Wednesday, December 28, 2011

#86 Milk

It’s Saturday night. We’re having a good time hanging out with Olen’s parents who are visiting.

Knock on the door. As a good husband would do, Olen answers it. But it’s for me.

I decide to go in to see a pregnant patient who isn’t breathing well.

I didn’t bring my headlamp because the moon is bright tonight. I should have. I get to maternity and the light is not working. I don’t know why. It’s probably burned out.

The nurse points her light on her phone towards the patient so I can see her. She is young and on her first pregnancy at 8 months. She is sitting straight up in bed. I have her lay down. I put my hand on her belly as I try to get a little more history.

She came in this morning. Her hemoglobin was 3. She got a bag of donated blood and got started on IV quinine for malaria.

I can feel contractions while I listen. She needs more blood. We don’t have any in our bank. I tried to get a blood drive going a month ago. I explained it all to the lab and left it in their hands. But sometimes you have to micro-manage everything here. Or it doesn’t get done. So, we have very little blood in the bank right now, and none of her type.

I check her cervix. She’s dilated a little and the cervix is quite thinned out. I wish we could stop her labor.

I asked for more family members to come to give blood. In the meantime I ordered IV fluids, steroids, and antibiotics in addition to the quinine being given. We are all out of nifedipine (a BP med that I give to stop contractions). I ordered salbutomol to try to stop her contractions.

In the meantime I go over to Urgence to tell Baikau what’s going on. She tells me about a woman who just died. They just came in this afternoon. It sounded like malaria. They have a 2 1/2 month old son.

I walk into the dimly lit room of the medicine ward. All 8 beds are full on the women’s side with patients. The family is gathered around one bed that has a brightly-colored African cloth over the body of the woman who died. A female family member sits on the bed with the baby boy. He is a healthy looking boy, but is sleeping right now.

He will need milk. He is sleeping, but he will wake up soon and will need to eat. It is the custom here to take the body as soon as somebody dies to start the funeral services. I told them I was very sorry, but they needed to wait for some milk for the baby. There was no one in the family who was breastfeeding and could share milk.

Thankfully we have a mother Teresa here on our compound. Tammy (who watches my boys) is like a modern day Dorcas here. She has a program for people who need milk formula. They come to her and she has them do a little bit of work to pay for the formula. She has 8-10 in the program right now and gets money from donations to help pay for the milk. It’s about 6 dollars for a little canister. That doesn’t sound like much, but when you are a family that only makes 1 dollar a day (if that), that is way too expensive.

Now when I say NEED milk, that’s exactly what it is. It’s not a choice here to breast or bottle feed. If the mother dies or she has HIV, then the baby NEEDS milk formula.

I walk home quite sad that this cute little boy has just lost his mommy. But we can do something to help here. I knocked on Tammy’s door and explained to Cory (Tammy's teen-age son) that I needed some milk. He brought me out a canister.

Cory was the reason Tammy started this whole program. A year ago he told his mom about a baby in a village who had lost his mom. She decided to help and it has grown from there.

I boiled some water and poured it into 2 glass jars to give to the family. They don’t have means to store clean water otherwise. I grabbed a bottle that I had bought from the states and headed back over to the hospital.

Cute little boy was still sleeping. I explained everything to the dad and 2 female family members. They tell me they can’t stay the night because they have to take the body back to the village.

You will notice on our blog,, that we have a link for donations. This is through Adventist Health International’s website. We believe strongly in the mission of AHI. We feel that AHI is an organization worth supporting. By donating through AHI, you can be reassured that there is a strong measure of accountability following your donation. Just mark the donation for ‘Bere.’ And remember that your gift is 100% tax-deductible.
Olen Zain: +235 62 16 04 93
Danae Zain: +235 62 17 04 80
Olen et Danae Netteburg
Hopital Adventiste de Bere
52 Boite Postale
Kelo, Tchad
Volunteers Welcome!!!

Tuesday, December 27, 2011

#85 Witchcraft

There is witchcraft here, so I don’t want you to take this too lightly. But witchcraft wasn’t the case here. At least I don’t think.

Last Thursday night was a very busy one for me. I had been inducing a severely preeclamptic woman who was 37 weeks pregnant. The nurse who was covering maternity and surgery was less than ideal, so I stayed in the hospital to watch the oxytocin drip and make sure the BP was getting taken. I’ve been burned before by eclampsia here. I was in all evening, then went home at 11:30pm and came back in around 1am.

Her BP’s were getting too high, so I was considering throwing in the towel and doing a c-section when another patient came in around 2:30am. Her name is Isabelle and she was on her first pregnancy at 9 months. Her sister brought her in when she found her in labor at home. Apparently Isabelle had seized. BP written down by the nurse was 110/70. Sometimes women fake seizures here when they are tired, so I took note. Plus there is no pain killer here for labor, so they really suffer.

There was no fetal heart by the doppler and I could already see the head. Who knows how long she had been pushing. She could push a little, but didn’t have enough force. The sister kept holding the patient’s mouth shut and pushing on her chest to try and help. The patient’s lips were swollen.

Then she seized. It lasted about a minute.

Okay, that was a real seizure! BP 190/130. Great, no IV antihypertensives! (I have ordered some from Kenya by the way. They should be here by March).

There were a couple of used Kiwi vacuums in a drawer that had been washed. (I didn’t have any new ones). The forceps were all in the OR. One of the vacuums still had some suction left in it. I cut an episiotomy, put the vacuum on, and pulled out the baby. The student nurse had a stethoscope, and I had her listen to the baby to make sure it wasn’t alive. I rechecked, no heartbeat.

I sewed up the patient, cleaned her up, and several of us carried her into the maternity ward at 3 in the morning. There are 5 beds in the biggest room with many family members sleeping on the floor. A few little kids woke up to get out of our way, so lots of crying accompanied.

After we got her situated, I asked the husband how many times she had seized at home. Four was his response. Six was the response another family member at the exact same time. So in reality it was probably like 10 or 15 seizures at home.

I knew it was eclampsia (seizures that goes with high BP in pregnancy), but I have seen malaria with eclampsia too. So...I also started her on IV quinine.

There were seven or so family members by now in the room. I explained a little of what happened, then headed off to the OR to do my induction’s c-section. I finally headed home at 7 am just in time to breast feed Zane from his long night of sleep (He’s sleeping all night 7 pm to 6 am, Yay!)

After about an hour I headed back in to check on my 2 ladies with high BP. C-section lady was doing well.

Seizure lady. Well, she was unconscious. I walk into the room to find her seizing. No nurse present. They were all in their fancy schmancy nursing meeting. Seizing patient that I had spent half the night with was unaccompanied!!! So irritating.

I gave her some more diazepam. I had not given her magnesium because her lungs sounded wet. There’s no half way with magnesium (it’s 2 big injections in the butt here).

I went off to look for a nurse to get them to stay with her. The big group of family members started to get uneasy about her being in a coma. I explained the sickness and that we were also going to get a malaria test, but that she was on quinine just in case. All of this we were doing for free too.

They were upset that she wasn’t getting better. They said they wanted to take her to a witch doctor.

Normally I tell patients here that this is not a prison and that they can take people if they sign a release. But I absolutely refused for this poor girl. I told them if they asked again, that I would make them all leave. I told them only 2 family members. If they didn’t respect my rules, then I would not respect them and would not let them come in.

She had six or so seizures that first day. More Diazepam.

She remained in a coma. Her breathing sounded like the death rattle. I gave her IV lasix and some steroids. I gave her IV antibiotics. Her malaria test was positive. We paid for her IV quinine.

We prayed for her. I told the nurses to keep a close eye on her so the family didn’t steal her. Three days she stayed in a deep coma. Here in our hospital WITHOUT an intensive care unit. No oxygen. No x-ray. No electrolyte tests. No platelet exam. No liver function test. No creatinine.

She started arousing a little yesterday. Olen did rounds and texted me that she had started to wake up. It was the best Christmas present for me! She had been so close to death.

Today at rounds I found her sitting up. Praise God! I was so happy to see the whites of her eyes. Isabelle is still very tired. Please keep her in your prayers. And the family. And the people here in Tchad where witchcraft is so prevalent.

olen and danae

Olen phone: +235 62 16 04 93
Danae phone: +235 62 17 04 80

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

Volunteers Welcome!!!

Friday, December 23, 2011

#84 Projecting

Ok, so we’ve had lots of people ask what projects we have going on and how they can help...

First, let me reiterate... The greatest help you can offer us is your prayers. I know it sounds cheesy, but it’s true.

Second, come visit us!

Ok, now I know when people ask, they’re actually talking about money stuff. And the question seems to come up more in December for whatever reason. Must be that giving spirit.

So here it is... a nice little list of ways we can put your money to use. I need to give a couple disclaimers, however. You will never catch me saying that we are a more worthy cause than some other cause. How can I be the judge of that? All I know is that if you choose to donate money to Bere, I can assure you that AHI (as well as myself personally) will assure that your money goes to what you want it to go to. I know what your money goes to, and I know that they are all important and worthwhile goals. However, if you donate to another organization, odds are good that your money will be appreciated and used appropriately and responsibly and will be meeting a need as well. Whether you give a gift to us or to somebody else, I just encourage you to make a sacrifice and give. Don’t make me break out Malachi on you. And give the good sheep, not the blemished one!

