Wednesday, July 1, 2015

Tchad bombings


More bombings in Ndj this morning. I'm not saying this to scare you all, bc we are far from the capital but doesn't make me want to leave the country either bc I have to go trough NDJ.
Here's what another missionary wrote/discovered about the situation, "the story is that the Tchadien police discovered a BH safehouse and raided it this morning. Those in the house blew themselves up which also killed 5 police officers. So it was not another attack except that the police attacked them. Still terrible but makes us feel better about it. "
Prayers appreciated!
This just after the bombings 2 wks ago. Hopefully things calm down before we are to go back to America in 3 wks (leaving via Ndj). Another reason why I don't like cities!

Tuesday, June 23, 2015

The Bomb

For those who haven't heard, N'Djamena just became a victim of international terrorism. Boko Haram, a terrorist organization based in Maiduguiri, Nigeria, crossed into Tchad last week and orchestrated twin suicide bombings, killing 29, wounding hundreds and striking fear into the hearts of many, causing them to seek out what could protect them, for some the Koran, for others the Bible, and for a great number, whatever spirits they feel can do them the most good. 

I want to thank you for your prayers. We covet them. I know there are many families and individuals who pray for us daily. 

The bombs went off in places we have been to dozens of times. My colleague, Dr Odeï, was scheduled to be there at that moment, applying for his passport. Due to a last-second cancellation, he wasn't there. Two other volunteers were driving away when the bombs exploded. They heard them and saw the smoke. 

This is real, but we remain optimistic. Optimistic security will now be at an all-time high. Optimistic Boko Haram will go back into its cowardly hiding. Optimistic Boko Haram will soon be annihilated. Optimistic God hasn't brought us this far not to have us finish the work He's set before us. Optimistic God will continue to protect us. Optimistic this will all not matter soon enough, and we will be on our way to a better home than even America can provide. 

Olen Netteburg

Missionarydoctors.blogspot.com

Danae.netteburg@gmail.com

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

Olen et Danae Netteburg
Hôpital Adventiste de Bere
Boîte Postale 52
Kelo, Tchad
Afrique

Volunteers Welcome!!!

Friday, June 19, 2015

Tchadian medical case of the day:

I rounded on medicine today since Odeï is out of town for a few days. Every day I follow his patients on the electronic medical records system and physically walk through the wards and ask Odeï and the nurse how the patients are doing.

So I knew already there was an elderly gentleman admitted for stroke nine days ago. They asked me what could be done when he arrived initially and I talked with them about blood pressure control and aspirin. Of course, the nearest CT is a day's drive away an out of people's budget, so we go with the 85% thrombotic rule and treat everybody with aspirin.

We had also discussed the benefits of a nasogastric tube and started him on feeds and switched him to oral medications a few days ago.

But today was the first day I discussed care at his bedside or examined him or talked with his family and I took the opportunity to delve a bit deeper to confirm his diagnosis.

I looked through the chart again and saw he had received quinine, ceftriaxone, flagyl, vitamins, parasite medications and just about everything else our pharmacy has to offer. And all tests were normal.

So I asked his wife, "Has he said anything?"

"No," she replied, but still smiling.

"Does he move?"

"No."

"Does he eat or drink or swallow?"

"No."

"Does he open his eyes?"

"Oh, yes! Just the day before yesterday he opened them. He's getting better!"

OK, great. So I have a vegetable whom the family believes to be improving and cares enough about for them to be feeding him via nasogastric tube 24/7. This means they won't be eager to take him home to die.

Then I noticed how skinny he was.

"Has he lost weight since coming to the hospital? Are we not putting enough into his nasogastric tube?"

"No, he's always been skinny like this."

"Oh. Um. OK. Does he normally walk around at home?"

"Oh my no. He just sorta scoots around on his bottom."

"Oh? For how long? A couple weeks?"

"For several months probably."

"Like since April?"

"Before then."

I figure I should speed this up. "2013?"

"No. He wasn't walking then either."

"OK. But he was talking and eating before he just recently got sick, right?"

"Oh yes! In fact, he was eating and talking and banging on the ground with his fists when he got sick."

"OK, so then... Wait. Did you just say he was banging on the ground with his fists when this started? Did it start suddenly or gradually?"

"Suddenly. I mean, one moment he was banging on the ground with his fists and quite literally the very next moment, he fell over on the ground."

"Uh. Weird. Was he singing and the ground was his drum?"

"No. I don't believe so."

"OK, was he seizing?"

"What's a seizure?"

"Never mind, was he trying to get your attention? Was he with it? Was he choking?"

"No, silly white guy. He was talking very clearly and loudly and banging on the ground right before he keeled over."

"OK. I need you to help me out. What EXACTLY was he saying the precise moment he fell over?"

"Well, he was in the process of putting a curse on his sister and her children saying they would all die, but he keeled over right at the end just before he could finish the curse."

And... Discuss. I skipped this lecture in residency at Baystate.

Olen Netteburg

Missionarydoctors.blogspot.com

Danae.netteburg@gmail.com

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

Olen et Danae Netteburg
Hôpital Adventiste de Bere
Boîte Postale 52
Kelo, Tchad
Afrique

Volunteers Welcome!!!

Sunday, June 14, 2015

Moving on up---MUST READ PREVIOUS BLOG for this to be complete

So how does Bere move past the huge amounts of money that has been stolen by hospital employees? (See previous blog.)


Fed up with all the stealing, we had started randomly asking patients where they had paid for their labs when we couldn’t find a receipt. One gentleman told me that he had paid outside of the lab (they are supposed to pay at the cashier’s office). The patient was all set to show me who he gave the money to, but the employee wasn’t at work that day. I was sure who it was, but two days later when I asked him to identify the accused, he could no longer be sure who it was. I’m sure someone else had gotten to him first, and told him to be quiet. And probably paid him to do so. Others we discovered and fired.


