Thursday, December 30, 2010

#6 Breech

Rat a tat tat.  The nurse knocks on the door at 6:30am.  I was already awake the day after Christmas to do some post Christmas shopping at the local mall.  Just kidding, but I was already awake with Lyol.  

Since my French is so bad, I thought the nurse said to come for a face presentation to labor and delivery (when the presenting part of the delivery is the face as to the back of the head).  I quickly look up again which face presentation is able to deliver vaginally, grab my headlamp (NEVER leave home without it), and head over to maternity.  I discover a breech presentation (butt first), which the nurse knew the whole time and had already written it down on the admitting paper.  (I just didn’t understand her.  I thought I had even pointed to my face.  Oh well, you just roll with things here, and it goes better).  

Now those of you who did residency with me know that I have been SEARCHING and WAITING for a breech presentation to deliver vaginally for me.  But....they just don’t happen in the states very often anymore!  They usually end up having a cesarean section.  Silly lawyers!

So, I check the fetal heart and it sounds good.  The woman in front of me is exhausted, and delivering her 8th baby!  The baby's bottom is still pretty high, and though she’s having contractions, they are not very frequent.  

What?  A chance to do a vaginal breech delivery and she is done with her contractions????  And...on her 8th baby, it should be easy for her!  I do not want to do a cesarean on her.  Even in good hands, cesareans are still hard here.  During my second one last week the lights went out and all I had was my headlamp to keep going (that patient bled like crazy too).  The lights came back on with the generator, but it’s just not as easy as in residency when we had all of the help needed!  

This is only my 2nd week here, but already I’ve learned to do a somewhat barbaric pitocin drip to increase contractions.  In America we use a machine to program the amount of IV pitocin the patient receives.  Add pitocin to the bag, watch the drips.....and turn it up or down based on the contractions.  I don’t have a protocol yet, but hopefully soon I can make one.  These little IV lines are not that wonderful at controlling the rate either.  

So...I decide to start the pitocin SLOWLY and give her 2 hours before going the surgery route.  Maybe there was another reason why she wasn’t delivering (like maybe malformation???). 

I head back home for a quick bite to eat, check on my sick malaria ridden husband and child, and then head back to maternity.  I’m a little sad that this will probably end in a c-section. 

When I return to maternity, I am surprised; the butt and legs have already delivered and the nurse is pulling on the body.  In my head I yell no!!!!!, but rush over there silently and slip on gloves.  Even though we didn’t have many breeches in the states, I know that you are supposed to try to let the mother push a breech baby out, otherwise things get stuck easier (keep your hands off!).  The arms were stuck over the head, but easily came down after sweeping around each shoulder.  

Now for the head.  I had searched earlier for some piper forceps just in case I would need them if the head were to get stuck, but couldn’t find any forceps.  I know the assistant is supposed to help hold the baby with a towel so you can delivery the head, but....we had no extra towels.  The mothers don’t even have much to clean up with here after a delivery.  You just use the clothes they were wearing to clean up the blood and poop.  With the head in a tucked position while pressing over the mouth, the head delivers easily.  Thank you God! 

The baby boy is a little floppy.  I put it on the mother’s belly for warmth, and grab the ambu bag (with no oxygen since we don’t have that here!, I learned the hard way last week).  After suctioning out the thick mucus, I give a few breaths with the ambu bag.  The baby starts to revive and I stimulate the back and feet, and then cut the cord.  I hope this one survives.  

As if delivery is not hard enough sometimes, it seems like the babies here have all the odds against them.  Only 1 of my first 6 deliveries here are living from last week.  I truly miss my labor and delivery nurses and NICU team!!!  Two had died before delivery, but the other 3 should have lived!  They were “term.”  It’s difficult sometimes to know if the babies are being fed during their first day of life.  Two of those babies died because they were just not checked up on.  Found out later they hadn’t eaten all day.  The nurses leave it to the patients to tell them if there is a problem, and the patients don’t know when to tell until it is to late.  With my improving French, hopefully I’ll be able to educate more and help these little ones survive.  They have a hard enough life ahead of them to start off with difficulties.  

As most of my ex-co-residents could guess, this same mother went on to have a post partum hemorrhage (8th baby), but thankfully we have pitocin here, and I was able to evacuate all of the clots.  I found out we even have methergine (another drug for postpartum hemorrhage) and used that too.  I explained to the husband to press on her belly every 10 minutes to make sure he felt the hard uterus and tell someone if she was bleeding a lot.  