Also, it’s tax-deduction season! Friends don’t let friends finish December 31 without maximizing their charitable contributions tax-deduction! Happy Tax Loophole Celebration Month!!! Only five more Tax Loophole Days left before January 1!!! Remind everybody on FaceSpace or MyBook or whatever the kids are using these days. And don’t forget, everybody’s connected by six degrees of separation at the most, so somebody out there must know somebody who knows somebody who knows somebody who knows somebody who... anyway... I want this blog on Bill Gates desk by Monday, people.

Current projects:
1. Public health outreach. Visiting the 21 neighborhoods of Bere and doing one week of health lectures, teeth pulling, etc in each neighborhood. Budget is almost $11,000, but I'm pretty sure we can trim the fat back to $7,000. As far as I know, it's completely unfunded, but we're moving forward in faith. This outreach is crucial.
2. Fencing in the new buildings of the hospital and the new doctor's (my in-laws') house. Close to $20,000. Can't imagine it would be more than that.
3. New private ward. Funded almost entirely already! Three cheers for A Better World Canada!!!
4. Building a room to house our new generator and the old generator together and new wiring. $5,000. Completely unfunded.
5. New OR. At least partially funded by our home church already. Possibly even fully funded. Go Springfield First SDA Church!!!
6. New doctor's house (for my in-laws). I would guess about $40,000, maybe a bit more. Completely unfunded. My in-laws arrive in February and will be living with us until we get their house built. I love my in-laws, but...
7. Truck to find and transport supplies for building projects. To help us find quality supplies and save on transport costs. $50,000 for a new vehicle, but we could definitely make do with a used one. In reality, we can survive without this. This is just one of those ‘If I had a million dollars’ kind of things.
8. New maternity ward. I would guess about $25,000, maybe a bit less. Completely unfunded.
9. Toilets for pediatrics. Completely unfunded.

Way in the future projects and completely unfunded:
New lab.
New ER.
New medicine ward.
New surgical ward.
Nursing school. This is an interesting one. Tchad desperately needs more good nurses and a nursing school is the way to do this. I think we can create the best nursing school in the country, but this one will cost a lot. This should probably be a higher priority, but I really want to have my financial ducks in a row before I tackle this one.

Way, way in the future projects and completely unfunded:
New pediatric ward.
New chapel.
New administrative building.
Computer school.

# 83 End of the Year Wrap

End of the Year Wrap (high protein, low carbs)

One year ago today (written December 15th), we arrived in Bere. As we look back, we’re just so excited about the many ways in which God has blessed us that we feel the need to praise Him publicly. We’ve had many struggles (which we’re very good about chronicling), but overall, it’s just been such overwhelming blessings (which we don’t chronicle quite as well).

We started off the year well in over our heads (and to be honest, we’re finishing it still well in over our heads). It was all new medicine we hadn’t been trained in, medications we had never prescribed, languages we hadn’t sufficiently learned, cultures we were unfamiliar with, climates we weren’t comfortable with, etc.

My third day on the job, I had a newborn die in my arms. It was a first for me. My thoughts of creating the perfect mission hospital where everybody knew all the patients would survive... well, that came crashing down pretty quickly. If I had known then just how often I would hold newborns, toddlers, kids, adults and the elderly in my arms as they took their last breaths, I honestly don’t know if I would have stayed. Fortunately for me, I had no clue.

Then, ten days after arriving, I fell ill with malaria on Christmas Eve. Then Lyol got malaria three times in his first six months. Then we took a new member into our family and held him while he died less than three weeks later. We lost a young patient who had suffered with us for weeks from his burns. We lost... well, we’ve been surrounded by more death and suffering than we ever could have imagined possible. It certainly took a heavy emotional (and at times, spiritual) toll on us. The roller coaster has been unbelievable.

However, we have seen God lead us in so many beautiful and miraculous ways. We must recount just a few of them for you...

We asked for an ultrasound machine... and received one. Donated! For free!

We almost ran out of Cyclophosphamide, which would have meant we’d have no treatment to save the lives of the children with Burkitt’s Tumors we see. In God’s entertainingly dramatic way, we actually ran down to our last vial of Cyclophosphamide. Several donors and a couple church groups donated money for this just in time for us to never need to turn away a patient. Throughout it all, we remained the only hospital in the country with chemotherapy.

Furthermore, a friend led us to AmeriCares. After much paperwork, this organization convinced Baxter, the producer of Cyclophosphamide, to donate us over three years worth of Cyclophosphamide. It arrived once again, when we were down to our last few doses.

We needed a new air conditioner for our operating room before the hot month of April, when our operating room is over 120 degrees inside. We found a couple generous donors for this just in time.

We asked for little things, like Veggie Tales DVDs for Lyol. We received several, and none of them duplicates!

We had dreams of building a new private ward and a new operating theater. A Better World Canada donated money to help build this private ward. Our home church in Springfield, Massachusetts raised the money to build the operating room. We also had some private donors contribute to these causes! Association Medicale Adventiste de Langue Francaise (AMALF) has agreed to outfit completely any structure we build, from the private ward, to the operating room, to whatever else we build, if we just pay for the shipping container from France. We hope to open the new private ward and OR before the end of 2012.

We ran out of misoprostol... and already we’ve found somebody to send us more!

We’ve been blessed with more than just stuff and money... We’ve been blessed with volunteers!

Our first volunteer in January was Jessica. What a great way to start! She showed up and rolled with the punches from the start, needing to come the last 30 miles on the back of a motorcycle with her luggage and then going straight to spend her first night in a mud hut with a family that didn’t speak her language. Then next day was Independence Day here in Tchad, so we went to the middle of town for the parade. Jessica, being a foreigner, was swooped up on the stage and given VIP seating for the whole thing. Now that’s an entrance! Sadly, we weren’t able to do that for all our volunteers.

Danae’s parents, Rollin and Dolores Bland, and well as my aunt and uncle, Bekki and Scott Gardner, came in January/February to help us out. Both Scott and Rollin are doctors with extensive surgical expertise and helped take some of our responsibilities for us as well as teach us during those important first months where we were both getting our feet wet and trying to keep our heads above water. (How’s THAT for mixing metaphors!) Bekki and Dolores are both nurses and helped out both at home and at the hospital. In September, Bekki and Scott became our first repeat-volunteers!

Grace came too. She’s a very experienced nurse and was our first volunteer who already spoke French. Short, skinny and starting to gray, we were a little worried about her when she passed out the first day! But boy did she ever regain her form. She might be a little older than I am (and weigh about half of what I do!), but I couldn’t even keep up with her after that. She adjusted to the heat, got properly hydrated... and then there was no stopping her. She was like an Eritrean/Italian Energizer Bunny! I don’t think we washed a single dish the whole time she was here. Plus she organized our hospital and helped be my nursing spy to inform me what nursing issues we needed to address with some additional education.

Heather was here and brought her fresh nursing degree (and passed her boards right before she came, go Heather!). Tough for your first assignment to be in Tchad! On top of that, she was our only volunteer for a long time. It’s hard to fit in when you’re living in the village with a non-English-speaking host family and the Parkers and the Netteburgs are on the hospital compound! Also has the distinction of being the only person Danae has ever accidentally poisoned with flaxseed.

Marc Kanor and his family came. Not only were Cory and Brichelle happy to have a couple girls here their age, we were happy to have Marc! He represented AMALF, which was highly appreciated, but he also alleviated much of our work in the hospital. As a surgeon from France, he easily filled in and even took some calls at night so Danae and I could sleep! He also taught us some surgeries that would have been much more challenging, probably even impossible, without him. Most importantly, he and his family gave us their friendship and encouragement. They also braved the hot hot month of April to come pay us a visit!

Cara and Drew came. They gave our spirits a lift and loaned us their expertise as physicians. For three weeks, we enjoyed each other’s company and benefitted from each other’s medical skills. When a motorcycle accident drove my thong flip-flop between my toes and split a sweet crevasse, I benefitted from Drew’s anesthesia before Danae put ten sutures in my foot. Cara benefitted from our hospital’s stock of rabies vaccines when a rat latched onto her toe, mistaking it for the world’s tiniest sausage.

John came. Round about 60 years young and fresh out of nursing school, John wanted to get his missionary feet wet and find a little experience to build on before starting his nursing career. After a few years of nursing experience in the states, he hopes to drag his wife off into the mission field with him somewhere. They both have past careers as engineers. With engineering and nursing skills together, I’m sure they’ll be a huge asset wherever they end up. John also had the fastest weight loss of any volunteer. Thirty pounds in his first two months! Luckily he had a belt.

Minnie came the same time John did. From the Philippines and armed with a resume like no other (including a Bachelor’s in Psychology and certificates in Artisanal Vegan Cuisine and Swedish Massage and Public Health and Underwater Basket Weaving and Cactus Husbandry and Quail Hunting and Renaissance Bodypainting and who knows what all else), Minnie is here for at least a year leading some public health projects. She’s been invaluable in making contacts in each of the 21 neighborhoods of Bere and presenting a positive face for our hospital. Still holds the longest record for first-timer to Bere without getting malaria.