But we’re tired of all the interrogations and corruption. I didn’t come to Africa to practice criminal investigation. I came to practice medicine. But it seemed that so much of my day was taken up asking where the patient got this medicine, or where did he pay, or why weren’t the number of medicines correct with the receipt. It was getting old. Time after time this kept happening. We were firing people left and right for stealing.


So we decided to be proactive.


One way to do this is with our A-team!


Introducing Dr. Dirk Wunderlich and Zachri Jensen!


If you’ve ever visited Bere Adventist Hospital, you have seen our patient charting. You have seen our notes and orders scribbled down in the little patient medical book called a carnet (car-NAY).


But lo and behold, things have changed!


We now have an Electronic Medical Record system!!!


Dirk, a German neurosurgeon, came to Bere via providence. Looking for something to do with his vacation, he emailed a supporting mission of the Adventist church and said, well, if they respond, maybe I’ll go on a mission trip. If not, maybe I’ll take a week and go skiing!


Well, the organization forwarded the email to a friend, who forwarded it to Olen, and Olen replied to Dirk, all in the matter of a few minutes. Olen explained to him that there wouldn’t be any neurosurgery to do, but he’d be welcome to come anyway. Dirk, figuring he’d never hear back and would be free to go skiing, was surprised and figured he shouldn’t ignore providence. So he came!


When Dirk got here, he was… Well, he had the same reaction everybody has when they see our hospital for the first time. A reaction that can’t really be put into words. Overwhelming needs. He was also crazy enough to think he could implement an EMR in the bush of Africa. Olen told him he could do it if he was willing to foot the bill and do all the work. (Olen is generous like that.)


Dirk had already created a note-tracking EMR for hospitals in Germany and Australia. So he set to work writing code so the program could do everything else we needed it to.


Again by providence, Olen got a random email from a Walla Walla University student, Zachri Jensen, asking if there was still validity to an ancient request we had made for somebody to start a computer school. We told him no, but there’s this project to implement an EMR. He agreed to help.


Now here’s where providence turns into divine intervention…


In November, when Zachri arrived, most of my staff had never touched a computer. Including 100% of my pharmacists and cashiers. Literally! As in, they didn’t know what one felt like on their fingertips. Let alone find the on button. Including my 58-year-old charge nurse and lead consultant in the emergency room, our main intake for the entire hospital.


So when we say, ‘Our first lesson was “Here’s the on button,”’ that’s a lie. Our first lesson was, ‘This is how you open a laptop. Now here’s the on button. And now here are the keys you need to peck at to log in.’ Our first hour was spent logging in.


In December, we started twice-weekly hour-long lectures. In mid-January, Dirk arrived to work out some kinks. January 24 at 9pm, we went live. Think about that for a second. In less than two months, we went from a majority of employees never having caressed a computer… To having a functional EMR. This may seem daunting for an American nursing staff to all learn a new EMR at once. But my nursing staff was different…


On top of this, there was ZERO network installed when Zachri arrived. He had to set up a server, a router, a switch, six unidirectional antennas and five access points. In addition, he built into the network no less than six backups of our patient data, five updated continuously and the other updated hourly and saving the backups for a month. Oh, and he also translated the EMR from German/English into French.


On top of this, we went live during our highest patient volume period (well over 2000 new patients per month for the first three months in a 70-bed hospital with 23 nurses).


And 100% of my employees have bought in.


We use this EMR for registering patients and their demographic data, prescribing ultrasounds and lab testing, ordering surgeries and tracking the surgical schedule, ordering medications, tracking ALL income, receipt printing, tracking ALL stock, automatically generating medication and consumable purchase orders for the hospital to prevent our stock from running out, surgical reports, ultrasound reports, admission notes, progress notes, discharge summaries, staff list, track floor usage of consumables, track inpatient list by service, track individual prescriptions of our precious free medications, track individual intake by each cashier/pharmacist and many other things. In addition, the software is capable of doing payroll and data mining and a glut of other modules we haven’t implemented.


This also opens up huge avenues for research too with capabilities to search the medical records.


Our humble little bush hospital, in a region of a million people with no electrical grid or public running water, 42 kilometers from the nearest pavement, computer-illiterate… We have an electronic medical record, despite all my bets against it. Credit goes where it is due. A really hard-working staff, three genius programmers (Dirk, Zachri and Adrian) and a pretty amazing God.


We are convinced that stealing, like in the rest of the world, is like a cancer. We can’t completely stop it. But we can better control it. We are so thankful to Dr. Dirk and Zachri for setting up and continuing to work out the details of this system!


Bere will never be the same! We have moved on up!!!


(We should state that this system has actually helped us continue to catch thieves, although we won’t reveal our secrets and state how.)

Toileting Looting



Ok, so it’s time to catch up a bit. Haven’t really written much since December, so probably won’t go into too much detail. (Nah, just finished writing. It’s a lot of detail.)




First of all, a huge thank you to all the people who gave us money in December. We started the month in the hole. We were actually borrowing money from AHI-Global to do our AHI-Tchad specific stuff. But thanks to your incredible generosity, we came out of the hole and more, and we haven’t yet had to stop our activities, even six months on. So thank you very much for allowing us to do what we do. We hope our projects represent you adequately and make you proud to be a part of this, whether your involvement be financial, volunteering, praying, thinking good thoughts (for my heathen friends who don’t pray and don’t mind me calling them heathen) or even just reading our blog.




First thing I should tell you about is a few of the challenges we’ve faced since December…




We’ve been doing our best to clean house at the hospital, at least as far as staff go. Since December, we’ve fired several for being drunk at work, several for sleeping with colleagues or minors, several more for stealing, others for absences, others for falsifying documents… I could go on and on. It’s been extremely stressful and depressing work, but I’m optimistic that it’s leading us toward establishing a team that can be a great witness for our God.




