety of tasks and people and pathologies we encounter each new day, we fear our blogs become just different verses to the same song, with a never-ending coda and a really annoying hook.


How many times can I write my frustration running out of supplies? Last week it was gauze and HIV tests. This week it’s gloves and syringes. It’s been forever since I’ve had an antihypertensive besides atenolol or a diabetic med besides metformin. We ran out of steroids yesterday. I could go on and on. Nobody can keep a decent stockroom stocked before things run out. Part of the problem is they can’t keep an electronic record. Part of it is the government won’t allow us to import our own medications. Part of it is the fact our regional pharmacy supplier is always bare. Part of it is the fact the national pharmacy, where we’re required to buy our supplies, has cupboards like Mother Hubbard’s. And part of it is the apparent inability to plan in this part of the world. The entire country ran out of Tylenol in July. Awesome.


How many times can I write about tumors the size of grapefruit, if not larger? Or women dying in labor, essentially dead already when they’re dumped on our doorstep? Or babies dead in the uterus prior to arrival? Or kids dying from malaria? Or my own kids being sick with malaria. I know there are tragedies all over the world. I know death is an ultimate common denominator. But there’s a reason Chad has the lowest life expectancy, and is always tops or near tops for maternal mortality, under-5 mortality, neonatal mortality, worst place in the world to be a woman, worst place in the world to be a sick child, most corrupt country in the world, worst country in the world to be a tourist, etc.


And yet on the positive side, how many times can I write about the lives saved, the diagnoses made, the diseases cured, the surgeries done, the free care given, the amazing staff found, the administrative successes, the protocols implemented or the fact we are still growing at a rate our hospital’s infrastructure can’t support, despite our location way out in the bush?


So there is this dissonance which is hard to define and even harder to explain in blog. We love our jobs. Our patients are so interesting. We’re filling a need. We know God wants us here. We have a supportive community of foreigners. We have supportive families in the states. We have friends faithfully praying for us. We work hard. We spend time with our family. We have no time for anything else. There is no free time. There is no leisure time. There are no hobbies. But that’s ok. We are full. We have time for our family and time for service. Life is beautiful.


And then the frustrations.


Every job. Every house. Every situation. There are always pros and cons.


But the cons here are just so… con-ish. So very very con-ish. Way out on the extreme of con. Like you drive out a mile or so to get to the normal con. Then you take a left, go around a hill and past a lake and a guy with a piece of straw between his lips, then continue driving another 2539 miles. Then you arrive at these cons.


But the pros are just so pro-y. And they far outweigh the cons.


How to explain this love-hate relationship with this mission field? I don’t know. Perhaps that’s why we have this deep-rooted desire to recruit help out here. Misery loves company. But it’s also no fun to celebrate your successes alone. And in the end, there is simply no way to explain Tchad to somebody who hasn’t spent time in Tchad. My friends who come visit from other countries in Africa are… impressed, often unaware there are still countries like this one on the same continent. Forgotten. Left behind. Like Kirk Cameron after the rapture. That’s Tchad. Yup. Tchad is Kirk Cameron. Print it.


Stay tuned for more blogs coming very soon.

Monday, November 10, 2014

Arrived

This is the stuff that you think about when you think of missionary doctors…


But in reality it doesn’t happen all that often. But it did happen today.


It was a normal Sunday. I did rounds on maternity. I have about 12 patients, so it wasn’t that big of a deal. My preeclamptic patient is still pretty sick with BP’s at 170’s/120’s while on atenolol pills. I gave her a touch of lasix today.


I have a premature baby that is 1.8 kg that is doing well and 2 weeks old. She didn’t want to go home yet though because she’s afraid her family will give her baby water. I said she could stay at the hospital as long as she wants. We are giving her free rice so she’ll have something to eat.


My postpartum intestinal perforation is looking better. She is now 12 days postop. Today I brought her to the OR to open her incision that was leaking some pus, not surprisingly. The pus was coming from her abdominal cavity, so thankfully there was an opening through the fascia to let it drain. I extended it. She’ll get better, but it will be a long time packing her incision. Just glad to get the pus out again, now she can get better. Glad to not see stool either! Her intestines were pretty fragile and inflamed.


One of my patients has placenta previa and came in at 33 weeks with bleeding that stopped. She is now almost 35 weeks and I have planned to do a c-section at 36 weeks. Today I repeated the ultrasound and it looked like the placenta may be only covering the cervix part way, and not fully. So I told her that we’d just wait and see if she bleeds. If she does, we’d do a c-section.


Her mother has been whining to me all week about going home. She’s tired of being at the hospital. It’s dirty here. She’s arabic and doesn’t like to be dirty. I’ve explained over and over that she’s here because she has a high risk of dying from bleeding. This morning it was the same thing on rounds. Finally, I said, “Ok, you can bring her home if you promise to come back in a week. No sex. No work.”