Linden came. Respectful of the Tchadians, brilliant with the kids, and a natural missionary, Linden decided to turn his five-week stint in Tchad into a year-long stint.

Amanda came. Affectionately known as ‘Citadel’ for her alma mater, Amanda’s attitude and spirit has been unparalleled. She eagerly jumped into the role of religion professor at the local Adventist school. Teachers and students alike love her and we’re all amazed at her energy, dedication, preparation, professionalism and joy. She’s also been tutoring the Parker kids and has proven herself to be a natural teacher.

Adam came. Adventurous, creative, artistic, independent. Always willing to strike out on his own. Always willing to shoot more pictures when Danae asks. Adam can often be found hunting out the next surgical case.

Anna came. Seems to be our malaria magnet. French-speaking and eager, Anna might just have the biggest story to tell of all our volunteers. We should know more about that by the end of the year... Stay tuned.

Janna came. A year-long commitment to nursing excellence here in Tchad! Janna is willing to do anything but willing also to voice her preferences. As a boss, that makes my job so much easier! She’s building a foundation to serve her in a career as a traveling nurse or a Medecins Sans Frontiers nurse or... well, who knows where she’ll end up! Just fell ill with her first (and hopefully last) round of malaria. She held out pretty long.

Mayline came. Oh, where to start. Mayline is a jokester. Always quick with a smile and with a laugh. There’s just no reason why somebody wouldn’t want to spend time with Mayline. Well, unless you were tired. I don’t think I’ve seen Mayline tired. So maybe she would be a little disruptive if you were trying to sleep. Even when she got malaria, she vomited with a smile.

Marci came. Also a one-year commitment. Marci has perhaps made the largest sacrifices to come here. Yet, she’s the last person you’d catch moping. She attacks projects with a ridiculous amount of creativity, energy and enthusiasm. She drew up the grant for our public health project and will be spearheading it this year. If she’s not careful, she might inadvertently be given the role of SM-mother. Also holds the distinction of being our first volunteer to be stung by a scorpion.

Dani and Matt came. They take their musical prowess from their airport responsibilities to our vespers every week. Bronwyn is also down at the airport. She’s like the baby-whisperer with Zane.

Kel and Josie are also return volunteers. The first time, they came for about four months. They’re back again for another few. Also extremely musically talented, Josie has been involved with kids ministries and sewing for the maternity ward and Kel has been doing construction. Even while he was in the states, we put Kel to work making computer drafts of all our building projects.

Joanna and Darren came. Interested in both aviation and nutrition, they are the perfect fit to be helping get the nutrition center at the airport off the ground.

Most recent to leave us was Stan. Stan put in his time at the hospital, the airport and also the new surgical center in Moundou. Guy knows everything from electricity to plumbing to well-drilling to building to generators to cars to... well, you name it. What a great resource he was while we was here. We’re sure he’ll continue to be a great resource for us, either from the states or on the ground here in Tchad.

Even my parents came (along with Janna’s mom) in November. Why, I think just about everybody’s been through Bere by now. We’re like the Champs d’Elysees of Tchad. If you stay long enough, you’ll see the whole world walk by.

I hope we’ve spent enough sentences in past posts to explain what an integral part of this hospital the Parkers are. Jamie, Tammy, Cory and Brichelle. Without them, life would be far harder and far less enjoyable. The same goes for the Roberts. Gary, Wendy and Cherise are indispensable. Also down at the airport are Jonathan and Melody. These are all multi-year folk.

We should interject here that we’re receiving a third physician here in Bere. We’ll give more specific news on this later, but it’s VERY exciting!

We’ve been blessed by amazing answers to prayer too.

We asked for prayers for specific surgical procedures, which then went well.

We asked for prayers for a little girl who needs to go to France for heart surgery. It looks like that will finally happen.

We asked for prayers for... well, for a lot of things.

Even if you’re not sure if your prayers can help from way over there to way over here... just keep praying for us. I can tell you, it helps. It works. It’s necessary.

We’ve been blessed professionally this year too.

Danae passed her written boards in OB/Gyn two days after giving birth to Zane.

I passed my written boards last year and my oral boards in September. Hooray for being officially board-certified until 2021!!!

Oh, and last, but most certainly not least, in fact, perhaps possibly most... We were/are blessed with Zane. Our latest addition to the family arrived June 25, safely in New Jersey. Zane Oliver’s birth story is probably unique in all the universe. It’s somewhere here on the blog if you have time to kill.

Hmm... It’s now almost midnight. This seems to have developed into quite the Christmas letter. I wasn’t intending it to be, but that’ll do. I’ll just post this, and how about that save me the trouble of writing a separate Christmas letter. Nice. I like it. Here you go. Enjoy. Merry Christmas!!! And how are you and yours?

You will notice on our blog,, that we have a link for donations. This is through Adventist Health International’s website. We believe strongly in the mission of AHI. We feel that AHI is an organization worth supporting. By donating through AHI, you can be reassured that there is a strong measure of accountability following your donation. Just mark the donation for ‘Bere.’ And remember that your gift is 100% tax-deductible.
Olen Zain: +235 62 16 04 93
Danae Zain: +235 62 17 04 80
Olen et Danae Netteburg

Friday, December 16, 2011

#82 Hair Today, Gone Tomorrow

Or more correctly, hair yesterday, gone today.

Mom and Dad just left yesterday for the states. They had spent two and a half weeks with us. Mom got the approval from her doctors after her first dose of chemo and had a blast. We all had a blast. Well, I should just speak for myself. I had a blast. And I perceived (correctly or incorrectly) that others had a blast. That should about cover the political correctness.

Mom got a little bummed that her hair started falling out, but we decided to shave it shorter and shorter until it came time for the razor. Then she just got shaved to skin. Then she got a sweet henna tattoo! That’s my mom, the biker chick with the sweet tatt on her head! She also learned lots of nice ways to use head wraps like Africans. We’ll see if she goes with the head wrap or the bare tatt for church.

Mom forbid me from shaving my head, but she didn’t say anything about a haircut. So I just decided to go with the 1/16th of an inch trim. I did it myself after midnight the day they left. Go solidarity! Can’t let Mom be the only bald one having fun.

This morning, Lyol woke up saying, ‘Go see Gamma, Gampa?’ Well, no boy. Gamma and Gampa went home. For the last two weeks, Lyol has woken up and asked to go see his Gamma and Gampa every morning between 6 and 7 in the morning. He was bummed this morning.

It’s been kinda like January 2 around here today. All the big holidays feel like they’re done already, but work/school hasn’t really gotten into full swing. Just kinda dragging. You know the January 2 feeling, right?

Anyway, love you, Mom (and Dad). Good luck with chemo! We’ll be thinking of you.

(By the way, Mom. I should’ve shaved my head long ago. The freezing cold showers go by much faster now.)

You will notice on our blog,, that we have a link for donations. This is through Adventist Health International’s website. We believe strongly in the mission of AHI. We feel that AHI is an organization worth supporting. By donating through AHI, you can be reassured that there is a strong measure of accountability following your donation. Just mark the donation for ‘Bere.’ And remember that your gift is 100% tax-deductible.
Olen Zain: +235 62 16 04 93
Danae Zain: +235 62 17 04 80
Olen et Danae Netteburg
Hopital Adventiste de Bere
52 Boite Postale
Kelo, Tchad
Volunteers Welcome!!!

Tuesday, November 29, 2011

#81 Bald

So Mom has arrived. One dose of chemo, one cell booster shot, one good cell count, 24 hours of travel, 300 pounds of luggage and a three-hour flight in a four-seater plane... and she’s arrived. She’s in great health and great spirits. She’s enjoying an interlude of feeling great before her next dose of chemo right when she gets back to the states.

During her next round of chemo, she’s expected to lose her hair.

I think it would be great to send her pictures. Pictures of bald guys. Or bald women. Famous. Infamous. Doesn’t matter. If you’re bald, take a picture of yourself and email it to her. If your spouse, parent/child, grandparent/grandchild, aunt/uncle, neighbor, teacher/professor, nephew/niece, friend, coworker, lunch-lady, supermarket checkout guy, etc is bald, take a picture and email it to her. If you have a favorite famous bald athlete, actor, politician, etc, download a picture and email it to her. If you lost your hair to chemo, send her your bald picture and your post-chemo hair picture. If you’re a college guy looking for an excuse to shave your head, buy a pack of cheap bics, shave it, take a picture and send it to her. If your boyfriend broke up with you, shave your head and send her a picture. (Or shave his head while he’s asleep, take his picture and send it to her.)

So there’s your assignment. At least Google ‘bald’ and download/send her the first hit. I want her to have an overwhelming inbox of beautiful, acceptable, common bald people when she gets home.

Her email is

Go to it.

Monday, November 28, 2011

# 80 Prayers

Mom hasn’t come to Tchad to visit us yet, which is weird. It’s weird because she, of all people, wouldn’t have any problem here. She could avoid the hot season, she’s no stranger to traveling where she doesn’t speak the language, she’s roughed it before... and I know she’s aching to see her two youngest grandsons. She’s a nurse, this is a mission hospital. She spent the first 18 years of life as a missionary kid. She was evacuated during Iraq’s civil war, as a little kid, by herself, to Italy. She found her own way there until her family found her.