What follows is a blog Danae wrote about one of these cases… (Olen’s notes in parentheses.)



Toilet Looting

I remember the day well. It was the 13th of January. I had a ton of cases waiting to be operated on. The OR had already prepped a hysterectomy for me. Dad is fully capable of doing a hysterectomy, but I really want to do them all myself since I’m preparing for my oral boards this year (you have to collect all of your cases for an entire year!). So when I yelled into the OR to have Dad just do the case, it was clear that something more important was going on.

(Back story: Back in October, after firing another pharmacist, my administrator Antoine made the decision to move to triplicate receipts from duplicate receipts. One receipt stays with the cashier, one receipt stays with the patient and one receipt stays where the service is rendered, be it consultation, operating room, ultrasound, lab, pharmacy, etc. Antoine ordered dozens of books of triplicate receipts, organized them into sequence numbered 1-24000 and put them into service. We started with receipt number 1 and had now progressed up to the 16000s. One day, we noticed a receipt in the 21000s, which seemed odd. Antoine checked his stack of receipt books and, sure enough, somebody had been pulling the receipt books off the bottom of the stack, without signing them out. And the three receipt books he had hidden in his file cabinet were gone too. There were eight receipt books missing in total.)

(So Zachri, a student missionary, and I looked through our surveillance video and discovered the cashier was switching out receipt books several times a day. It was clear as day. He’d see somebody come up with a surgical form, which looks different from all over forms and is a much more expensive bill than anything else, then close his window, pull out the naughty receipt book from under a pile of papers, switch the books, then open the window and work for a couple hours out of the fake receipt book, then close the window and switch back. He might do this twice in a day. At the end of the day, he’d smash a massive wad of $20 bills into his back pocket and walk out.)

(However, it was clear he wasn’t working alone. He didn’t have access to Antoine’s office. Furthermore, the receipts that were turned into us every morning from the previous day’s activities… and the false receipts were always missing. So either everybody was in on it… or my accountant was in on it. I didn’t want to believe that as my accountant had become one of my closest and most trusted friends. I even paid thousands of dollars out of my own pocket for months of lovenox injections when he got a DVT/PE. It hurt pretty bad. I was eager to have concrete proof one way or the other.)

(So at 9pm, I snuck into the hospital and slipped into the ultrasound room and locked the door behind me. By light of headlamp, I counted seven bogus receipts in the stack. Then I snuck into the operating room. With a surgical instrument and my headlamp I extracted two fake receipts from the locking box, to which I didn’t have a key. I then returned them to the box. I looked in both consult offices, pulled more receipts out with my surgical instruments and headlamp and discovered even more false receipts, numbered in the 21000s when all the real receipts were numbered in the 16000s. I had enough proof, so I went to bed and tried to sleep.)

(The next morning I went into the hospital and counted the 21000 receipts in the ultrasound office again. Still seven. I opened the door between the ultrasound office and my office and I sat in a chair. My accountant came in and took the receipts. All of them. I saw it with my own two eyes. I was 100% certain he took all the receipts, including the seven bad ones. And just to be certain, I had written down ALL the receipt numbers, good or bad, from the ultrasound stack.)

(I then went to Antoine and told him to detain my accountant when he arrived to deliver the previous day’s receipts in an envelope, as was his daily habit. An hour or so later, the administrator called me to say my accountant was there with the receipts.)

(I went into the room and asked my friend, the accountant, Are those ALL the receipts from yesterday? He replied in the affirmative. There aren’t ANY receipts missing? He said no. So I asked him to open the envelope and separate the receipts into those from the 16000s and those from the 21000s. He looked at me dumbfounded and claimed there were none from the 21000s. So I asked, Are you certain you are the ONLY person with a key to the receipt boxes and that you collected ALL the receipts this morning and ALL the receipts you collected are in that envelope? He insisted it was true. So I made him open the envelope and confirm there were no receipts from the 21000s, which he did. I asked him where he had put the receipts from the 21000s. Then my friend, who was a leader in our church, looked me in the eye and told me, ‘Doctor, before GOD, I know nothing about any receipts in the 21000s.’ I asked him to go home before he could invoke the name of God again, think, and come back in two hours.)

(At nearly the exact same time, Miki, another student missionary, called me. I had asked her to watch the live surveillance video feed and call me when the cashier closed the window, switched books, and opened the window again. She said it just happened. I walked in and found the receipt book in the 21000s. And under a pile of papers, the receipt book in the 16000s. I picked up the receipt books and didn’t say a word to him, but asked him to give me his key and go home and come back in two hours.)

(They came back and continued to deny it, ‘Before GOD!!!’, repeatedly. I never asked them to swear anything before God, they just kept saying it themselves. And of course, they’re tribesmen. After several hours of denying it, I took my accountant into his office, asked for his keys and told him he would be fired. At that moment, he broke down crying and admitted to it, saying the other guy, the cashier, had fooled him into doing it. His role was to get the receipt books and destroy all the bad receipts. He burned them, he said. The cashier was the one who swapped receipts books and controlled the money.)

(We went back into the committee meeting and he admitted to the others he had gotten the book from Antoine’s office and had burned the evidence. Then the cashier got mad my accountant had fessed up. They said it was the only receipt book they had stolen and they knew nothing of the other seven. The other seven were all later numerically, so it made sense they had just pulled off the bottom each time and this was not the first. But they swore it was the first. There were only three days’ worth of receipts in it, but in those three days, they had acquired $1000. Not a bad three-day haul for an institution doing less than $400,000 of business a year. Roughly 1/4 of hospital income was vanishing with these two guys. And since it was the accountant, we didn’t notice. We trusted him. But of course, it was only three days.)