They are actually from NDJ, but had family here in Bere and promised to stay in Bere.


She packed up to go home. Then she broke her water. “Now she has to stay again. Let me know if she starts bleeding,” I told Sabine, the nurse.


I go home around 2pm and eat yummy burritos that my mom made today. Literally, she made hand-made tortillas! Yum! I love mexican food! I enjoy a little time playing with Lyol, Zane, and Addison.


About an hour later, Sabine calls me from the hospital phone, “She’s bleeding a lot!”


I call Mason on the phone and tell him to get to the OR as I’m walking quickly to the hospital. Dad is informed too to come help with surgery.


At the patient’s bedside, I lift up her dress and see about a liter of bright red blood between her legs. She’s got no IV. Her Hbg had been 13, so we’d probably be okay. Still, she’s bleeding. The placenta must have just been too close to the cervix.


We had known she would probably bleed, just was trying to get the baby more mature.


She was in the private room on maternity, thus there was no way to get the stretcher in the room. Plus, I would have to run all the way back to the OR to get it. There was simply no time! I wanted to get her into the operating room as fast as I could.


So I picked her up in my arms and carried her to the operating room. I felt like some hero on a movie set. Maybe just less makeup on me, and a little more fully clothed than today’s woman hero in the movies. Though blue scrubs are so sexy.


However, it wasn’t fake blood on a movie set. It was real blood. And we needed to stop it quickly.


Everyone gawked as I carried this hemorrhaging pregnant woman all the way to the OR. All the while blood is running down from her and saturating my scrub pants. There was no time! We had to get her into the operating room. Plus she only weighed about 90 lbs, so really was NOT heavy.


We all worked quickly. Ndilbe put a plastic drape down on the OR table. I yanked her pretty arabic dress and flowing drapes off that were now soaked with blood. Sabine got an IV and we poured IV fluid into her.


I listened for a heartbeat with the doppler, but couldn’t hear one and was convinced the machine just wasn’t working right. But I wasn’t sure if the baby was living. It didn’t matter either way. We had to stop the bleeding to save this mom’s life.


Mason quickly got her spinal and we prepped her abdomen. Dad and I scrubbed, and we did a quick entry. Cut to fascia. Rip fascia apart with fingers, rip muscles apart, tear into peritoneum. Bladder flap down, Cut into uterus. Rip uterus apart. Delivery of Baby….


Baby girl screams.


Relief.


Close mom up.


Survey the scene.


Beautiful.


This afternoon was one of those times. I told Mason in the OR that I had arrived. This is one of those times when you thank God that He has prepared you for this kind of life in the mission field. It’s exciting. It’s rewarding. I had the blessing of carrying a hemorrhaging patient into the operating room, cut out a screaming baby, stop mom’s bleeding, and be thankful to save two lives in the process. Our OR team is awesome. Life is good. God is good.


Back home to play with our kids. Aahhh…..After showering off the nasty blood of course.


As a friendly reminder, we accept tax-deductible donations through Adventist Health International at ahiglobal.org/Bere. Or there’s a donate link on our website missionarydoctors.blogspot.com that will take you there. You can pay by PayPal and shoot AHI an email to notify them you sent in a donation for us. Or you can send a check to “AHI - Bere, 11060 Anderson Street, Loma Linda, CA 92350” or call 909-558-4540 or fax 909-558-0242 or emailahi@llu.edu. You can even set up recurring donations. So many easy ways to give! AHI has a new standard of 100% of your donation will arrive here in Bere. They find all their overhead operating costs from other sources. Anyway, we’re very humbled by how God has chosen to use us and if you would like to be a part of it, please help with your prayers, finances if possible and volunteerism if you’re feeling called!

Saturday, November 8, 2014

Abortion

There are those who say abortion is illegal no matter what. There are those that say abortion is LEGAL no matter what. There are those that say abortion is illegal unless the mother’s life is at risk.


Please define that. Do I want a non-medical somebody defining that?


Do I want the government defining what is safe for a mother’s life and what is not?


The medical field does have some black and white lines. In fact, it has many. But it also has lots of grey ones.


What is abortion? It’s terminating a pregnancy.


I live and practice in a country where abortion is illegal. I also live in a country where NOTHING is illegal. Corruption is rampant. Are rules really rules?


Trust me. I have my religious convictions. But I also think that God created us to USE OUR BRAINS! The Devil has created sicknesses, diseases, and terrible parts of pregnancies that cause death to a mother. This is even more rampant in the developing world here.


I have seen my share of death. Believe me. Where over 15 moms die a year at my hospital, I have seen my share of death! Multitudes of developing fetuses die. Multitudes of newborns die (prematurity, vertical transmission of malaria, neonatal tetanus, sepsis from home deliveries, prolonged labor causing hypoxemia, etc). I’m not exaggerating. Multitudes.


I am NOT in favor of killing. The fetus or the mother. But whose life is more important? Can a dead mother support her developing fetus anyways?