At first she said silly things like, ‘Well, when you’re on the electric grid, I’ll come visit.’ We’re still not within a hundred miles of any electric grid.

But this is not a woman who waits. This is not like her. Mom has lots of strong traits. Patience with her family is one of them. Patience with absolutely anything else under the sun is decidedly not. She is always on the go. She has one gear: Top gear. It’s all or nothing. She does not stand in line, she does not wait for results, she does not wait for appointments, she does not wait for nausea or pain. It’s now. She does not wait.

She is all energy, full speed ahead. This is part of what made her the cool mom in high school. She was the mom who would throw parties for all my friends... even if I was out of town... and they’d still come, just to hang out with my mom. If I had any degree of popularity, it was on account of two things: I had a van that we could cram a dozen plus people into and I had the cool mom.

Mom’s always a gamer. Not patient enough to devote her undivided attention to television, commercials, books, firework displays, the opening scene of Saving Private Ryan or Barnum and Bailey’s Circus, Mom was always the one to round up the troops for whatever game was en vogue and could be played with Rook cards, dominoes or anything else within arm’s reach.

Mom’s a cop’s friend. At the end of the month, if they haven’t made their ticket quota, they can just follow Mom around. No time to do the speed limit when you’re going on about the Lord’s business, right Mom? Stop signs are just put there by the man to drag you down. No patience for any of that. And not much of an attention span either. Radio, mirrors, rabbit running in that yard over there, isn’t that an interesting tree, hey was that guy in the movies and thunk, Oh, I guess I may have just rear-ended that guy.

And the apple doesn’t fall far from the tree. I despise standing in line, I have a strong sanguine streak and I have the attention span of an ER doc, look, a lightening bug!

There was never any question that Mom wanted to see her youngest grandsons. Throughout the 32 years of my life, Mom has consistently demonstrated priorities of God and family, with everything else coming much further down the line.

Finally this summer, Mom alluded to coming out to see us this fall, and to bringing Dad with her. Plans were finalized and Mom bought tickets for Sunday after Thanksgiving. Mom got excited and started to prepare.

But plans change, excitement abates and preparations become unnecessary.

Mom got cancer and had surgery. The indefatigable got fatigued. The recklessly optimistic got down. The iron-stomached vomited. The stoic showed pain. The strong showed weakness. The unshakeable cried. The woman of steel bruised. The impervious chinked.

Mom doesn’t have the cancer that guarantees your death, but neither does she have the cancer that guarantees your survival. She has the cancer that requires surgery and chemo and radiation to might make your hair fall out, your guts turn inside out and your energy take a Sabbatical... in order to maybe be put into remission. It’s scary. It’s unresolved.

With the encouragement of her doctors, we are expecting Mom to die... in her sleep... peacefully... at age 120... from something other than cancer. More likely at age 120 while driving to a chair aerobics class after leaving the first chair aerobics class because nobody else showed up five minutes early.

Nonetheless, I would ask you to pray for my nurse, my professor, my mother and my friend, Ronnalee Netteburg. Pray for her. For her doctors. For her healing. For her treatments. For her symptoms, pain, nausea, fatigue. For her spirit. For our family. For her peace. For her faith.

Better yet, I would ask that you pass this along. Pass it on to people who might know Mom. Pass it on to people who know somebody with cancer. Pass it on to people who have or have had a mom. That should about cover it. Put it on Facebook. Link it. Take out an ad on TV. Put it on a billboard.

And post something for Mom in the comments section of this blog. Or email her. Or call her. Or send her a card. Or all of the above.

Don’t tell her what you think caused her cancer or what you think she could have done to prevent it. That’s stupid and useless. Just tell her that it’s a bummer, but a bummer you pray God can turn into glory for Him.

And since Mom is who she is... she’s still coming, leaving Sunday after Thanksgiving... after she’s already started chemo and had the surgery. Pray that her immune system holds up while she’s here.

Tuesday, November 22, 2011

#79 Loaves and Fishes

Okay, so this is not exactly about feeding the 5000, but it is about miracles.

I can’t tell you how many dead babies I deliver. But it’s at least 1 a week. When you don’t deliver that many normal ones, that gets to be depressing. Normal babies usually deliver at home however. Okay, okay, stop thinking nice clean delivery in your bathroom with running water. Think, small dark hut with dirt floor. Painful. Hemorrhage. Dirty. To name a few words.

So when I can help prevent a few baby deaths, I praise God and it feels good.

When I first came here almost a year ago, there was a left over bottle of misoprostol in the office. I don’t know how many pills were in there exactly, but it wasn’t a full bottle. No big deal. I made a mental note to get some more on annual leave.

But I didn’t. You can’t exactly just go buy pills in the states at your local pharmacy without a prescription. And I don’t even have a prescription pad. Though I do have a license in Indiana of all random states. Ask me about that in a different conversation.

Anyways. Back to misoprostol. It’s actually very cheap in the states. But you can’t buy it here in Tchad that I can find. We use in in OB land for postpartum bleeding (8 or 10 pills) or for inducing labor. To induce women we usually use 1/4 of a pill every 4 or so hours. Inductions can take days and we continue it depending on how the cervix reacts (usually for 1 night). Once the cervix softens and or opens, we start oxytocin (the IV stuff that gives contractions).

Oxytocin drips here are dangerous because we don’t have an IV pump to monitor the amount of medicine going in. It’s a matter of counting drops, and that gets dicey. I NEVER give it at night. It’s not safe to give when your only nurse for maternity and surgery is covering 30 + patients.

For the last several weeks I’ve only had a couple of pills left of misoprostol. I keep saying, “It will be really sad when I run out of misoprostol.”

Two weeks ago I induced someone for postdates. She was 42 weeks. That in itself is a miracle to actually KNOW her dates. Now that I’ve been here for some time, I’m reaping the benefits of knowing how far along a pregnant patient actually is from my earlier ultrasounds. Usually people come in at 8 or 9 months and have no idea when their last period was. So I’m getting pretty good at dating ultrasounds.

Two weeks ago I said, “This will be my last induction with misoprostol.” I use foley bulb catheters too, but sometimes miso is better. I cut the last 2 remaining pills into 1/4 pieces. I gave the first 1/4 pill and explained to the nurse who was covering that night how to give it vaginally again.

God is really making our misoprostol work! She actually DELIVERED after 2 doses. It was her first baby, and she went from a closed cervix to delivering in only 2 doses. The end result was a healthy baby girl.

I put my precious stash of misoprostol away for the next usage. 1 1/2 pills left.

Abre is one of our OR nurses. His wife has been pregnant with her first baby. Six weeks ago she broke her water. If she would have delivered then, the baby would have never lived here. I gave her antibiotics and sat on her. I even let her go home later since she lives so close to the hospital and could come for ultrasounds easily.

Long story short is that today I decided to induce her. She was 1 cm dilated and not in labor.

We gave misoprostol. First dose, nothing.

Second dose. Drum roll....Within the hour she went from 1cm dilated to delivering. Seriously, God has made that stuff turn potent!

A beautiful healthy 2.6 kg baby girl. A baby girl who probably should have died, but is now healthy.

And I still have 1 pill left to use for the next patient.

Or two or three.


Olen phone: +235 62 16 04 93
Danae phone: +235 62 17 04 80

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

Volunteers Welcome!!!

Thursday, November 10, 2011

Survivor Bere

Disclaimer: This will be far more interesting to parents of our SMs than to most others. (Even then, only 37 percent of those polled said this was an interesting blog. Which would actually be a high enough percent approval rating to win you the Republican nomination.)

Welcome to Survivor: Bere

Travel across the world with us...

Meet the contestants. Thirteen who no longer know just exactly where in the Sahel they are. They come from far and wide. One from the Philipines, one from South Africa by way of the UK, one from Canada, one who claims Canada when it’s convenient and nine from the good old USA. Now they are here (for better or worse) in this place we call home, Bere, Tchad.

Cory, will his vast experience serve him to the end?
Brichelle, will the strong and silent type succeed?
Minnie, with the power of awesome dried Philippino mangos.
Linden, will all his education be practical here?
Matt, can fancy guitar fingers start a fire with a magnifying glass?
Dani, shorn for speed.
Amanda, a military training couldn’t work against her, could it?
Bronwyn, like that accent’s even real.
Anna, now with antibodies to malaria, can she regain her form?
Adam, we know he can build a hut, but will he be able to eat at Samedi’s?
Janna, the only one with a license to heal, will others’ jealousy take her down?
Mayline, is she a physically weak specimen, or is the so-called malaria just a ploy?
Marci, last to arrive, will she be the freshest in the long run?

While Danae and I are the only two church-employed missionaries here, there are 21 self-supporting long and short-term missionaries; Jonathan and Melody (pilot and nurse), Gary and Wendy (pilot/nurse and nurse), Jamie and Tammy (maintenance director and community helper guru), Darryl and Joanna (the newly arrived South African pilot and nutritionist) and the thirteen listed above. The thirteen listed above are the brave young volunteers who are part of Survivor: Bere.

Episode 1: Water and Fire. Recap.