(I was getting nowhere with these two guys trying to figure out how long they’d actually been doing it, as they were giving completely different stories, all stories being unbelievable. And they keep repeatedly insisting ‘Before GOD!!!’ that it was the truth, only to blatantly contradict, backtrack, or admit partially to lying later. This was now my fourth day out of five spent interrogating these guys. So I decided to call in back up…)

Olen had texted me that our 2 thieves in the administration and cashier’s office still weren’t telling the truth. I asked if I could have a go at it. Hey, it was worth a shot. And I was sooooooooo sick of employees stealing from our hospital.

Olen was stuck again in yet another administrative meeting. This time he was trying to get 2 thieves to admit to their crimes.

The cashier and the accountant were caught red handed. We had footage of cash going into the cashier’s pocket and footage of him switching the books. We also were able to confiscate the book that was in the cashier’s office. Unfortunately it was only 3 days old. In 3 days, the total money stolen was over $1000! The other missing books, however, were nowhere to be found.

All of this and we were somehow still functioning!

So now it was my turn.

Olen allowed me to talk to the accountant, who still wasn’t talking or telling the truth.

Since Olen and I had started watching Suits, a TV show about lawyers, I felt like I could be one of them too. There is no real justice system here, so if you don’t get to the truth yourself, you never really get to it. That’s one of the frustrating things about living here. You can’t just give the job to someone else. It won’t happen.

The accountant and I went into a room by ourselves. We had a long talk about how we’ve known each other for a year now. It was he who had caught our previous administrator in stealing. We talked about how Olen and I had personally paid for his medication for his DVT that became a PE when he had been sick last March and April. He was our friend, and even if he did do something unimaginable like stealing loads of money, we would forgive him.

He finally accepted that he had stolen money, told me the amount (less than $1000 total), I called Olen in, and we all prayed together.

Well he told a few tidbits of truth. But one of those tidbits helped seal his fate. He told me that there were 5 receipt books total (also a lie) and that 3 nights before he had thrown them in his toilet.

Now this isn’t just any old toilet. There aren’t flushing toilets outside of our compound in Bere.

It’s a pit toilet.

Very dark. Very smelly. Very deep. Very……

Gross.

I told Olen my new found information, who was of course STILL in the same meeting. He texted me, “Get me those receipt books!” He was still working on getting more information out of the second accused, who wasn’t admitting to a whole lot yet.

Now….Who was going to help me?

Of course, our outstanding SM, Zachri!

So, Zachri and I set out to find the old receipt books in the disgusting, maggot filled toilet. We brought 1 pair of work gloves, 1 rope, 1 metal hook thing, 1 flashlight, 1 long stick, and a few other things we imagined we would need.

Zachri and I arrived at the correct toilet a few hundred yards away from the hospital compound. The accused was renting a room, so it wasn’t actually HIS toilet. There were a few little kids scampering around us wondering what we were doing going into their toilet room. I tried to explain that I dropped something in there and really needed it. I just kept smiling and tried to look like I knew what I was doing.

Chadian toilets are pretty simple. It’s a 10 foot by 5 foot enclosed mud brick wall with a cement floor. In the center is a small hole that you aim for when you do your business. (And no, Tchadian aim is no better than Kindergartner aim.) Zachri and I pressed our faces against the nasty floor and tried our best to aim the flashlight without dropping it. You could see down 20 feet or so to a mucky mess of crawling maggots. Vomit in my mouth a little bit. Flashbacks to our volunteer losing her headlamp in the latrine. Flashback to another volunteer falling IN the latrine when the cement floor gave way.

It was a long ways down. The flashlight wasn’t that bright. But there in the corner…..

We could see the receipt books! We’ve got to get those! But how? We tried several attempts of stabbing them with my parents’ fruit picker. No luck. It was so deep, and the books were loaded with pee and poop secretions. They were so heavy.

Olen texted again. “Having any luck?” We were running out of time. He was tired of stalling. “Get it now, or forget about it”.

We’ve got to break the toilet, I thought. I texted Olen my awesome plan.

It was a no-go unless I could find the owner of the house before I did it.

Olen texted Zachri and laid the pressure on. “Come on Zachri, you’re an engineer!” (Mechanical engineering major at Walla Walla University.)

I had a new plan. I decided to run home to get some cloth. We would tie a few pieces of rope on to the corners of the cloth, then push the books over on the cloth and cinch it up just like the removal of a large ovary in laparoscopy. It was sure to work!

I ran home to get my needed supplies.

Out of breath, I ran back to the crime scene toilet. Zachri had one book up near the hole already! He had managed to use the hook to get under it and balance it while pulling it up. Not wanting it to fall, I grabbed it and pulled it to safety (yes, with my bare hands). Then I almost vomited again in my mouth. (I can’t believe I actually make babies with this woman.)

One by one we pulled 3 more up. You could see that there were more in there though.

I put the work gloves on and wrapped the 4 books in a pillow case. I ran to the hospital and pushed my way into the meeting with the two accused, where both were still very far from telling the truth.

“This is what we’ve found so far. There is more where these came from. ARE YOU GOING TO FORCE ME TO CONTINUE TO DIG IN A TOILET BECAUSE YOU REFUSE TO TELL THE TRUTH? OR ARE YOU GOING TO START TELLING THE TRUTH?!” I yelled while still out of breath from running.

Everyone could see and smell the evidence.

I like to think that our digging in the toilet helped our case. In reality, it was God protecting our hospital, because it was a complete miracle that our hospital is still a float. We just like to imagine what our hospital could be without the HUGE amounts of stealing that we keep finding!

The stealing had been going on since our new accountant came last January. Huge amounts of money that we can only estimate. With the help of the toilet books, we could see that it had been going on for longer than 3 months. The cashier finally admitted to his fault, but the accountant has yet to return to Bere.