It was a most GLORIOUS post Christmas day with the good health of a mother and new baby, and for me....the present of a vaginal breech delivery!!!  It is nice to be an obstetrician here.  It’s not about the lawyers, it’s about trying to save a life (or 2).  Now I need to learn to be a pediatrician as well. 

Posted by Danae Netteburg, the well, non-malarial doctor.

#5 The Blow-by-Blow

Disclaimer: This was actually written in real-time and has not been edited.

December 22

9PM: Lyol blows chunks in bed. Danae heroically scoops him up and rushes in to the bathroom. He throws up three times before arriving at the shower. Once at the shower, he stops tossing his cookies.

Much less heroically, I’m trying to fold up the sheets in a way that don’t allow leekage of the liquidy emesis, but all the while forgetting that every precious second allows more barf to seep through onto the mattress cover. Oh, and we’ve placed 90% of our clothes on our bed to motivate us to put them away before going to bed (didn’t work, we were practically asleep with all sartorial appendages still adherent to the bed). I throw the clothes around to get the sheet off without placing the clothes on the soaked mattress pad or on the unbelievably dusty floor.

Lyol fusses, but falls back asleep. I set to putting away all the clothes. Danae, ever the heroine, cleans up the vomit. Very foul-smelling chunks of still-recognizable watermelon and seeds mostly.

I think... He’s had a little diarrhea today. Come to think of it, it did smell extra special today. I figured it was just my sensitivity since we changed to cloth diapers today. And he feels warm (which intellectually, I know means nothing). Well, diarrhea in the states I don’t care about. Why should I care about it here? Oh right. Malaria, typhoid, parasites, etc. Hmm...

Our Arm & Hammer based cleaning spray is still marinating the mattress pad... and it still smells of vomit. The mattress pad goes in the laundry.

We place Nanny’s large green pad (the one assigned the task of keeping furniture smelling nice) over the offending spot and place Lyol on top of that.

11:30PM: I feel the need to shower.

And so I shower.

6AM: We wake up. Danae and I realize that we feel a little queasy. I eat a little rice and stew. Danae stays back with Lyol. I grab a water bottle and head for the hospital.

At the hospital, I continue to ponder... can it just be a benign reason he’s sick? If this were the states, I’d say virus and remain well-hydrated. Oh yeah, we’re in Africa still. It would be beyond strange for us to all have malaria at once, and we’re all feeling queasy. Must be some intestinal thing, not just a side effect.

2PM: I make it home for lunch. My stomach has been gurgling. I go to the bathroom. That’s interesting. I could have sworn I was pooping, but it sure sounded like peeing.

3PM: Lyol blows chunks again. This time it’s banana. Doesn’t smell as bad. Daddy gets to be the hero this go-round. He’s still going through cloth diapers like he’s shooting skeet.

5PM: I lay down the ultrasound probe. I turn and tell the husband that his wife has a liver that reaches down to her pelvis. It’s probably cancer. My stomach turns. That’s odd. I’ve delivered much worse news, this week even, and never been queasy from it.

6PM: I’m in the hospital, in my office. I’m talking to Mr le sous-Prefet about the new HIV diagnosis his family member has. My stomach rumbles loudly for about 30 seconds. It sounds like sloshing water.

I wrap up the meeting as quickly and as tactfully as I can and head home.

7PM: Ok, two emergency trips to the bathroom in the last hour, but I’m feeling pretty good now.

Danae and Lyol are sleeping on the couch. Our anesthesiologist (who didn’t have any actual formal training) stops by to ask for a computer lesson. We practice turning it on and off, logging on and off, opening/closing programs, saving files and he goes home.

7:20PM: Whoa. What was that? A chill? I’m in Africa. Danae’s in short sleeves. Lyol’s in a diaper. I’m wearing a sweatshirt. I’m always the last one to get cold. Not cool.

7:30PM: Hmm.. This has progressed from simple queasiness to full-blown nausea. I could steal my wife’s Zofran, but it’s not nice to take medicine from your pregnant wife. I learned that on the internet somewhere.

7:40PM: Why do my joints feel stiff? Time to grab my Tropical Infectious Disease textbook. Wow, that’s a lot of words dedicated to my symptoms. Let’s try Tintinalli. Hmm... typhoid fever? Danae and Lyol and I are all afebrile. Malaria? Again, unlikely we all got it at once. Simple food poisoning? Probably, but hey, we’re in Africa. Hey, that’s vertigo I just felt. Stop that.