The unlucky 13 find themselves lost in the Sahel. Not yet adjusted to African Standard Time, most competitors arrive for the scheduled 3pm start at, well, 3pm. Novices. The experienced know that African Standard Time dictates that things get underway about 4:30pm. With the two most experienced (also the two youngest), Cory and Brichelle, as captains, the teams are drawn from a hat. Team Cory seems to have the best team spirit, but Team Brichelle has experience, education and raw muscle.

We know that watering holes are where the action happens in Africa. It’s also where survival of the fittest is most evident. All animals must share water for survival, but all the while, keep a keen eye on each other, distrusting every moment.

We brave the wild animals and head for the Bere watering hole, a plastic inflatable pool about seven feet in diameter. Dangers here include Lyol’s inflatable crocodile and the fact that a two-year-old struggling to gain urinary continence has been playing in the pool all day. Here the teams will compete to see which team can hold their breath the longest.

Head-to-head, literally, the first member of each team plunges their head under the surface. Team Brichelle pops up almost immediately, forcing the second member of their team to start their turn early. Things aren’t looking up for Team Brichelle. Team Brichelle even goes through several more team members while Matt holds out for Team Cory. Finally, Matt’s gills beg for mercy and he surfaces. Team Brichelle quickly comes to their last two members, Linden and then Adam. Linden, the dark horse and the breath-holding shark plunges his face down with vigor. The ex-competitive swimmer begins to settle in for the long hall. Team member after team member of Team Cory runs out of air. At long last, Linden runs out of air just before Team Cory runs down to their last team member. It’s up to Adam now, starting out with only a few seconds of disadvantage. In the end, Adam and Team Brichelle come away with a 90-second victory.

The 90 seconds get carried over to the next challenge. The teams are sent off the compound to collect all supplies necessary to boil a half liter of water. A charcoal stove, charcoal, matches, kindling and lungs doubling as bellows. The minute and a half proves to be more than enough for Team Brichelle. They quickly reappear with the necessary supplies and bring the water to a nice, rolling boil.

Team Brichelle noshes victoriously on massive brownies, rarer than a November rainstorm in Tchad, while Team Cory is left with the scraps.

Then the teams receive their projects for the week: To create an English class. Each team is left with the open instruction. The teams can decide the time, location, cost, structure, supplies, etc for their English class. They are put on notice that they will be judged in two weeks time, based on a presentation they give representing attendance, mission spirit and several other factors. The game is on...

Episode 2: Now That’s Using Your Head! Recap.

This episode opens a full two hours late, due to multiple motorcycle victims arriving at the hospital and requiring emergency attention literally minutes before our regularly scheduled program was set to begin. Nine lacerations sutured, two broken bones set, and one blown pupil assessed later, we begin.

The teams report on their successes. Both teams had attendance in excess of forty students and both reported students desiring continuation of the classes. Team Brichelle continues their winning streak and wins the right to drink smoothies Friday night at the hands of Team Cory’s smoothie-making labors.

The first challenge of this week is an intellectual challenge of recalling minutiae from an informational packing list sent to them before their departure from their native lands. Remarkably, both teams show impressive long-term recall. But alas, there can be only one winner and it is Team Cory, with their first success of the season.

Going from intellectual noggin’-usage to physical skull labors, we move to the brickyard. The teams are lined up for a classic African carry-stuff-on-your-head race. Team Cory has the benefit of first pick of bucket and head padding. The teams pick their brick to put into their bucket. The major advantage is that Team Cory gets to choose two Africans to help them in their quest.

Cory and Brichelle, brave captains, race off at the starting bell, twenty yards down the field, around the lit latern and back again, neither dropping their bucket o’ bricks, Brichelle crossing the line just ahead of Cory. Quickly Brichelle passes off the bucket to the next team member, but troubles start. Even finding the initial balance before starting forward progress proves to be a challenge. Team Cory doesn’t fair much better, but after several failed attempts and restarts, Team Cory gets their second team member across the line. Team Brichelle catches up. After each team has four members successfully across, it’s still neck-and-neck. But them Team Cory brings out their two final team members. The newly drafted Africans, fairly substituted, run, literally down and back while balancing their bucket o’ bricks on their heads. Game over.

This time, it’s Team Cory victoriously noshing chocolate cake while Team Brichelle only has a meager morsel of tasty chocolate each.

And finally, well after the last glimmer of dusk is past, the teams receive their challenge for the next two weeks. They are to create a 30-second radio commercial advocating breastfeeding only for the first six months of life.

And how will they do? Who has been born with the advertisers gift? Will the cream rise to the top? (Sorry, couldn’t let that last one go. Just too good. Get it? Breastfeeding? Cream? Aw, come on. That’s funny!)

Stay tuned.

Working Myself Out of a Job

It’s finally going to happen.

Several times I’ve told people that I want nothing more than to need to fire myself. I would love to be out of a job. I would love to not be needed. In a perfect world, I wouldn’t be. Interesting thing about being a doctor.

When I say that I want to work myself out of job, I’m usually referring to one of two things. The more common one in malaria. I often say that if there was no malaria in Tchad, I’d be out of business. It accounts for most of our pediatric hospitalizations (and deaths) and a good chunk of our adult medicine patients. Even several of our surgical patients need to stay at the hospital longer than planned, due to malaria. Losing one or two kids every week to the same disease is getting really old. I hope I’m not getting calloused to it.

The second way to lose my paycheck is to get involved in public health. Here at the hospital, I can only treat one patient at a time. Getting involved in public health, I can treat whole communities at a time. Better yet, I can prevent them from getting sick and prevent them from ever even needing my services at the hospital. The catch is that going out into the communities and teaching them this stuff doesn’t pay. Not a dime. In fact, it would hurt my bottom line. If they don’t get sick, they don’t come to the hospital. If they don’t come the hospital, I can’t order tests on them or sell them medicines or do their surgeries. I won’t make any money. I’ll be losing money. I might just need to fire myself. Awesome!

This has been my thought for a long time, ever since my food policy friend informed me, sarcastically, that, ‘As a doctor, you can only harm one patient at a time with bad decisions. Writing food policy, I can hurt scores if I make a stupid mistake.’ Of course, his insinuation was that the corollary would also be true, that good policy can save more lives than I can by seeing one patient at a time in the hospital. It was his tongue-in-cheek way of drafting me into the line of public health. Since then, I’ve toyed with the idea of getting a master’s or doctorate in public health. But after medical school and residency, the idea of more schooling is still a little painful. Maybe someday.

And ‘maybe someday’ is where my good intentions always seemed to end.

And then manna fell from heaven, right into our laps. Manna in the form of two women. In June, Minnie arrived from the Philippines. Although her degree is in psychology, she has vast experience in public health projects, as well as a resume spanning from licensed massage therapist (no, not the real reason we brought her here) to licensed artisanal chef (also not the reason we brought her here) and everything in between.

When Minnie arrived, I was pretty much hands-off and left her to her own devices. It’s not like I know anything about public health where I could actually be of any benefit to her. Minnie seized the bull by the horns and jumped right into it, taking the initiative to visit all 21 neighborhoods of Bere and meet with their local governing chiefs and officers. She presented them an amiable face to represent the hospital and asked them what we could do to help them. I won’t delineate all of what we learned, but much of it was surprising and much of it was embarrassing for the hospital, honestly. Minnie put some psychological salve on open emotional wounds and left people with a better impression of our hospital.

Our second-helping of manna was Marci, who just completed her Master’s in Public Health from Loma Linda University. Both Minnie and Marci have committed for a year, with Minnie potentially staying much longer and Marci trying to establish a program bringing us a new year-long public health graduate every year. Marci arrived just one month ago and has quickly and synergistically reinvigorated the work Minnie had already put into motion.

Whereas Minnie is a humble, meek, petite, quiet, organized, detailed person, Marci is a tall, gregarious, outspoken, big-picture, dreamer person. They complement each other perfectly. Two Marcis or two Minnies wouldn’t be as effective as one of each. Such a blessed pairing!

Since her arrival, Marci has developed a public health outreach project to address several of the needs voiced during Minnie’s assessment period. We will be starting one week of meetings in each of the 21 villages in our new Project 21.

Pardon my cutting and pasting, but I’ll insert some of Marci’s 14-page project proposal, which was approved.