(In an interesting turn of events, the receipt books from the toilet told a story. Once we cleaned the crap and maggots off them, we could see the numbering was completely different. These weren’t the triplicate receipts! These were from the old duplicate receipt books! So this had been going on since well before October. And there were more than eight receipt books involved. The one receipt book was only half-filled and had over $1000 stolen. As best as we can tell, the stealing started March 2014 and continued for ten months.)

(As more and more information came in, we discovered our accountant, who only ever admitted to less than $1000 while his colleague admitted his own part in the take was over $12,000 at a minimum, was sending nearly $1000/week up to persons unknown in N’Djamena. As a further investigation, we pulled out all surgery forms from October to December and found $12,000 of missing bills ONLY from surgery and ONLY from three months. Extrapolated over all the ten months and including the other services of consultation, pharmacy, lab, ultrasound, etc… who knows what their take was.)

(I’ve also sadly learned the game of fake receipt books is pervasive in the country. Even income tax payments aren’t exempt.)

(This case is still not resolved in any sense, least of which spiritually. My friend the accountant threatened to kill himself the day I handed him a letter from my hospital committee asking him to repay his debt he had stolen. He told me he would kill himself and it would be my fault. I refused responsibility and informed him that innocent men don’t do that. Plus, five family members of his heard him say it, so it’s their responsibility to make sure he doesn’t do anything stupid. Supposedly, he drank acid that night. But after a quick trip to the hospital, he was released without injury. Nobody saw him drink acid.)

(At any rate, please pray for both of them. My heart breaks for the cashier and even more so for my friend the accountant, whom I’ve been extremely careful not to name. He really is a dear soul to me. But if he cannot ever come to admit to what is clear to all, I fear what becomes of him. Once we allow pride to enter into our lives to such an extent that we start lying, then become consumed with fear of being found out, things just continue to spiral downward. Pray he can come clean, be honest, make amends, and then move on with his life, not allowing this to define him as a thief, but allowing it to define him as a man who made a mistake, lost his way, and then repented and ran back to his Father’s arms.)

(As Danae wrote, it’s God protecting His hospital at this point, because I’m sure not doing a decent job of it. Besides this, we have my ex-administrator who stole well over $36,000, but we’re only holding him to $36,000, none of which he’s repaid yet. We are repaying a social security debt of greater than $36,000, about half of which has been repaid. We spent over $40,000 on medications and lab supplies we gave away for free. Nurses and lab workers are taking fees directly from patients and not having them pay at the cashier. I fired all government workers so we are responsible for 100% of our employees’ salaries. And somehow we’re still afloat.) 

Aren't you glad blogs don't include smells!!!!


Ps. If you visit, bring your own pillow cases. You never know….we don’t throw away anything here!

Olen Netteburg

Missionarydoctors.blogspot.com

Danae.netteburg@gmail.com

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

Olen et Danae Netteburg
Hôpital Adventiste de Bere
Boîte Postale 52
Kelo, Tchad
Afrique

Volunteers Welcome!!!

Thursday, May 28, 2015

May 27, 2015

I haven’t written a blog in a long time. So much to write. So little time. So many excuses.

But today I received a letter. And I can’t really ignore it until I tell you about it. But I don’t really even have commentary to give. Much. I’ve been here for four and a half years. And I still get surprised.

Anyway, this letter is from the court system asking for my witness in a judicial case.

I will give you my best and most honest and most literal translation of the bad French (although there are parts that are difficult to understand due to the lack of French by the author). And I will leave the commentary to you. Remember, this is a case in a legal regional court in a country in 2015. I’m doing my best to not pass judgement. Honestly, I’m not sure what I would do differently if I were the President of the Tribunal of Lai.

Note: I will translate ‘Village Chief’ for ‘Chef du Canton’. A canton is actually quite large, comprised of dozens of villages. So the Chef du Canton, although a traditional (and typically genealogically-anointed) figure, still bears massive political clout over the nominated government authorities sent to an area.

I will also translate ‘Marabout’ as ‘Witch Doctor’. A marabout is an individual with zero formal schooling who learns his craft in a secret apprenticeship. A marabout cures illness with the sacrifice of animals to various individuals and creating traditional potions and inflicting various wounds. (Example: I had a patient with an empyema, pus in his chest cavity outside of his lung. Before the patient came to the hospital where I placed a chest tube and drained the pus, the patient had gone to the Marabout, who sacrificed a chicken and then scratched him on the chest with the deceased chicken’s foot, thus combating the spell his mother-in-law had placed on him which was causing his chest pain. He also had to drink a potion created with the deceased chickens most spiritually important parts.) These potions can bring large blessings as well. The less respectable marabouts will use their powers to cast spells on people. Then they run the risk of becoming sorcerers. Sorcerers and marabout will often engage each other to do the other’s dirty work, either in collaboration or at odds, doing and undoing spells, ensuring the other stays in business.

Marabout is not to be confused with Tchoukou. A Tchoukou is an individual who passes out modern medication (which are legally controlled and protected), however, does so with zero formal schooling and zero legal authority. As such, a Tchoukou is illegal, practicing without the authority to use controlled substances, like Tylenol. A Marabout is legal, not using controlled substances.

So if you have appendicitis and a spare chicken, go to the Marabout. If you have a headache and want a pill, any pill, go to the Tchoukou.

First Page


From the Regional Tribunal

To the Medical Director of Bere Adventist Hospital

We have the honor to come and ask you to diagnose Patient R, who was treated at your hospital. And for an equitable judicial decision.

We are counting on your collaboration.

26 May 2015

President of the Tribunal in Lai,

M


Second Page…

25/05/15

Complaint by Mr N, subsistence farmer living in Village G, Canton T, against Mrs L, housewife living in Village K Canton T in the care of Mr M, for reclamation of the health of his child after poisoning. The accused does not acknowledge the facts.

