Monday, November 10, 2014

Arrived

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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Baby girl screams.


Relief.


Close mom up.


Survey the scene.


Beautiful.


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


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


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

Saturday, November 8, 2014

Abortion

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


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


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


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


What is abortion? It’s terminating a pregnancy.


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


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


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


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


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


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


So I decide.


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


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


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


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


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


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


So did I take one life to gain another?


Yes.


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


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


Maybe.


Would mom have had a higher chance of dying?


Definitely.


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


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


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


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


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


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


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


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

Nasty

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


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


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


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


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


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


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


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


So I did. And it’s a good thing.


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


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


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


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


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


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


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


HIV test came back.


Positive.


Uggh….


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


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


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


Yes, I should have been wearing protection!


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


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


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


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


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


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


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


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

Sunday, October 19, 2014

RhoGAM

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

Of course it would all be worth it…

if there was a heartbeat still.  

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

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

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

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

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

But ours was not to be.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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


Don’t take first-world medicine for granted!

The Meaning of Missions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We found their camp… abandoned.

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

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

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

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

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

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

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

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

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

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

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

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


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

Wednesday, October 1, 2014

From the oldest kid, Me-Lyol


A note from Lyol to the Williamsport Eagles,

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

Hello from Tchad, Africa!

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

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

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

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

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

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

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

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

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

love
lyol

missionarydoctors.blogspot.com

Olen Tigo: +235 91 91 60 32
Danae Tigo: +235 90 19 30 38
Olen et Danae Netteburg
Hopital Adventiste de Bere
52 Boite Postale
Kelo, Tchad
Afrique
Volunteers Welcome!!!


Saturday, September 20, 2014

Other Contact

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

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

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

Sunday, August 3, 2014

Perfect Timing


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

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

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

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

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

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


“Olen get out here!” I screamed again.  

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

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

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

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

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

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

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

Now came the scary part.    

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

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

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

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

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

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

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

“In my house!”  

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

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

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

Monday, June 16, 2014

Same old, same old...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



Saturday, May 24, 2014

Entertainment


Things we do for entertainment in Tchad…..

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

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

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

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

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

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

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


Bok


The Things We Do for a Bok

Two quick chicken stories:

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

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

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

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

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

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

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

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

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

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

love
olen and danae

missionarydoctors.blogspot.com


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

Olen et Danae Netteburg
Hopital Adventiste de Bere
52 Boite Postale
Kelo, Tchad
Afrique

Volunteers Welcome!!!

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."