7:50PM: So it strikes me that I’ve asked for this. I always wanted to be a ‘real’ missionary. ‘Real’ missionaries get malaria. Maybe that’s what I’ve got. This isn’t as much fun as I expected becoming a ‘real’ missionary to be. This is no fun at all.

8PM: Shaking chills. A rigor. I always imagined it being a relief to have a cold sensation in Africa. Nope.

8:10PM: I’ve been checking my temperature. It’s gone from 96 to 97 to 98.4 to 98.7 to 99.2 to 99.3 to 99.4. Somebody give me a lighter. I want to at least have a fever if I’m going to feel this bad.

8:20PM: I swear I just got hit by a truck. One of those overloaded African trucks carrying cargo easily three times as tall as the cab of the truck. Yeah, one of those suckers must of just hit me. I should probably go to bed. It wouldn’t be the first time I’ve gone to bed this early in Africa. I’m exhausted. My back hurts. My stomach hurts. I have a headache. I can barely keep my eyes open. I’m afraid if I lay down I’m gonna ralph.

8:30PM: Lyol hurls. In his sleep. He wakes up for a couple seconds afterwards, but he’s just too tired. I clean it up. These bananas smell worse than the last ones. I throw the couch cushions outside and make a mental note to apologize to the Appels for getting vomit on their bed and couch. Actually, I suppose I shouldn’t apologize until tomorrow. We’ll probably be getting vomit on something else too. Might as well be efficient and stream-lined in our vomit-stained apology.

8:40PM: Oh yeah. I’m sure of it now. I’ll be vomiting with Lyol shortly. I don’t know if I see the hospital patients being rounded on tomorrow.

8:50PM: 99.6. Come on fever. Big money. No whammies.

So what should we get tested for tomorrow. Malaria? Typhoid? Stool ova and parasites? Urine? Any number of other things? Is there a test for dengue? Or yellow fever?

I’m really thirsty. I want to drink. But I think that will just add fuel to the fire and might be the difference between making it to the bathroom in time or not.

Why does my neck hurt? Is this meningitis? I have been diagnosing that quite a lot and doing lumbar punctures without face masks or shoes. Could I have given it to Lyol and Danae? I’d actually feel pretty bad about that. Oh hey, ebola! I hadn’t thought of that. Not much sense in testing for it though. Not much to do.

I’ve been diagnosing patients clinically with tetanus and rabies in the hospital.

Tularemia? I saw a rabbit the other day.

Plague? Sure, why not?

Diphtheria? Uh, probably not. I’m vaccinated.

Spotted fever? As good a guess as any. If I could just get that fever.

Anthrax? I did see some weird things on people’s necks that looked kinda like super-early anthrax lesions. I diagnosed them with tuberculosis and Burkitt’s Lymphoma. They seem to be getting better with treatment. So probably didn’t catch anthrax.

Leptospirosis? I just like how that one sounds.

Shigella/Salmonella/Campylobacter? Those all sound like great options. I’ll put them up high on my differential.

Polio? Unlikely.

9PM: Note to self. Please please please. Do NOT belch again. That was dangerous and highly unpleasant.

I have had no encouraging signs whatsoever that make me think I’m not going to vomit before this is all over.

What should I be starting in the morning? Azithromycin? Cipro? Flagyl? Quinine? Mebendazole? Praziquantel? All of the above?

Man, I just can’t keep my eyes open except out of feel of vomiting.

Come on Netteburg! You have an iron stomach! Man up!!!

9:10PM: Ok, can’t stay up. Going to sleep. $20 says I vomit by sunrise...

11PM: Another urgent trip to the toilet.

1AM, December 24, Christmas Eve: Another urgent trip to the toilet. My money’s now on giardia.

2AM: Another trip to the toilet. This time the nausea is pretty severe. I pick up a pressure-cooker pot and take it with me. I’m choosing between which end to stick in the toilet and which end to risk. More severe diarrhea. We’re out of the good toilet paper. Now we’re using the toilet paper which doubles as a file for camel hooves. Awesome.

3AM: It’s coming hourly. I’m laying in bed deliberating how last-second I should wait. My back is absolutely killing me. I think it’s because I’ve been sleeping semi-upright. I dare to lay on my side. The nausea’s worse. I hear Lyol pass a load of diarrhea. I think it psychologically stimulates my intestines. Now I need to go. I hand a diaper to Danae and head to the bathroom. Back in bed, it smells pretty horrific. Danae says the diaper leaked a little.