Next Section…

From the Military Brigade

25 May 2015

The Adjunct-Chief, C, Commander of the Brigade of Research of Bere, Officer of the Judicial Police, Auxiliary of the Attorney General of the Republic for the Tribunal of Great Instance in Lai

To the President of the Tribunal of Great Instance in Lai

I have the honor to willingly transmit to you the presently cited complaint for competent analysis.

The Commander of the Brigade

X


This next section is the actual formal complaint itself, written by the father of my patient.

23.05-015

I have the honor to come very respectfully before your lofty personality to address this complaint against one named: L, housewife in Village C.

I bring prejudice against her for a very serious affair which is against us. It’s an affair we didn’t even know about. It’s a miracle of God. When my child was sick, we believed it to be a sickness from God. We brought our child to different hospitals, three times to Hospital X and three times also to Bere Adventist Hospital. It was the third time in Bere when the child was operated on. During the operation, they did not detect any sickness. We were obligated to bring him home. Suddenly, the child died. It was during this death that he came back to life just as suddenly as he had died. He automatically denounced the name of the accused, that it was she who killed him. He insisted we take him to her. This was in a big crowd. This is a verified fact. This is not merely an accusation or hearsay. As we said before, it was a miracle of God. We were obligated to bring Madame L. It was a dialogue between her and the child. The child asked her, “What did I do to you at my age that you want to kill me? Please forgive me.” She refused. We were obligated to call the pastors to bless the child in the presence of this sorceress. We believed the affair was finished. We continued without problems. But to our great surprise, she called us before the village chief to say we accused her of being a sorceress. Once judgement was rendered by the village chief, she declared she wanted to take an oath. But the village chief didn’t want that. The question was posed if we should take her to the witch doctor. The village chief delegated one of his advocates to accompany us. Once there, the witch doctor declared the sorceress guilty, that it was in fact this sorceress who was the origin of the death of the child. The witch doctor commanded the sorceress to give the antidote to the child and declared that would heal him. But the sorceress said she didn’t know which antidote to give. The witch doctor himself made a decision and said, “I will give you an antidote, which you will give; if it is not you who poisoned the boy, he will not vomit. If it’s you, he will vomit.” The sorceress then gave the boy this medication before the village chief. The boy vomited, even in public. The medication was finished. Everybody told the sorceress to go get another medication, but she didn’t want to. Now there is a relapse. Everybody says there’s a piece of wood she introduced.

We didn’t do everything, but we don’t have the faculties. We don’t have cold steel nor any other weapon to combat this very sad phenomenon. Afterward, the sorcerers went somewhere to glorify themselves. We don’t know where they went, but they go home unhurt.

Therefore, we don’t have the ability, such as your superior authority as officer of the judicial police, to take the matter into our hands, to discern the good from the evil of this affair.

Waiting for a favorable continuation, Sir the Commander of the Brigade, I present the expression of my most distinguished sentiments.

The interested,

N

And the final page…

From the Village Chief of T to

The Commander of the Military Brigade of Bere

I have the honor to transmit the complaint of Mr N from the village of G, Canton T against the named Mrs L from village K, Canton T

Motive: Poisoning by fetish (sorcery).

Mr N has filed a complaint against Mrs L, who poisoned his child at the age of twelve (12) years. This woman, L, has been declared a fetisher by the seer of Village A. Having been declared guilty, the conciliation recommends Madame L to give her antidotes to the sick to recover his health, but she didn’t want to. As this is an affair which will lead to certain death, I transmit the case to you.

For the competence of Sir the Commander of the Brigade of Research of Bere.

Done in Canton T, the 22/05/2015

The Village Chief,

K

Note: The brothers of Madame L have declared that if this affair is taken to the justice, she will not do anything for her brothers, so they leave the matter in your hands.

So witch doctor is better than sorcerer and seer is better than fetisher, I guess.

I’m sorry. I just can’t muster any commentary on this. So sad. What am I doing here? Please pray God somehow gets Himself glorified in all this, cuz I sure don’t know how to do it.


Olen Netteburg

Missionarydoctors.blogspot.com

Danae.netteburg@gmail.com

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

Olen et Danae Netteburg
Hôpital Adventiste de Bere
Boîte Postale 52
Kelo, Tchad
Afrique

Volunteers Welcome!!!

Thursday, April 30, 2015

FLIP

Two weeks ago we were out in the village. It was Sabbath afternoon
and we had decided to visit one of our bush church sites, Nangere.
(Note: Nangere is both the name of a small village and the name of the
local language.)

We first went there on a Sabbath a year ago when we got lost driving
around on the moto. It was a total fluke. We had just failed at
finding a nomadic tribe who had packed up camp (literally) and up and
left town the day before for greener pastures (again, literally).
Bummed at our failure and filled with ennui, we stopped under a mango
tree next to a foot-pump well and threw out a blanket to sit on.
Villagers came up. So… We sat and sang songs and taught them the
story of Noah. They asked us to come back the next Sabbath. The rest
is relatively history.

Anyway… Of all our bush churches, we love them the best. Yes, we
have favorites. Despite not having an actual church and just meeting
in the dust under the mango tree, they are always excited when we
come. When we drive in on the moto or in the car, the kids all come
running, squealing as they run. They all start screaming, “Animaux,
Animaux!” because when we first went there we taught them a children’s
song called Animals. In fact, all you need to do is drive through the
town and the kids will come running “Animaux” at the top of their
lungs to any foreigner. Others may think the kids are calling
foreigners “Animals!”, but in actuality, the kids are just hoping
you’ll make a rooster sound!