Community Health Education
After analyzing the expressed and observed needs seen in the communities, ten topics were chosen for general education of the villages. These ten topics are as follows: breastfeeding, maternal health, clean water/water borne illnesses, nutrition/malnutrition, natural remedies, malaria, AIDS, tuberculosis, abuse, and personal and oral hygiene. Lectures on these topics will be prepared and presented by or with the supervision of a public health specialist or nurse with use of a translator for local dialects and French as needed. Large posters with be created to illustrate the topics of each lecture and other visual aids will be purchased such as food to illustrate information during the nutrition lecture. This method was chosen because of limited access to electricity and the portability of posters. The educational classes will be presented at a central location within each village that has been pre-agreed upon with the local chieftain. To encourage attendance, raffle tickets will be given out with drawings for food, and other topic relevant items such as toothbrushes. On the day the topic of water is covered reusable water bottles will be handed out. For the day nutrition is covered 30 bags of food will be raffled. On the personal and dental hygiene day 30 toothbrushes, each with a tube of toothpaste, will be raffled. Each village will have classes for three days, starting on Monday and running through Wednesday, with three to four topics covered per day. The classes will be presented from around 3:30 pm to 5:30 pm each afternoon. This timing fits with the approximate end to the work day and before dusk when the mosquitoes become a deterring factor. The estimated time for completing the community education portion of the project is five and half months giving one week per village and allowing for expat and local holidays.
In conjunction with the community health education lectures, a mobile dental clinic will go to each village on the morning and afternoon of the third day of lectures in that village. The dental clinic will provide free tooth extractions. The will be one dental provider working to extract teeth. Depending on the amount of work needing to be done on each person an estimated 30 people will be treated per village. Each person treated will receive a toothbrush and toothpaste.
Community Health Workers
First Aid Agents are persons who have been trained by the Red Cross for three months and have been given some follow up training. Their primary role is to be on call for emergencies and to help educate the people of their village about hygiene and prevention of diseases such as Cholera. It was requested for them to obtain more training. They also requested equipment to help them do what they have been trained to do. The program will have the village elect two First Aid Agents per village to attend training to become Community Health Workers. As part of the training they will be required to attend the lectures presented in their village. They will be assessed for their current knowledge of CPR and First Aid skills and given training or a refresher course on these skills. On the afternoon of the fourth day in each village the assessment and training of CPR and First Aid will be covered. There will also be a final training in groups of about 10 to 15 participant during the end of the sixth month. In response to their request for supplies they will be given a basic First Aid kit consisting of gloves, gauze and a mouth guard for CPR if they have completed the entire program. To increase the perceived value and involvement in getting a health worker for their village the program asks for 500 CFA which is about $1.10 dollars for tuition for each community health worker. Also, the village is to create a two wheeled stretcher for transportation to the hospital.
Midwives/Traditional Birth Attendants
Midwives vary in number for each village; some villages said they did not have any midwives while others have two or three. Midwives who were interviewed had been trained by the catholic mission with follow up training at the district hospital. From observational assessments by Béré Adventist Hospital staff more training is still needed which agrees with the expressed needs assessment from the villages and the midwives themselves. The midwives interviewed expressed the need for equipment as well as the desire for more training and were very open to being involved in a referral system with the hospital. This pilot project aims to fill all these requests and create a referral system in which the midwives can be empowered and supported in their roles, pregnant women will receive at least three prenatal visits (preferably four, distance from the hospital allowing), and the women at risk or experiencing complications will be brought to the hospital in a timely manner.
The training portion with be conducted in French and Nanjire, the local language, and will cater to the illiterate. The program will look to establish a base knowledge and assess current skills. Instruction provided will include but not be limited to the following topics: breastfeeding, discontinuing the cultural practice of removing the umbilical cord (a practice in which the umbilical cord is removed by compressing the abdomen with extremely warm hands repeatedly until the umbilicus fails off which is an unnecessary practice and is very likely cause for the high rates of umbilical hernias), the importance of stressing to mothers and families to not give water to babies under six months, kangarooing for premature infants, risk and complications and when to refer to the hospital, programs at the hospital, and the importance of prenatal visits. At the end of the pilot project training and as incentive to continue to work with the hospital the midwives will receive disposable gloves, scissors and a pink lab jacket. The lab jackets will give her something to wear for delivering babies and also give her a more medically authoritative appearance. In order to increase the perceived value of the program participation in the training program will cost 500 CFA which is about $1.10 dollars.
The goal of the midwife portion of the pilot project is to train and establish a working relationship between the midwives in the villages of Béré and the hospital. By working more closely with the hospital the midwives can become an extension of the hospital in the village. To establish this relationship, portions of the training will be done at the hospital to familiarize the midwives with the hospital layout, routines of the hospital and the staff. A referral system will be designed with mostly pictorial referral cards for illiterate midwives which would provide a record of the midwife’s assessment of the pregnant woman throughout the pregnancy. This collaborative relationship between the midwives and hospital will be assessed at the end of the pilot program for changes, more training and funding needed for successful continuation.
Women’s Skills Training
Skills training was requested by the villages. Project 21 will train 10 women from each village to create handicrafts which they can make from home with limited initial financial outlay and that will fill a hole in the market. The project will work first with women’s cooperatives then widows. These criteria will be given to the village and then they will be responsible to elect the women who will be involved in the training. Through focus groups and observational assessments it was noted that there are limited number of toys and no dolls or teddy bears market in this area of Chad. Purses are also valued items. From initial assessment clutch bags and the “Rungi Chungi” teddy bears and dolls are marketable in this area with the potential for extension to the local region and abroad. These will be the first projects undertaken to train the women on. The skills training will take place during the morning of the first and second day of the community health educational classes in each village. To increase the perceived value of the project each women will pay 200 CFA for two mornings of training.
The women will also be given a short talk on marketing and basic business. With continuation of Project 21 further business skills training for these women is recommended. Other skills could be also taught in the future as well.
To provide general health education to the 21 villages of Béré, Chad, as well as specific training for the midwives and community health workers and to build a collaborative relationship between them and the Béré Adventist Hospital and to provide skills training for village women.
Objective One:
To provide three day health education classes to each of the 21 villages in Béré, Chad, over the duration of five and a half months.
Objective Two:
To establish community health care workers by assessing and provide furthering education to two First Aid Agents per village during a one day lecture in each village and a culminating day of training for all at the hospital.
Objective Three:
To assess and provide furthering education to two midwives per village during a one day lecture in each village for the midwives and a culminating day of training for all at Béré Adventist Hospital.
Objective Four:
To train 10 women from each village in the art of making and selling handicrafts, specifically dolls, teddy bears and clutch purses.

As you’re reading this, you can probably see the costs start to add up. The overall budget for this project is over $10,000. However, we have already approved it and are going to move forward, as we feel this is such an important work. As we try to further the work of our church and hospital, we feel that this fits very well into God’s plan of providing for the health of His children. Not only will this help people live healthier lives to glorify God, this will build up a solid reputation for both church and hospital (which are actually inextricably linked here).
It’s taken us almost a year to realize it, but we now know that we’re not here to heal people in the hospital. That’s important, yes. But, we’re here to build relationships. And this will help us build relationships. Hospital to community. Community to community. Hospital to people. People to people. People to Christ. It’s all about relationships.
I’m not a fund-raiser by nature, nor is it something I particularly enjoy. But I’ve had enough people ask what specific projects they can give to, so I thought I’d offer this as one. Obviously, we don’t expect anybody to cover all the costs. Every little widow’s mite helps.
And while I’m on the topic of fund-raising, I need to give a little praise. We are planning on expanding our hospital and so far we have already received donations from A Better World Canada as well as Springfield First Adventist Church in Massachusetts. Both are funding entire buildings!!! As well, we’ve had several generous individual donors toward the ends of new buildings. And Association Medicale Adventiste de Langue Francaise has agreed to send a container or two full of equipment for the new buildings once their built. New, modern, functional, useful equipment has been a thorn in our side since arriving, and this will be very welcome. To the same end, we’ve had many other institutions be generous with their donations of supplies, such as Florida Adventist Hospital and Baystate Hospital. Thanks to one and all!!!
If funds are tight, please support us with your prayers. These are far more important than any money!
You will notice on our blog,, that we have a link for donations. This is through Adventist Health International’s website. We believe strongly in the mission of AHI. We feel that AHI is an organization worth supporting. By donating through AHI, you can be reassured that there is a strong measure of accountability following your donation. Just mark the donation for ‘Bere.’ And remember that your gift is 100% tax-deductible.
Olen Zain: +235 62 16 04 93
Danae Zain: +235 62 17 04 80
Olen et Danae Netteburg
Hopital Adventiste de Bere
52 Boite Postale
Kelo, Tchad
Volunteers Welcome!!!

Monday, October 31, 2011

#65 Operative report #2 omphalocele

Omphalocele. Said like ohm-FALL-oh-seal.

An omphalocele is a malformation of a newborn baby. The cute little baby is born with some or all of it’s gut within a thin membrane on his or her abdomen. So if this thin little membrane gets infected or cut, all of the intestines spill out and the baby dies. The cure is to fix it with surgery.

Did I mention that these problems arise in NEWBORNS?! Very small, tiny, itty-bitty babies? Well, actually, they arise in utero while the baby is forming. But, most people here don’t get ultrasounds during their pregnancy.

These are pretty rare. I’ve never seen one here before. I’ve never seen one before here. Samedi and James saw and operated on ONE during all of their time here before.

God forsaw this and James just happened to make a last minute trip here yesterday to get some of his belongings to Moundou.

Then during rounds a lady came in with her baby girl. Malformation. Diagnosis. Omphalocele. At least I knew what it was.

“Hey, James, have you ever done one of these?”

“Yeah, one time with Samedi.”

“Do you mind staying a little longer to help us with this?”


The cute little girl was born the day before. She hadn’t eaten any breastmilk yet, but the family had already given her water. (This problem is SOOOOO getting old!)

We brushed up in the surgery book before starting.

Now comes for the interesting part.

Simeon gave her some IV Diazepam. Maybe the first problem. The O2 sat read 70%. Oh, wow! We haven’t even given ketamine yet. She is only 1 day old. This little girl was perfectly fine before we started. Well, minus the water, but at least breathing well.