I used to think… Wow! That’s a hard decision to make. I would let the family decide.


Well, guess what? Families don’t decide here. Women are used to having no rights. Really, NO rights! And the men never come to the hospital because they have no backbones and are afraid they will have to pay something if they show up. Or maybe they might have to give blood to save their hemorrhaging wife. Meanwhile they have 2 other wives at home.


So I decide.


I decide to let mom live. I FIGHT for mom to live. I SCREAM for mom to live. I GET ANGRY for mom to live. I PRAY for mom to live.


One of my moms on maternity right now came in a few days ago with generalized edema. She was probably only 16 or 17 years old and on her first pregnancy. She measured 33+5 weeks on the ultrasound. The baby measured just over 2 kg’s. She had severe preeclampsia with very elevated BP’s. Severe preeclampsia is very dangerous here. The treatment and road to recovery is delivery of the baby. (The only helpful lab work here for this are blood type, hemoglobin, and a urine dip stick…….No platelets, liver, or renal labs).


I explained to her 2 sisters and her that her pregnancy was making her very sick and could kill her if we didn’t deliver her baby sooner rather than later. I also explained that at over 2 kg, the baby had a high chance of living but was still premature. On the ultrasound the baby looked quite active, so didn’t appear unhealthy.


I gave her steroids for fetal lung maturity and induced her. It was her first baby, but still she delivered quite quickly with cytotec. She delivered in the night with one of my best nurses.


The baby died soon after the delivery. The nurse said she had a hard time pushing the head out, so maybe not enough oxygen during labor along with prematurity could be the cause of death.


Mom’s diastolics are still in the 130’s the day of her delivery. She’s still quite sick and at risk for death here in the bush of Africa. Preeclamptics die of pulmonary edema here. I’ve seen it many times when they come in late in the game and seizing. There’s no back up when mom’s lungs go south. There’s no ICU to send her off to. It’s best to prevent pulmonary edema by knowing the risks for developing it. If you get pulmonary edema with severe preeclampsia here, there’s lasix, but…then you either live or die. It’s not easy here.


So did I take one life to gain another?


Yes.


I don’t believe God is EVER happy with losing life. He CREATED life. He made us to love and hope for the best in things.


It’s easy to look at things in the rearview mirror and judge. Lets say if I would have waited another week to induce mom. Would baby have had a higher chance of living?


Maybe.


Would mom have had a higher chance of dying?


Definitely.


It’s never black and white in these difficult cases.


Next patient comes in and breaks her water at 12 weeks. The fetus is still living. She’s hemorrhaging. But her cervix is closed. Can I help the mother live? Or should I just sit by and watch her die? Can I do a life-saving surgery on her? It’s an abortion.


Or maybe she’s not hemorrhaging. Maybe she’ll just develop sepsis in a couple of weeks and die from that overwhelming infection. I’ve seen it all here because people come with extremely delayed care here. Should I wait and see? I make my choices to help mom live.


I know why people are against abortion religiously. The Bible says do not kill. If you allow a government to carry out killing, then you are guilty of killing too. If you have the chance to vote against killing, and don’t, then God will hold you accountable.


But please use your brains. If the government can say that abortion is illegal no matter what, it then favors the killing of a mother when her own life is at risk.


I for one would prefer to make my OWN choices as an OB/GYN. I don’t want some non-medical professional telling me how to treat my patients.


My patient is my number one priority. And I deserve to have a choice. I just try to have God guide me to make the right decisions. It’s all in His hands.


Just something to think about the next time you want to judge abortions.

Nasty

She came in 2 ½ weeks postpartum. She must have come in Friday afternoon because by the time I saw her on Sunday, she already had an abdominal ultrasound that showed “ascites and her uterus was empty.”


I wasn’t overwhelmingly impressed with her state. She was neither fantastic, nor sick. She was a young Arabic girl who had delivered her first baby. Her baby was skinny as they had been giving him water, but nothing unusual. I gave them the spiel to not give water.


Something just didn’t quite feel right about her abdomen. I couldn’t really feel a small fundus, like I should. Her abdomen wasn’t really distended, but wasn’t really as soft as it should be either. She had no pain and was eating some. Apparently she had had pain the day before, but was getting better on oral antibiotics.


Something was just off, and I couldn’t tell what it was.


I told her not to eat the next morning, so that I would have the option of doing surgery if I wanted to. I hadn’t decided if I was going to do a D&C for possible retained membranes or a laparotomy for possible abscess.


She really had nothing special clinically to go by. It just wasn’t quite right. (Can I write that on my preoperative diagnosis?……not quite right?) Doctors call this a ‘gestalt,’ a gut feeling resulting from a combination of tiny parts of a patient’s being that seem fairly innocuous but add up to an ominous future.


The next morning, she didn’t look better, but no worse either. I repeated an ultrasound and found her uterus to be completely empty, but she had a 3cm cystic mass in her right lower quadrant.