5AM: Sweet. We’re now spacing it out to every two hours. Oh wait. Oh no. I just lost my lunch (since I didn’t eat dinner) in the toilet. I would think with all the diarrhea there wouldn’t be anything left, but sure enough, there’s quite a bit. And it’s coming out quite violently. I wash up, trying to get the vomit out of my nose. I collapse into bed. Hmm...

7AM: Danae takes one for the team and decides to go round by herself. Lyol keeps bringing me books and climbing up into the bed and playing quietly while Daddy sleeps.

9AM: Danae’s done with surgery and maternity. After I suck it up and steal my pregnant wife’s Zofran I feel a little better and agree to accompany her on medicine and pediatric rounds. We stop at the lab do get a malaria test done on Lyol and me and to drop off my stool. Danae notes all the petechiae on my face.

10AM: My head is pounding. I’m dizzy. I’ve been drinking quite a bit while rounding, but I feel pretty terrible.

Noon: Danae leaves me for surgery. I finish up pediatrics and start some ultrasounds and ER visits.

1PM: The lab visits. Lyol and I both have malaria. What the deuce? I’ve lived in Africa before. I’ve visited several times before. I’ve traveled many times to endemic zones in South and Central America. I’ve been to Southeast Asia. How have I been in Tchad for less than two weeks, during dry season no less, and have malaria? Oh well, at least I’ve officially attained missionary status.

2PM: I take my pills. Lyol cries and vomits when he tastes the quinine. I try to explain to my 22-month-old son that his options are either take the medicine or get an IV. He just doesn’t get it.

3PM: Come on. Daddy needs a new pair of shoes. Yes! 101. Officially febrile. Finally.

4PM: I nap.

5PM: Danae wakes me up to play with Lyol. Mostly I sit on the couch and he brings me books.

5:30PM: I ride on the back of a motorcycle to Gary and Wendy’s (missionary couple down the road). Wendy serves a delicious meal of banana bread, cinnamon rolls and plum pudding. It smells delicious, so I imagine that it is and I go lay down on the mattress in the middle of the room and fall asleep. I awaken intermittently to Christmas carols and Christmas stories. I actually love the good Christmas company, but I contribute zero to it.

8PM: We’re back at home after another motorcycle ride. I take my first pee of the day. I feel like I just ran a hundred miles. My joints hurt, my muscles hurt, my back hurts, my head throbs, my stomach churns. I don’t think I’ll be awake at 10PM for my next quinine dose. I take it and go to bed.

5AM: Hooray! Made it to 5AM with only two emergent trips to the bathroom!

6AM: Lyol’s up and wants to eat and play. How come he has malaria too and is bouncing all over the place? Well, at least I’m feeling better. Just a lingering headache.

7AM: Wow, I’m really dizzy. This is borderline trippy.

8AM: Well, I guess my stomach isn’t completely cured. Still quite nauseated, but able to eat a piece of bread and keep it down.

9AM: Lyol barfs. I don’t think we’re making church today. I think most of the patients will need to fend for themselves until tomorrow.

9PM: Wow, what a Christmas. I was too dizzy/nauseated/fatigued to leave the house until an hour ago when I had to go see an urgent patient. Constipation. To their credit, he was really constipated. I thought he had splenomegaly just like all the other malaria patients, but when I ultrasounded it, his spleen was peristalsing alot like intestine. Man, they’re right. Quinine really does affect your ears.

A Merry Christmas to all and to all a good... Oh hang on. Gotta go. Be right back.


It’s now December 28. I can say I’m on the downslope. Currently, I’m only suffering from quinine and no longer from malaria. This stuff is the most bitter medicine in the world. It also makes you very dizzy and nauseated. I have barely eaten in the last week, but fear not. I packed on enough reserves in France that I’m doing just fine.

As always, we can be reached at

You might be in Tchad if...
You think you’re pooping, but it sounds like you’re peeing.

#4 Doubts

I wake up in a cold sweat, crying. A nightmare? Just thoughts. Voices. They’re pulsating in and around me. Crushing down on me from every possible direction. It’s too much for you. It’s too much for you. 

I know immediately what the voices are talking about. Tomorrow, I take my wife and infant son to Africa. And we just learned that Danae’s pregnant. 

The voices are so real, so vivid. I can’t be crazy. I’m a little old for a first psychotic break episode. But yet they keep squeezing the life out of me. I can’t breathe.