I had a patient the other week on maternity who said she was from
Nangere. She said she came to our “church” (mango tree) from time to
time. Just to prove it to me she started singing, “Animaux, Animaux,
Dieu a fait les animaux.” (“Animals, animals, God made the animals.”)
They all know us by that song. This is mostly because Olen is never
embarrassed and belts out the sounds of animals and makes them all
laugh.

So back to two weeks ago… One of our 4 visiting ER docs from Loma
Linda happens to play the guitar really well, so we made him play for
them in Nangere. They went through all of their songs (Jesus’ love is
a-bubblin’ over translated into Nangere, Alleluia-Praise Ye the Lord
translated into French and Nangere, Read Your Bible Pray Every Day
translated into French and Nangere, Making Melodies in My Heart
translated into French, Father Abraham translated into French,
including versus that are guaranteed to make you dizzy with jumping
and dancing, etc). As usual, the kids eagerly doing vigorous action
songs in their tattered clothes stirred up an impressive dust. And
just like every other time, the Alleluia-Praise Ye the Lord song went
on indefinitely until the pitch was too high for anybody to continue
(the joys of a tonal language). Olen told a little Bible story and
then we visited with them. At the end, they asked us again to start
coming twice a week and the chief told us he’d give us a property to
build a church. He was drunk at the time, but I think he’ll make good
on his promise.

As we were visiting, I noticed a little girl trying to do a cartwheel
out of the corner of my eye. As an OLD gymnast (Ugh, I hate to say
that!), I tried to encourage her to do it again. Then I did a
cartwheel for her. Before we knew it a HUGE crowd had gathered around
me and this little girl.

Brad and Andrew, two of the visiting docs, played around a bit too.
Brad said he could probably still do a back handspring. After all, it
had only been nine years. And it’s not like he was my age. I still
had five years on the whipper-snapper.

We had no mats. This was hard, non-rained on dirt. It was worse than
cement because it was uneven too. As a gymnast, that fire in you
always burns. It’s a passion that never dies even when your body
feels more like Rice Krispies than Wheaties, and if I get that old,
will still burn when I’m 80. (“Come on, Sparky! Don’t make me get
out there with my walker and show you how it’s done!”) Occasionally,
it turns out to just be heartburn, but often, it’s still that gymnast
fire.

So Brad had to go and do a standing back handspring. I spotted him
for the first couple just to prevent any neck injuries in the bush of
Chad. But he got it down and was actually looking quite springy.

Then Andrew, who I didn’t even know knew any gymnastics, pulled off
several front handsprings!

They practically forced me to show these cute little kids how to do a
roundoff back handspring, my first in several years.

So, I plucked up my courage, pulled my junk together and did a
roundoff back handspring. Ouch, my joints. (There’s the Snap,
Krackle and Pop I had for breakfast!) Then two. I really need to do
a few more stretches next time. And switch to Wheaties.

Okay, that was about it for now. I don’t want to push it too much for
the soon-to-be Netteburg number four. (Editor’s Note: Actually, it
will pull the grand tally of “Netteburgs” in the world all the way up
to nine!) Gymnastics is okay during pregnancy, assuming you don’t
kill yourself at the time! Maybe I should wait until December to get
in shape!

Welcome, Flip! It’s an only fitting name. Lyol was Blip, Zane was
Blitz, and Addison was Spaz(z). (Please note: The parentheses are
officially part of that name.) Flip will be re-named after delivery
around November 8.

Did you make it all the way to the end of this blog?

(Editor’s/Husband's Note: As it turns out, crushing up your birth
control pills in your shampoo and lathering into your scalp is not
effective. Much better to just swallow them. Although the first method
does make your hair quite shiny.)

Sunday, April 26, 2015

17.4 WEIGHT LOSS

There are many ways to do it here in Bere. One way is with pure heat
exhaustion.

It’s hot season now. We have 3 visiting ER docs from Loma Linda. I
was happy, well not happy, but pleased. Anyway, I noticed that one of
the ER docs was completely drenched with sweat when we took off our
non-disposable surgical gowns after a complicated C-hyst (hysterectomy
done at the time of Cesarean-section, a very undesirable surgery for
both patient and surgeon, but necessary on rare occasion). It was
nice to know that I’m not the only one that sweats like a pig in the
operating room. Visitors do it too. You constantly have to replenish
your fluids here between surgeries or you will pass out (or get kidney
stones, which both of our fathers have managed to do here). However,
it’s one method of weight loss. At least until you rehydrate on the
plane trip home.

Another effective method is eating the ripe mangos that fall to the
ground without washing them in bleach water first. Giardia. It’s a
beast. First comes the belching of rotten eggs. Then comes the
bloating that you wish would go away. Then comes the diarrhea that
gives no warning and runs like a faucet. We’ve said you’ve never
really been a missionary till you’ve pooped your pants (we accept
sheet-soiling as an acceptable equivalent). It’s also a quite
effective method of weight loss if left untreated for too long.
Flagyl treats it, but also makes everything else taste metallic and
nasty, furthering the anorexia and weight loss. Once your poop stops
sounding like urine hitting the toilet bowl, you usually put the
weight back on.

Typhoid, Malaria, traveller’s diarrhea… all good methods. Being an
insanely long way away from any good restaurants or stores that have
processed foods, another good method. All easily correctable once you
return to America, however.

Watching what you eat or exercising. I’m going to have to say, not
really toppers of our list here in Bere. Unless you count refusal to
eat rice for the 21st time in one week as watching what you eat.

Although all of the above methods are good and effective, by far the fastest method of weight loss here at Bere Adventist Hospital is to undergo our state-of-the-art surgery. In February we had 3 visiting medical students from Loma Linda. They were eager and ever ready to help when needed. So when I asked them if they could help me with one patient who had been suffering with her problem for 4 years, they jumped right in. They just didn’t know it was going to be such labor
intensive work! It’s hard work to get rid of weight sometimes!