We obviously don’t have a CT scan, although that would have made things much easier. Something just told me to open her.


So I did. And it’s a good thing.


Upon entry of the abdomen, liquidy pus came out, followed by liquidy poop.


Awesome. My favorite. I hate the smell of poop. I had just gotten over the pregnancy hormones and was actually feeling back to normal. I was actually feeling great. After the miscarriage, I got malaria for a couple of days, but then was feeling awesome! But I still hate the smell of rotting poop in an abdomen.


She was a mess inside. She must have been perforated several days. I don’t know how she looked so good clinically. The ascites seen on the ultrasound by Doudje several days before must have been diarrhea in the abdomen, or pus. Now, her intestines were all stuck together. While trying to gently separate some of the intestines we kept finding pockets of pus.


We managed to find 2 sites of intestinal perforations and repaired them. Even though they were less than a cm each, it’s never easy to repair inflamed tissue. Somehow we got a couple of layers of suture over the holes. We irrigated a ton, and put a couple of drains in. Then we began to close up her infected abdomen.


Upon suturing one of the drains, a used suture accidentally flung up into my unprotected eye.


Yuck. I closed up the fascia, put in interrupted sutures in her skin, then unscrubbed and washed my eye.


Let’s get an HIV test, just to be sure.


HIV test came back.


Positive.


Uggh….


Did the suture really go in my eye? Or did it just touch the outside of my eye as I closed my eye. I wasn’t really sure. It was just dirty suture on my eye. It’s not like I got poked. It probably didn’t even touch the inside of my eyelid. Did it? I’m not sure.


Well, I know the HIV prophylaxis medicine is really nasty to take. I remember an attending in residency on those meds for a month and he looked awful by the end. It gives really bad diarrhea and just overall ickiness. I remember Ndilbe last year taking the meds here for a month. By week 3 ½ he looked terrible too.


But would I be mad at myself 10 years from now if I could have prevented HIV?


Yes, I should have been wearing protection!


Eye protection, that is! But it’s so HOT here that I can’t see with goggles on because they fog up instantly. I make a mental note to get some really nice, anti fog clear glasses or goggles next time I’m home.


But now, I didn’t really have a choice. I had to take HIV meds for a month. Olen would want me to. I will do it for Olen. Olen had been in America for 10 days and was now getting ready to go to the airport to come home.


I texted him and told him, and we both agreed for me to take the nasty meds.


So now I’ve been on nasty meds for 1 ½ weeks. I’m back to being nauseated again. It’s not quite as bad as pregnancy nausea and doesn’t come with the same fatigue. But it’s not fun. I now understand why people spit during hyperememsis gravidarum. They spit because even their spit tastes bad.


My spit tastes bad. Water tastes bad. Food tastes bad. I feel icky all of the time. But praise God that I have medicines that I can take. And it’s only 2 ½ more weeks to go!


Oh for 2 ½ weeks to pass quickly! Morning and night nasty effects of pills. I’ve got it easy though compared to the sick people here.


My patient is slow to recover. But she is recovering. Please pray for her continued recovery.


As a friendly reminder, we accept tax-deductible donations through Adventist Health International at ahiglobal.org/Bere. Or there’s a donate link on our website missionarydoctors.blogspot.com that will take you there. You can pay by PayPal and shoot AHI an email to notify them you sent in a donation for us. Or you can send a check to “AHI - Bere, 11060 Anderson Street, Loma Linda, CA 92350” or call 909-558-4540 or fax 909-558-0242 or email ahi@llu.edu. You can even set up recurring donations. So many easy ways to give! AHI has a new standard of 100% of your donation will arrive here in Bere. They find all their overhead operating costs from other sources. Anyway, we’re very humbled by how God has chosen to use us and if you would like to be a part of it, please help with your prayers, finances if possible and volunteerism if you’re feeling called!

Sunday, October 19, 2014

RhoGAM

I’m so tired of being nauseated.  It’s not really pure nausea.  It’s more of a green feeling, an I-don’t-feel-like-doing-anything feeling.  And morning sickness is a dumb terminology.  It lasts all day.  It’s probably worse in the evenings than in the mornings.  A man must have dubbed that term.  Pretty much I just feel like ick.

Of course it would all be worth it…

if there was a heartbeat still.  

I don’t always share very personal things on our blog.  That’s usually for Olen.  

But he’s not here, and I have no one to complain to.  So I write to you.  

There’s not too many OB/GYN’s who would find themselves in my predicament.  But I live in Chad, enough said. 

I’m one of those OB’s that can’t seem to figure out how to follow their own advice, like birth control.  No just kidding.  I know how to use it.  Olen and I just really like kids and we are pretty much crazy.  