I sit up. They still taunt me. It’s too much for you. What are you doing? What are you thinking? Are you trying to save the world? You don’t even speak French. You don’t know enough medicine. What are you doing? It’s too much for you. You can’t help. You can’t do it. It’s too much for you.

I walk around the dorm room. I tell myself over and over. It was just a bad dream. Maybe you’re still dreaming. Snap out of it. Pinch yourself.

I get back into bed. Stress. It’s all just stress. But the voices, real as any, continue. It’s too much for you. It’s too much for you. You’re too weak. Too feeble. You can’t do it. You can’t can do anything. You can’t help people. It’s too much for you.

I acknowledge the truth. It IS too much for me. It IS too much for me. It IS too much for me. I realize the voices are right.

Perhaps we should go back. How can I explain that decision to my wife? How can I explain it to our families? How can I explain it to the church? How can I explain it to all the people who have donated to us?

It IS too much for me.

I realize the truth. It IS too much for me. But I know One who can accomplish all things. I know One through Whom I can accomplish all things. I know the One who strengthens me. I know One for whom it is NOT too much.

I reach up. I reach up mentally. I reach up spiritually. I reach up emotionally. I reach up physically. Literally. I take hold of the hand of the One who strengthens me, of the One who can do all things.

The voices continue. I claim the promises of God. It’s too much for you. I still hear it over and over again. Yes, it IS too much for me. But it’s not too much for Him. One by one, layer by layer, the crushing all-encompassing voices lessen. I can breathe again. Soon, all the voices are gone.

I’m just a boy now. Walking along with his hand stretched up as high as it can go, holding onto his Daddy’s hand. Not a care in the world.

I’m asleep again.

As always, we can be reached at

#3 Language Submersion

At the last second (which seems to be the way all things have fallen into place), the General Conference was able to arrange for three months of language study for us in France, at the Seventh-day Adventist school in Collonges-sous-Saleve.

We left our loving families and boarded the plane, knowing it would be many months, many countries, many continents and many changes before we would return. All-in-all, there weren’t many negative emotions, as we had both left our home country many times before (and for longer stretches) and we felt strongly that God was the One dragging us overseas.

Landing in Geneva after an overnight flight and a connection in Charles de Gaulle airport in Paris, we stumbled to baggage claim, only to discover our bags were missing. Sparing you the rest of the story, our bags arrived several weeks later.

We move into our dorm room. That’s right. For the next three months, we’ll be in a dorm room. Lyol has his little bed in the corner. Danae and I have two twin beds that we’ve romantically pushed together. We don’t have any sheets or blankets to cover both, so we keep to our respective beds. You know, living in a girl’s dorm isn’t all it’s cracked up to be.

A few days later, we move to a different dorm room. Pretty much the same, but on a floor without students so Lyol won’t disturb people.

On placement test day, we guessed that I would get a better score than Danae, so Danae watched Lyol while I took the test. Turns out it wouldn’t have mattered. Debutant Francais for us!

The first Sabbath, I awaken with an uneasy feeling. What am I doing? I took my wife and infant son to France for three months before going to Africa. Is it really smart to take your family to Tchad? Is this really what God wants. I trudge to church with an empty heart. Lyol is fidgety, so Danae takes him outside while I sit in church alone. I can’t understand a word they’re saying. I can’t understand the songs, even with the words projected on the screen. My pronunciation is so bad it sounds like I’m singing a completely different song than anybody else. I’m too old to learn a new language. After a year in Bogenhofen I didn’t speak enough German to function as a doctor. Now I’m supposed to do it in three months? A dorm room. I’m 31 and living in a dorm room. The front door locks at night and I can’t get in and out after hours. And I’m 31. I can’t even enjoy church. This isn’t going anywhere. This is impossible. It’s too much.

Church is over. I meander outside to find Danae. As we’re leaving, Gosia finds me. Gosia is one of the language professors, although she doesn’t actually teach us any classes. We’ve already bonded, because she speaks German. I try to talk to her in French, but my French is so bad, that it usually becomes German. She’s actually Polish, but learned German and French. She introduces me to her husband, Philippe, and her two young sons, Sebastian and Thomas. She invites us over for lunch. I say great, but I hardly feel like it.

After a day with Gosia and Philippe, I feel rejuvenated. I’m reminded that, even though we don’t speak the language, we share so much in common. They speak so many languages, that surely we can learn enough French to help people. Now I know our time in France will be okay.