We don’t have oxygen here, remember? The O2 sat improved and James, Samedi and I scrubbed.

If we don’t use a spinal, we do everything else here with ketamine. Not INTUBATED! It works surprisingly well actually. Except when they’re not breathing well!

We had barely started the surgery. I tied off the umbilical vessels, then made an incision about 4mm next to the edge of the omphalocele to undermine the skin all the way around. Then the same thing happened again.

James broke scrub and started doing CPR. I broke scrub and helped Simeon with respirations for the baby with the ambubag. I told someone to go get Olen to help with anesthesia. Olen came and helped out.

We re-gloved and continued with the operation. James cut off the small part of skin that was on the omphalocele. I undermined the skin that was left on the abdomen. Next, James pushed the herniated thin sac with intestines back into the abdomen and I closed the skin with mattress stitches. It was too tight to close the fascia. This will have to wait another 9 months or so for a second operation.

Then the baby would NOT wake up. The monitor wasn’t showing a good oxygen saturation. When we used the ambubag, it would improve, some of the time.

It was several hours after the operation was done. I had gone home to be with the kids and feed Zane. Olen called. He needed a break from baby that kept threatening to die. He couldn’t leave Janna and Adam alone with a sick baby. The oxygen saturation kept reading 60-70% for the longest time even with respirations. Should we cut all of the sutures? Maybe there was not enough space inside for the tiny lungs to expand.

So we switched out. I brought over a different oxygen monitor. The new monitor read 90%. Maybe the first two monitors just hadn’t been working. By now the baby looked okay. I put my finger in her mouth and she actually started to suck. I had the mom express some colostrum and used a syringe to put some in her mouth. She did well.

Janna volunteered to stay with the baby during the night to watch and observe. Usually we just leave the patient with the family to guard the patient, but we were sure the family would fall asleep and then the baby would just die if she needed to be stimulated to wake up.

By this time it was dark. I had a GYN patient to see in maternity, then a baby in urgence (the ER) with another malformation.

You will NOT believe this!

Another baby girl with an omphalocele! She had just been born that same day (at home of course, just like the one today). I could not believe it! TWO babies came on the same day with this rare problem.

So today I did the second operation. James wasn’t here. Samedi was out. So it was me and Abre. There were so many problems yesterday with anesthesia that I decided to do it with local anesthesia. I kept Olen in the room with me this time, just in case. It actually went much smoother not having to worry if the child was going to die or not. And no, the child was not suffering. The lidocaine actually worked well surprisingly.

We fixed the immediate problem of the exposed membranes, but the fascia (the thick stuff that causes hernias if it’s broken) was too tight to pull together. It will have to be done at a later time. If someone knows a pediatric surgeon who would like to come fix these two precious girls’ abdominal hernias, they are welcome here in 9 months or so. Otherwise it will be us.


Olen phone: +235 62 16 04 93
Danae phone: +235 62 17 04 80

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

Volunteers Welcome!!!

Thursday, October 27, 2011

#64 Operative Reports #1

If I keep this up, I’ll never be able to take boards with these cases:

Cesarean Section, 10/25/11

The patient presented at “8 months” with vaginal hemorrhaging and the baby was determined to be alive with the fetal doppler. The patient verbally consented for a cesarean section for the indication of placental abruption. She was transferred from the delivery room to the operating room by having her hobble along with blood dripping down her leg.

Once on the table a spinal was attempted, but failed. I instructed anesthesia to please try again because lidocaine with ketamine makes it hard to separate the abdominal muscles. Anesthesia was indeed able to obtain spinal anesthesia. We prepped, scrubbed, and draped. (During scrubbing the water went off, so someone was sent to turn on the pump to fill up the tanks. We continued scrubbing).

Before incision, the patient’s heart stopped and she stopped breathing (yes, she died). (What? I didn’t even know there was a problem, Simeon. How long has the monitor not been picking up an O2 sat or heart rate. I did notice it was quiet, but I thought she just wasn’t hooked up yet.) Anesthesia started mask breathing for her. First assist and lead surgeon traded off chest compressions. Another nurse in the room ran to get Mr Dr Netteburg from rounds.

Her heart started up again. Anesthesia continued bagging. High spinal suspected.

Mr Dr Netteburg entered the room, but by this time things had somewhat normalized. Mr Dr Netteburg checked her pupils.

“Dear, her pupils are fixed and dilated.”

A Pfannensteil incision was made. This was sharply dissected down to the uterus. The baby was delivered in cephalic position. The cord was clamped and cut. The APGARs were...well, he was crying some, so that’s good, right? The baby boy was passed off to the awaiting NICU team (or, um, ER doctor) for possible resuscitative measures.

The uterus was closed in 2 layers with 0-chromic. Irrigation was done. Fascia was closed in continuous fashion with 0-vicryl. Skin was closed with 3-0 vicryl using interrupted suturing because EVERYTHING gets infected here it seems.

So, this was pretty much an uncomplicated surgery except that she died and came back to life.

Baby was sent outside to the awaiting family to wrap up in a non-sterile brightly colored African cloth.

Mother received artificial respirations long enough that the spinal wore off. As I was shining the bright lights in her eyes, she eventually started blinking and pushing me away with her hands. So, her fixed pupils improved, and I don’t even know what caused them.

Mother was transferred to maternity where the family was awaiting. Strict instructions were given to family members that if she stopped breathing, look for a nurse (which sometimes can be hard to find).

I learned I was supposed to give epinephrine for a high spinal apparently.

Mother and baby are doing very well now. The mother knows I will kill her if she gives her baby water. (And it’s not the first time she will have died, she does know that too.)

Yeah! I definitely can’t turn this operative report in. Although it IS the first one I’ve written in over a year. (At least one that’s been over 3 sentences long.)

olen and danae

Olen phone: +235 62 16 04 93
Danae phone: +235 62 17 04 80

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

Volunteers Welcome!!!

Saturday, October 22, 2011

#63 Girls Just Wanna Have Fun

Sweet 15. Oh, wait, 16 is another year away. But still, she’s growing up and it’s only fair for a girl to just wanna have fun on her birthday.

Brichelle is one of the most amazing teenage girls there is. We’ve written about her before because she’s Lyol’s babysitter. Everyone loves her. Especially Lyol.

Everyone pitched in to make her day. Marci and Mayline were in charge of recreating Australia inside the Parkers’ home. Marci had brought huge rolls of white paper with her, so they made several murals of the Great Barrier Reef, Sydney at Night, The Australian Outback, and Australian animals. That Marci... such a talented drawer! Since Brichelle is 15 (Tchadian marrying age), they even made a Crocodile Dundee to take pictures by.

Brichelle’s favorite food is Sushi, so Dani’s asian roots came together too for that.

One minor glitch. A positive malaria test the day before her birthday. Poor Brichelle. Luckily she wasn’t vomiting for her birthday and was able to continue her pills.

I had the easy role to play. After work I went with Tammy, Brichelle and Naomi (Tchadian who knows a million languages) to the local “foot spa.” We went to an arabic lady’s house for the afternoon to get henna done on our feet. It was scorching hot inside her hut. But hey, a girl’s gotta feel pampered somehow here in Tchad.

After we were done, Cory arrived with the motorcycle to escort Brichelle back to her birthday party. After a big “surprise!” 18 party-goers were off to start a picture treasure hunt. Even though it was already dark, four groups set off to find various things to take pictures of. The person with the most points after an hour would be the winner. There were things like ......

A picture with a baby goat.
The picture with the most dogs in it.
The picture with the most cows in it.
A picture of a Tchadian couple holding hands.
A picture of the best Crocodile Dundee impersonator. (Lyol won easily.)
A picture of blueberries.
A picture of fish and chips.
A picture of the tiniest Tchadian money and the oldest Tchadian money.
A picture of a bouquet of pictures.
A picture of a Tchadian kid with an English-writing T-shirt.

Afterwards we ate and watched the picture show to determine the winner. Of course Brichelle’s team won! She’s so good!

It was quite a fun night. Even though 15 is marrying age, we hope Brichelle waits a little longer at least.

olen and danae

Olen phone: +235 62 16 04 93
Danae phone: +235 62 17 04 80

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

Volunteers Welcome!!!

Wednesday, October 12, 2011

#62 Triple Trouble

‘Say what?’ ‘Come again?’ ‘Watchu talkin’ ‘bout, Willis?’

These were all things I tried to say, but it kinda came out like, ‘Uuuoooooaaaaapppttthhh.’ I think I picked it up as one of the local tribal languages for the above sayings.

Mom was just explaining that there’s no dating here. Apparently, it’s a rule. It was originally meant just for the student missionaries here. (Which, by the way, are multiplying like rabbits around here!!! We’ve got thirteen right now!)

Normally, I wouldn’t be upset about this. But you gotta pull this out on me in public? Right now? Right in front of my girl? Seriously? But, Mooooooooommmm! It’s not fair!

