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!

Monday, June 16, 2014

Same old, same old...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



Saturday, May 24, 2014

Entertainment


Things we do for entertainment in Tchad…..

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

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

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

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

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

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

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


Bok


The Things We Do for a Bok

Two quick chicken stories:

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

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

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

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

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

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

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

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

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

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

love
olen and danae

missionarydoctors.blogspot.com


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

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

Mom, Mom, Mom


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

Probably one of them is your Mother!  

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

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

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

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

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

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

And we are the good hospital.  

Seriously.  It’s sobering.  

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

Bumpy roads.  

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

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

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

How do we get them to come?

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

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

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

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

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

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

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

It’s almost finished!!!  

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

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

HAWA


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

Literally.

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

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

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

I don’t know.  

I don’t know a lot.    

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

And a lot of you are persistent.  

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

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

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

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

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

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

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

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

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

When do we give up?  

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

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

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

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

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

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

It’s just not finished yet! 

Stay tuned in June and July.