Three months in France fly by.

As always, we can be reached at

Tuesday, December 21, 2010

#2 God's a Biker

In early September, we packed our 20-foot container of all the belongings we would need for the next six years. On Tuesday we learned that two days later, packing day, we wouldn’t be able to ship the vehicle we had bought the week before, specifically for Africa (4x4 diesel Toyota, sayonara $8000). Hence, we reduced the container from 40 feet to 20, unpacked everything and re-triaged all our belongings to suit an unfurnished house for the next six years. We ended up leaving many things behind, but we know we still have everything we need.

It was interesting to wrestle internally about bringing things for the hospital versus bringing things for us.

Processing the news that we couldn’t ship our car and that there was no reliable vehicle at the hospital, we decided to buy motorbikes.

We found a motorbike over an hour away from our house, about four years old. It was moving day. After not sleeping the night before (due to packing), I picked up a U-Haul trailer at 7AM. My friend Don drove out to pick up the motorcycle. Don called later to say that the man wasn’t ready to sell the motorcycle because it was still in the shop. Mildly perturbed, I called all the motorcycle dealers around. The closest one had two motorcycles left of the exact type we were looking for and gave us a wonderful deal, provided that we could pay cash.

Don was driving back and stopped at the motorcycle shop. Between what I was able to withdraw from the bank and what he had, we had exactly the right amount of cash.

As I was in the motorcycle shop, the first motorcycle owner called. As it turns out, Don had actually met some other man with the same type of motorcycle for sale at the same shop in the same small town in Western Massachusetts!!! The first man still wanted to sell the motorcycle, but there was no time to go pick it up again and we were signing the papers for the two motorcycles in the store. (In addition, the brand-new motorcycles were discounted to the point of being almost as cheap as the used one.)

I convinced the store owners to not register the motorcycles in Massachusetts, saving me money. We left the fuel and oil tanks virgin and never connected the batteries, making the motorcycles much better for shipping.

I drove the motorcycles back home on the trailer, where the movers had waited impatiently (but waited!!!) in front of the house for thirty minutes to get the motorcycles on our container.

Going inside after an exhausting day, I checked email and read the message that any motorcycle over three years old would not be importable. If we had bought the first motorcycle, we would have been stuck.

I don’t know why, but God wanted these specific motorbikes in Tchad.

To all who want to contact us...

#1 Arrived!

Where to start... I was born... skip a little... I went to school... skip some more...

In college, Danae spent a year in Zambia. She spent much of that year in a rural clinic. She knew she wanted to go to medical school and return to Africa.

After college, I spent half a year traveling Africa. The original plan was to spend four weeks in a hospital (with my friend, who was deciding between medical missions in Africa vs medical missions in America) and four months doing what I wanted to do (preparing videos for the church).

We had a blast in the hospital. We stretched four weeks into five before our video obligations drew us elsewhere. On the train leaving Heri Hospital in rural Tanzania, I knew I would be missing something if I didn’t go to medical school and return to Africa.

My first year in medical school at Loma Linda I met a girl. She was up front in church talking about a mission trip to Ethiopia. All I knew about her was that she was hot, compassionate, funny, intelligent and passionately in love with God. I turned to my friend beside me and said, ‘I’m gonna marry her.’ (By way of full disclosure, I said that a lot, just because I thought it would be awesome to be able to say that some day about my wife.)

After she shot me down asking her out on four dates, she eventually recognized that true love ignores restraining orders (just kidding) and married me.

Danae finished medical school a year ahead of me and began Obstetrics/Gynecology residency. The next year, God answered prayers and I started Emergency Medicine residency in the same Massachusetts hospital.

Two years later we found ourselves preparing for the mission field. On a scouting trip, leaving the capital of Tchad, N’Djamena, on the was to the Adventist hospital in Bere, Tchad (southwestern Tchad), we felt like we had found our home. One week later we asked to replace the departing doctor and were conditionally approved. This was August.

In April, we found ourselves beginning the formal process of becoming missionaries. So many miracles fell into place that I don’t think I can describe them all here. Many individuals in the General Conference worked very hard to overcome some slow political machinations to get us to Tchad. Everything fell into place in the exact timing necessary without even breaking any protocols, although I must admit being nervous staring down $300,000 in medical school loans coming due and being unemployed right up until the last possible second.

August 13, we became missionaries (even though it had to become retroactive), employed by the General Conference of Seventh-day Adventists.

For those who wish to contact us...