My patient was a bit unusual, however.
She looked like she was
Note how thin her arms are
pregnant with 5 babies. The only problem was that she had been the same way for 4 years! Samedi brought me her carnet (medical booklet), asking how the hospital could help. I had seen her back in 2012 and forgotten about her after filling out a surgical form for surgery.  She came back a year later and was told that she still needed surgery.  Now, 3 years later, she still had no money. So we decided to do her as a social case.

Here she is preop. I was quite nervous there would be huge vessels attached everywhere. But thankfully it was relatively mobile.

We took out a 17.4 kg ovary! (That is like having 5 full term babies in your belly at the same time!) The other ovary was small and looked normal. Her uterus was small. I WISH I had pathology. She did well post-op (in her weight-loss course) and was discharged home in normal condition. I saw her 3 weeks later and she still was going well.
Dr. Bland hold the mass
Not everyone has it so easy, but I must say, she is someone who deserves to lose weight easy as she suffered with a “pregnant” load in her abdomen for 4 long years! That poor woman! Praise God we were able to remove it relatively easy. Thanks Mason, Dad, Megan, Mai-linh (and thanks for prividing the pictures!), and Kelsey for your hard work helping!


The best part, when you take out a huge mass in Africa, is the gawkers outside of the OR. That is like the icing on the cake. Oh, and in
case you were wondering, she hasn’t regained the weight.


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!!!











Thursday, April 23, 2015

Swiss Steak

Don’t judge me while you read this.

I just downed a can of Swiss Steak. All by myself.

Opened the can, got a spoon, and just started eating it. Before I knew it, the can was empty.  Completely. And this wasn’t the first one this week. It’s like the 5th can.

It might be okay if I had shared some with my sweet children or loving husband. But I just ate them all by myself.

The rice and beans, beans and rice thing is getting old. Toast with peanut butter and mango sauce is good, but not the 20th day in a row (although my husband seems to never tire of it).  Sometimes you just want some good ole’ soybeans, processed to the point of unhealthy and unrecognizable in a form expected to marginally resemble meat in taste and texture!

So this week, I caved in. When no one was watching I would just open another can and down it.  I’ve got one case left. It’s soon to be gone.

What’s next?

Swiss steak now sounds disgusting.

Tonight I downed a whole can of Chili Man all by myself.

Now I know what you’re thinking. You’re thinking, ‘Well that’s not so bad.’

The problem was, I snarfed it down WHILE I was preparing my actual dinner.

Now you may still be thinking I’m not a gluttonous gluten-ous pig, addicted to fat and salt tainted with a touch of soybeans. But what if I told you the dinner I was preparing was Swiss Steak sandwiches? Which I ate, despite the appetizer of an entire can of Chili Man.

And I don’t even feel guilty. What’s wrong with me?

As it is I’m always 10-15 pounds skinnier here in Africa than in America! I need calories! It’s so hard to find processed food here!! I’m tired of eating healthy! Give me processed Adventist comfort foods, laden with chemicals!

Thank you Loma Linda (Jerry Daly) for sending us so many cases of veggie meat on the last container!!! I’m not sure who exactly is responsible for donating the veggie meat, but I am so happy to have it! Thank you AHI for sending the container of medical equipment and personal items for missionaries. All those stethoscopes made for a handy cover story allowing us to import cases of veggie meat.

PS. If you don’t know what the vegetarian product Swiss Steak is, you are missing out.
Google it! Then buy two cases. Keep one and send me the other!

PPS. If you happen to be the President of Worthington Foods or Loma Linda Foods, feel free to send us a care package of your finest soy products. We promise to write rave reviews!!! Or if you happen to be acquainted with the President of Worthington Foods, go ahead and let him know we’re waiting. Or if you happen to have internet, Google

Kids unloading crutches from the container
that came in November

‘President Worthington Foods’ and tell him to hook us up!!!

Sunday, December 28, 2014

Got milk?

Got Milk?


It’s me, Addison, the baby of this great Netteburg family.


I’m so thankful for my mommy. She loves me. She also gives me milk. It’s one of my favorite things in the whole world. And it’s good for me too!


Do you like milk?



Mommy says breast milk is the best. I’m so thankful that my mommy could give me what I needed to get big and strong. Now I’ve graduated to special powdered cow’s milk. Yum! It’s so good.


Sometimes families here need help with milk for their babies. Mommies die here, leaving a grandma or an aunt to become the new mommy. The new mommies don’t have breast milk or enough money to buy powdered baby milk.


We have a program to help the new mommies. We have anywhere from 12 to 24 babies at a time in our baby milk program. They find out about us from word of mouth. We do an investigation via tribal drum languages to surrounding villages to make sure they are legit. Then one person comes once a week to get milk and work a little. The babies come with their new mommies every few weeks.


Our friend Tammy used to run this program, but she moved back to America, so now we have been helping out the orphan babies since this past summer.



Mommy says that true religion is to care for the orphans. I guess these babies just don’t got milk and need it. It’s as simple as that.


My friends in the pictures are not orphans, but their mommy had THREE babies at a time in June. I think she was getting another chance at having lots of babies because she has had 6 children die. Now she has 4 children! The triplets breastfeed, but mommy helps them out with 1 can of baby milk per week. They are 5 months old and looking so cute!


An orphaned baby usually gets 1 can of formula per week up to 1 year of age. Each can costs $6. So for the 12 babies currently enrolled, it costs $288 per month (that’s a lot of math for my 1 year old brain). This past summer we had up to 25 babies in the program, but many of them graduated.


I love helping my mommy with this baby milk program. I know you will too!


If you want to help with this program, you should still give via AHI. Just tag it Bere Baby Milk.


Merry Christmas! Love Addison Noel  

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!!!

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.