So we decided to try for 4!  The big announcement was soon to come out since we were soon to be 12 weeks.  I usually never tell before 12 weeks because I see so many miscarriages.  They are quite common.  It’s impossible to know how many go unnoticed, but at least one in five pregnancies will end in a miscarriage.  I don’t know how the world gets populated. 

But ours was not to be.  

Our ultrasound machine is not working properly.  Olen’s uncle, Scott, was visiting from Moundou, and he brought his nice portable machine to loan us.  (Thank you Scott!)  So Olen and I decided just to look on Friday night.  No irregular symptoms, just wanted to see our baby.  

He was taking his time looking, and then said, “Dear… I don’t see a heartbeat.”  

We had done an ultrasound 13 days earlier, and it measured 7 weeks and 6 days, with a heartbeat. The fetus was measuring right on with dates of 9 weeks and 5 days, so it must have just happened.

We were both sad at the news, but then came the real worry for me.  

“Uggh,” I groaned, “We don’t have any RhoGAM here!”  

RhoGAM is a special injectable medication that pregnant women with a blood type rhesus negative take to prevent their bodies from forming antibodies against a possible rhesus-positive fetus when there is bleeding in pregnancy.  I needed some to protect the next pregnancy from being unnecessarily complicated.  Normally you get it at 28 weeks if there is no bleeding.  We had planned to have Olen bring it back from the states with him on his upcoming trip to California. This is only necessary for rhesus-negative women with rhesus-positive baby daddies. I’m A negative and Olen’s O positive. I married poorly.

During the last 2 pregnancies I had RhoGAM brought over on ice in the checked baggage of someone who was visiting us.  

RhoGAM doesn’t exist here.  As far as I know.  I have never seen it.  We don’t practice first world medicine here!  

And I am here.  In Chad.  Practicing third-world medicine.  And receiving third-world medical care at the moment.  

No RhoGAM means we may not be able to have another kid.  I’m already 35!  That’s a high enough risk.  I don’t need more risks!  

But the present isn’t looking so inviting either at the moment.  I need to induce myself to pass the miscarriage.  Olen has just left for America for a conference at Loma Linda, so I’m on my own at night.  And, if I hemorrhage, the only other surgeon is my dad.  Ya….no thanks.  Dad, you’re a wonderful surgeon, but ya, no.  

So in my head I think about how I’m going to do an emergency D & C on myself in case I hemorrhage.  With no anesthesia because I don’t really want Mason in the room either.  Sorry Mase.  

And if I bleed too much, I really don’t want a blood transfusion either because, even though they were HIV negative at the time a donor gave to our tiny blood bank, the risk is still higher here. And we very rarely have rhesus-negative blood in the bank. And when we do, it’s B-negative, which you can’t give me, as A-negative. Ya, no thanks!  

So pretty much….No thanks to this whole situation.  

No thanks to not having RhoGAM.  No thanks to doing surgery on myself.  No thanks to having my father do it either if I’m hemorrhaging.  No thanks to our nasty OR if needed.  I see what goes on in there.  The blood everywhere.  Gross.  No thanks to our sterile instruments that are probably sterile, but we have run out of indicator strips long ago, so who really knows.  No thanks to having an IPAS (manual aspirator for miscarriages) that I re-use over and over again on patients after cleaning it, but it’s not really sterile either.  I am not using that on myself!  

But truly, thanks be to God because I know He does have a plan for our family.  Even though this plan of ours didn’t turn out the way we had hoped, I still have peace in His plans.  

Today, I have done 3 D&C’s on patients.  One was a young woman who came in hemorrhaging with a 12-week miscarriage.  As I went to put the speculum in, the amniotic sac delivered right into my hands.  You could see the fetus perfectly formed floating inside the amniotic sac, not yet broken.  He was so perfectly formed.

Each life is a miracle, even the ones that don’t make it.  

You made all the delicate, inner parts of my body and knit me together in my mother's womb. Psalm 139:13

I chose you before I formed you in the womb; I set you apart before you were born. Jeremiah 1:5


Since this blog writing, Olen was able to find some RhoGAM in the capital on his way to the airport.  He went to several pharmacies to find it and sent it back with a friend who made the 10-hour bus ride with it in a cooler.  It looks legitimate since it’s from Belgium.


Don’t take first-world medicine for granted!

The Meaning of Missions

Sunday - Church board meeting, 8am, followed by school board meeting… Until 1pm. ‘Seriously? Do you people really have no clue what a budget is?’ I educated them. It was my meaning in missions.

Monday - Had morning meeting with the employees. Patient came in, made tough diagnosis. That’s why I was there. I’m a good doctor. It was the meaning of my mission. Fired two nurses for sleeping together. Cleaning house was my meaning of missions.

Tuesday - Called in for emergency. I’m an excellent emergency physician. Job well done. Met with hospital accountant. Numbers look way off, but there’s money in the cash drawer. Whatever. Keeping this place making money carries some meaning to my mission. Fired another nurse for being drunk. A little fire and brimstone in my meaning of missions.

Wednesday - Led staff worship. That’s right. I’m being an awesome missionary. Met with local authorities. Fired a lab guy for stealing money.

Thursday - Another morning staff meeting, followed by hospital board meeting until 4pm. Apparently committees are the meaning of my mission. Fired… Nobody. It was an off day. The meeting went long, after all.

Friday - Fired a guy for not showing up. Again. Fired a guy for stealing a mattress. Two-fer!!! Made up for yesterday. Vespers.

Sabbath - Had had a week just chock full of the meaning of mission. Tired, wanted to stay home and listen to a sermon on the computer. My wife was also tired.

Nonetheless she said, ‘Dear, wouldn’t it be fun to go out into the village?’

What I heard - ‘Dear, wouldn’t it be fun for you to drive the motorcycle with me and our three children on the back through the sand in 120 degree heat while Tchadians run behind me pointing and shouting NASARA NASARA NASARA?’

I replied, ‘My darling, I love you too much to expose you to the risks of heat exhaustion, motorcycle crashes and sweat stains. After all, my week has been just so full of missions, I don’t know if I can move.’

But she’s much too brave to fear these silly risks and with her gentle and persuasive missionary spirit she replied, ‘Sweetheart, I really think it would be fun. Let’s go, shall we?’

I replied sagely, ‘Wouldn’t it be just delightful to stay? We have so many wonderful sermons on the computer we could listen to. I’m just so exhausted from being such a good missionary this week.’

She prodded ever to tenderly, ‘Man up. Grab the keys and get your butt on the motorcycle.’ We have three young children, so she instinctively started, ‘1, 2, 2.5…’

I’ve been in this situation often enough to know my wife is not great at math and doesn’t do quarters. 2.5 is as high as she goes. But I nevertheless continued with my argument… In my mind. My mouth said, ‘Yes, dear.’ And I made it on the bike before she got to three.

My five-year-old hopped on the front, I reached around him to grab the handlebars, my three-year-old hung on behind me, followed by my wife with our baby strapped to her back, Tchadian-style. There is no Child Protective Services in Tchad.

We drove off searching for a Fulani village we had stumbled across a couple weeks earlier. They are nomads. Danae, my wife, loves their culture, how they braid their hair, their clothing, their language, their animals, their children. She love befriending them and taking pictures with them, then turning around the camera and showing them what they look like on the screen.

Yeah, I think they’re pretty neat too. Except they don’t have any houses and just sleep in the middle of all their pooping animals and I always need to do some ridiculous tip-toeing Charlie Chaplin dance through the donkey dung just to get close enough to say hi.

We found their camp… abandoned.

As you can surely imagine, I was just devastated to turn the motorcycle back home so quickly into our outing.

Driving home through another village, we saw some kids playing at a drilled well. It was foot pump operated and they were jumping up and down it like a game and playing in the cooling water that came out the other end. It looked inviting.

We parked the motorcycle under a mango tree and meandered over to the kids. They noticed us coming and had the typical Tchadian child response. Half screamed and ran to hide. The other half ran straight up to us and then screamed. We played on the well’s foot pump. We pumped water for the ladies who came. We exchanged smiles. We practiced our Nangere tongue. They laughed at us. We laughed at ourselves. Of course, the only Nangere we know is medical, so perhaps they thought it humorous that our greetings included questioning if they were vomiting and having diarrhea.

Our thirsts slaked and fun had, we walked back over to the motorcycle. The kids followed, as did the more-timid adults.

Danae took off her wrap and threw it on the ground. She then sat down on it with the baby. Other kids came and sat down with her. She started quizzing them. Who’s Christian? Who knows the Bible? Who knows the story of Noah?

They were all Christian, but nobody knew the story of Noah. In French, my wife recounted the story as I sat back and observed. She started singing, and they joined in as she learned the simple, ‘Jesus Love is A-Bubbling Over,’ which we translated into the local languages. We taught and sang more songs.

We asked who had prayed in the last week. Not a single one of these Christians had prayed, or was brave enough to at that moment. By now our group was at least 70, maybe more. And so we prayed. Simple, simple stuff.

It was nearing lunch and my stomach was rumbling. So we saddled up the motorcycle once again, some missionary equivalent of clowns in a VW beetle.

As we pulled away, the crowd stopped us. They asked, ‘C’est comme ca?’ (It’s like that?) You’re just going to leave? You come, you teach us the Bible, you teach us songs, you teach us to pray, then you leave? This is not good! Will you not return next Saturday?

I discovered the meaning of missions, taught to me by my wife and children. That village still has somebody come visit them every Saturday, to share another Bible story, to sing songs and to teach them to pray. Regularly, there are more than 100 souls there. We have been asked to build a church.

We have found our meaning. We have found our mission. We know God calls everybody to different things. But God calls everybody. Have you spent enough time with Him to know how He calls you? To you have the courage to follow Him?

Care to come join us? Care to find your mission? Care to find meaning? If God is calling you to the first-world, that’s ok. If God is calling you to the third-world, that’s ok too. Let us know how He calls you and we’ll be thrilled to encourage you to follow His calling. We are at danae.netteburg@gmail.com


Or if God happens to be calling you to help in other ways, if you’re as excited about what we do as we are and you want to be a part of it, financially or otherwise, go to www.adventisthealthinternational.org and find out how you can be involved.

Wednesday, October 1, 2014

From the oldest kid, Me-Lyol


A note from Lyol to the Williamsport Eagles,

Dear Williamsport Eagles,
My January birthday party at the river, eating an apple

Hello from Tchad, Africa!

Naythan, it's really hot here. That's the first thing I think about when people ask me what it's like. The food is really different too, partly because it's so hot and partly because people are so poor. Like today, for example, I ate an apple. But that's really rare. They don't grow here because it's too hot. They are all imported, which makes them really expensive! An apple costs 50 cents, which is half a day's wages!!!

Titus, for fun I play and eat whatever fruit is growing on our trees. Right now, we have more guavas than we can eat. I'm only five, so I don't climb the big guava trees very high. But in the smaller guava trees, I can climb high enough to pick my own guavas. Otherwise, I ask my older friends to climb high and they pick guavas for us to share. When guava season is finished, the mangos start. I looooooooooooooove mangos. Around 6pm every day from January to July, you can find me covered head to toe with mango juice. They're so good and so much better than you find in the stores in America. And we have so many huge mango trees. There are more mangos than we can eat. We also grow a lot of papayas. We have a few pomegranates we brought over from America. Last week we ate our first pomegranate from our own tree! We also have a lot of banana trees, but we don't get bananas super often from our own trees. More often, we have to buy them from the outdoor market or from the ladies who come to our door to sell us fruit. I know how to climb up our pantry shelves to where mommy and daddy keep the money. Then I take the money outside, buy the fruit (we also get okra, potatoes, sweet potatoes, tomatoes, carrots, eggplant, eggs and other stuff) and then bring it inside.

I play with my brother and sister, Zane and Addison, as well as other missionary children, Emmie and Grace, who are 9 and 11. I also have lots of Tchadian friends. I played with Papa (Nicolas), Tony, Appolinaire, Tessem and some other kids today. I'm learning a lot of French, but a lot of my friends don't even speak French. They only speak the local language, Nangere, so I'm learning a little bit of that too. I'm even learning a little Arabic, as it's spoken often here too.

Titus, we have running water whenever Zane picks up a pail and runs with it! Just kidding. We do have running water. Although a week ago, the generator wasn't working well, so we didn't have good electricity, so the water pump couldn't get the water up to our tower and there was no running water. We used to run out of water a couple times a day, but now we have an automatic float switch in our water tank, so the water pump turns on automatically when it's low. It saves my dad from needing to walk up to the hospital in the middle of the night to turn on the pump.

And Titus, I love playing with legos too!!! My dad says I'm really good at it. Maybe we can play together with legos some time! That would be fun.

Elrik, of course I'm obeying my mom and dad! I'm a missionary kid. We're perfect! I'm just kidding again. I'm not perfect and I get in trouble with my mommy and daddy just like any other kid. But I try my best to be good and obey.
Tchadian dress for church

Joy, we do get sick sometimes. It's usually malaria. We have to take really yucky medicine, quinine. I'm really good at swallowing pills. And I get candy after I take it. I like the other medicine better, like Tylenol and Motrin, but that doesn't work against malaria.

Karen, we go to church. Actually, we go to churches. Sabbath is probably my favorite day. I love going to church and I get really excited. We like to go out to small villages on our motorcycle. We just stop under a big mango tree and all the kids come around. It's kinda weird, because even far away from our house, all the kids know my name and yell, 'Lyol, Lyol, Lyol!!!' I don't even know them! They also like to touch my skin and hair, because it's different from theirs. Mommy or Daddy tells a Bible story. Sometimes I help with the felts. Or we'll act out the story. Or we'll do something else. I love singing the songs. I know songs in French and Nangere too. So we usually do that, then come to our big church at the hospital too. Our big hospital church is probably like yours, just without electricity or pews with backs. We don't have adventurers, but we have pathfinders! But I'm too little still.

Nathanael, I do have a lot of toys! Daddy says I have too many! I like to share them with my friends here who don't have any. But my Tchadian friends are really smart! They know how to make the coolest toys from mud and sticks. In fact, they make me toys. Those toys are some of my favorites. I love my friends here so much, but I also really miss my cousins in America.

love
lyol

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
Afrique
Volunteers Welcome!!!


Saturday, September 20, 2014

Other Contact

For those wanting to stay more in touch, we often post medical pictures and other such things on Facebook. I've been informed Facebook is only for old people, but hey, we're aging gracefully. We're not yet hip enough to tweet much. Anyway, it's http://www.facebook.com/netteburg Feel free to friend me. If we ever become cool enough to tweet regularly (although I've been told that even Twitter is now, like, so totally passé), we're @netteburgs.

Now I just need to figure out these hashtags... #poundsign #numbersign #whatdoesthisdoanyway #itsreallyhardtotypewithoutspacesandpunctuationthisisjustwaytoounnaturalwhatareweteachingourkidspleasemakeitstopigottagetouttaheresendmebackonthenextplanetotchadwherethemostadvancedtechnologyisthehospitalschainlinkfenceyoucanhitchyourdonkeyto

By the by, Adventist Health International is so awesome, they don't actually take any of your donation to pay their overhead. That's right, 100% of your donation now comes directly to Bere. It's like you can give 10% more! Woo-hoo! #woohoo #whydidijusthashtagthat #ifyouneedmoremilesyoushouldjustdonateusmoneyonyourcreditcardbabyswipeaway

Sunday, August 3, 2014

Perfect Timing


I hardly ever sit on my couch in the evening.  I’m usually the one that falls asleep with the kids in their bedroom while I’m putting them to bed.  Lame, I know, but still.  

It had been a busy day at the hospital.  I was trying to straighten up in the house because we had visitors coming in 2 days.  Instead of cleaning, I sat on the couch and made a list, so as to not forget things like clean the toilet and move old hospital beds to another location.  Procrastination, but still important because I was tired.  

Olen was in the kids’ bedroom putting them to sleep.  

If you were to come inside our house, you would enter the front porch first.  Then enter through the front door which opens directly into our living room.  All of our bedrooms have doors off of the living room.  It’s very open, yet the kids are not very far from us if they need anything.  So if you were to go to the kids’ room, you would have to walk across the living room to get into their room.  They are all three sleeping together in one room for the time being.  

So as I was saying, I was minding my own business, writing out my list, siting on a small couch right next to the door.  

SCREAM!!!!!!! (that would be me screaming!)  I noticed a tiny little snake slithering quite rapidly across the cement floor towards the rug in the middle of the room towards the kids’ bedroom.  


“Olen get out here!” I screamed again.  

I REALLY hate snakes, as those of you who hate snakes can relate with me.  It makes me cringe and want to ball up and not do anything all at the same time.  Yet, I never thought of myself as wimpy.  I don’t mind mice, spiders, most other animals, dirt, blood, poop, etc…….But SNAKES!  I LOATHE!  

Olen came sleepily out of the kids’ room into the living room.  Zane tried to come out and wondered why mommy was screaming.  

“Oh, it’s nothing Zane, go back to sleep, honey,” I lied.

I couldn’t help but let out small screams and high pitches of fear as I watched this snake seem like it was going to go under the rug or slither across into my kids‘ bedroom!  

Again, I had to cover and tell Lyol and Zane that mommy was just surprised and that it was nothing.  Go to sleep!

“Dear, kill it!”  Get it, don’t let it get away!” I told Olen.
Olen bravely grab 2 My Bible Friend books, stacked them, and held them over the snake that kept slipping on the cement, not making much headway.  It was only a little baby snake from the looks of it!  

Olen held the books up high and let gravity take it’s effect.  Down came the books and smashed the snake.  He carefully lifted the books and thankfully had killed the snake on the first try.  My hero!  

Now came the scary part.    

The scary part was thinking about how this little snake got into my living room!!!  The more I thought about it, the more my skin crawled.  We put the dead little 10cm long and less than 1cm wide snake in a cup and took a picture of it.  We put it on facebook.  

Friends wrote back.  Answer: Dangerous viper, the kind that makes you bleed out from all of your orifices.  

So now I really started to freak out!  I made Olen go talk to the boys on the compound, Appo and Papa to ask them what they thought.  Same response!  That snake was no good!  

Normally I walk barefoot in my house.  There’s not much light at night in the house usually, but I’ve never really thought about that.  But not now!  Every step I took that night, I kept wondering if I was going to step on a creepy, dangerous snake!  

Olen and I searched for a while for more snakes, or perhaps a mama snake that just spawned her nasty children.  We found nothing.  So finally we went to bed, prayed for protection for us and our children, and left the rest in God’s hands.  

I finally got to sleep, but got called into a postpartum hemorrhage around 1am.  I brought the picture on my phone to show some of the locals at the hospital.  

The mother of my patient got the worst look on her face when I showed her the picture.  “That is not a good snake.  Where was it?”

“In my house!”  

More of the same from all of the other people who saw the photo. 

I went home more creeped out by snakes than ever.  Somehow I still had a sense of peace as I crawled into bed thinking of snakes slithering across my floor.  

I knew that God had put me on that couch at that exact time so that I would see that nasty snake before it got to the kids’ bedroom.  And we are thankful for His protection!