Friday, I was just minding my own business, doing my thing. You know how it is. Coo for a little bit. Look real cute like. Pretend like you’re gonna cry, but then break a smile at the last second. (That one busts people up, man. Works every time.) Breastfeed a bit. Turd in your pants. Make ugly faces at your brother when Mom’s not watching. Read A
Tale of Two Cities when Mom’s not watching. You know how it goes. I don’t need to tell you. You’ve all been there. Anyways, this total hottie rolls up, right. Looking all sassy in her onesie. Sporting these hot pink cloth diapers. You feel me? So of course, I’m all like, ‘Hey, what’s up, baby? You new around here? Cool, cool. No worries. Don’t be scared. I know it’s like, Africa and all, but no stress, baby. I’ll show you around a bit. Just stay close, you know, cuz this is like all real up in here. We’re talking Africa-style. There could be like vicious tigers and bears and woodpeckers and penguins and dolphins and stuff around. So stay real close in case I need to fend ‘em off for you.’

She totally fell for it and was diggin’ on me. She let me slip my arm around her. Everything was going great.

Of course, then her big brother came barging in. Dude can’t respect privacy, man. This cat was on my shoulder all day like bird dookie. Anyway, he got all scared by the talk of lizards, so he started crying. The crying was killing the mood, man. So I stuck my thumb in his mouth since I couldn’t find a pacifier. Then while he was distracted, I totally slid my hand down his sister’s back to her derriere. You can see in the picture what I mean.

Anyway, that’s when Mom caught us and busted out the whole ‘No Dating’ speech, right in front of everyone. It was no secret that it was aimed at hottie and me. Anyway, baby, while we’re apart, you know I’ll be thinking about you and waiting for you.

Oh, I should explain. Hottie is Miriam. Her big brother is Adam. They’re the Appels. They were actually born within 24 hours of me. What are the odds? Three Americans in Tchad born within 24 hours! That’s a first, I guarantee. They’ll be moving to Moundou, a couple hours away while their parents open a surgery center there. But you know we’ll be in touch.

Friday, October 7, 2011

# 61 Return

I started writing this blog 5 months ago. But there was a change in the outcome that was difficult for me, so I did not finish it. Plus our blogs can be depressing enough.

Olen has been gone for 9 days taking oral ER boards in the states. (He’s coming back today by the way). It’s 4:30 in the morning, the 2 boys are asleep, and I was just awakened to check on an OB patient.

In Olen’s absence I’ve been rounding on the whole hospital. Our census is not as high as it could be, but it still takes up a good chunk of the day. Thankfully Scott (surgeon uncle) and Bekki (nurse aunt) are here to help. The last few days Scott has been practicing his French and taking over surgery rounds.

Yesterday I started in pediatrics. We have about 16 or 17 patients on pediatrics right now. Most of them have malaria and severe anemia. One has Burkitt’s that is amazingly improving, but it was my first patient of the day that caught me with my guard down.

The nurse started presenting to me: “5 months old, vomiting, fever, pale.” More of the same things I usually see on pediatrics. But I could not get over the father’s face. He looked so familiar.

The nurse explained more of the history. This baby is an orphan.

“What?” I usually only understand about 1/2 of what they explain to me in French, so I have them repeat it again and again. But I’m getting better.

“Okay, okay, sounds like the baby has malaria, but why do I know him?” I would remember that face anywhere. If you’ve been through something traumatic with someone, it’s hard to forget them.

Then it came out. “The baby’s mother died here.”

Here at this hospital. Here under my care. Here at this Christian hospital where miracles happen.

Then I instantly remembered him. His puffy eyes. His wailing when he received the news.

His pregnant wife had come in initially after having broken her water at 8 months. The problem was that she had 2 c-sections already. I struggled over her plan of care, but decided to hospitalize her and sit on her (no, not literally). I gave her antibiotics. The baby was doing well. I explained to her and her husband that I planned to do a third c-section, but was waiting for the baby to get bigger (We have no Nicu). If the baby came quickly and easily, then maybe a vaginal delivery. Very unlikely.

She was hospitalized a couple of weeks. Things settled down. She did not get infected or have labor.

The family demanded to leave. I urged them not to. I was angry at this man, her husband. He did not understand. I tried to explain. I was probably too harsh. But in the end, they left. I knew she would come back with a dead baby, or hemorrhaging, or with her uterus ruptured.

She came back. With labor. I don’t remember the time line now, but she came back. I ended up doing a c-section, one of the hardest of my life. There was so much bleeding and scar tissue. We had no cautery (it intermittently works). It took me a very long time just to get to the baby. I had to cut and tie off muscle and thick pieces of scar tissue that were attached to the uterus.

The baby boy came out small but alive. I remember searching for her tubes so that I could prevent another c-section like this and maybe prevent her from dying with another pregnancy. I couldn’t even get her uterus out. It was stuck in her abdomen. I couldn’t find her tubes. I irrigated her several times. Her muscles were a little oozy after being cut. I carefully searched out any source of future bleeding. I did not want to go back in this abdomen again.

I planned to write a blog of this great story of both mom and baby returning to the hospital and living.

But the next day she died. She may have bled into her belly from the sounds of things. I was at the river when it happened. I went directly to the morgue where all of her family had gathered. There were gobs of people, but her husband did not arrive until after I did. He had gone to the village.

The family was getting ready to take my patient home to begin the funeral services. But the baby. The baby was still living. Who was going to care for the baby? We unfortunately had gone through this scenario before.

Everything was happening so fast. I ran back home to prepare a quick bottle of formula. I don’t usually like to give away whole cans of formula because babies die so easily here and then it gets wasted. Or they just sell it for money. But I felt compelled to give a bottle and can of formula to this precious little boy.

The father was understandably too upset to listen to how to mix up the formula, so I found a teenage guy who spoke decent French. I explained that the water needed to be boiled, don’t dilute it, and never give plain water to this small of a child. I begged them to return if they needed any help.

And with that they were off.

I didn’t hear from them. I assumed the baby died. Then we went on annual leave.

I still remember the deaths I feel like I maybe could have changed. I think of them often here. Today God allowed me to see the beauty of this little child He is watching over and allowed me to bring into this world. Please pray that this baby continue to thrive.

olen and danae

Olen phone: +235 62 16 04 93
Danae phone: +235 62 17 04 80

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

Volunteers Welcome!!!

Tuesday, October 4, 2011

#60 - Scary

It’s been a really long day, but I would like to ask you for your prayers for our health.

Last night we had dinner with Tammy and Jamie to discuss some plans for our student missionaries. Tammy made some yummy fajitas with some real burrito shells that someone had sent her in a care package. The first clue that Olen was sick was that he didn’t eat any. He said he wasn’t hungry. Probably jet lag he thought.

We got home later. He was exhausted. We got ready to go to bed. He felt hot to me, so I took his temperature. 100.7.

“Oh great, Dear. You probably have Malaria. Do you want to start quinine tonight?”

We said we’d get him a test in the morning and wait to start quinine till the morning.

I got woken up at 4am to go deliver a baby. Same old story. Labor for a long time. Baby delivered with meconium. I couldn’t find the deLee suction. Nurse ran to the OR to get me another one. Baby ambubag wasn’t working well. I did mouth to mouth. Grandma actually came over to me after a couple of minutes to say it’s okay to stop. I said no. Cute baby girl is still living now. And actually doing well. Praise God.

I came home around 5am. I felt impressed that I needed to really pray extra hard today. I felt God’s peace before starting the day.

7am came and Olen still felt bad. He barely woke up. He wasn’t vomiting, but said he felt nauseated. I was the good missionary wife and let him stay in bed. I was pretty sure he had malaria. Zane stayed in bed with Olen, while I brought Lyol over to the Parkers.

After morning worship and the staff meeting, I went home to feed Zane. Anatole came over as promised to get Olen’s malaria test. Olen was very exhausted and stayed in bed, but said he would try to come round on medicine and pediatrics later.

I rounded on maternity. Thankfully the cute baby girl who delivered today was still living. I tried to get her to eat. She had the energy, but the mom had “agitation” (whatever that is), so didn’t really have any interest in feeding her child. I can’t figure out if she’s mentally ill or not yet.

On to surgery rounds.

It was getting late. I already didn’t scrub with Samedi for an interesting case of perforated intestine/infected abdomen because there were so many patients to round on.

I got Olen’s positive malaria test and bought him some quinine pills. I ran home. Gave him the meds and made him eat a banana. He looked really tired, but said he’d come in a few minutes to do pediatric rounds.

I started medicine rounds and by the time I finished, Olen had finished pediatric rounds and came over to Urgence with me. I noticed his scrub top was drenched in sweat. It was hot out but not that hot.

“I guess the tylenol helped your fever break.”

By this time it was around noon already. Juliette kept presenting patient after patient to us in Urgence. Where did she find so many patients? Olen sat at the desk in urgence, he started to doze off. He’s probably just tired I thought.

I had 3 new volunteers with me (2 premedical students and 1 nurse). I had Amanda, Anna, and Janna take turns interviewing the patients. We saw several, about 5 or 6. I would interrupt Olen’s dozing to ask him questions from time to time.

Then a guy came in with elephantiasis of his leg I think. “Olen, this is up your alley, not mine.”

“Olen, here drink some water.”

Nothing. He just spurted air out of the side of his mouth.

What? Olen is REALLY sick. He’s not really conscious. He is drifting.

The girls helped me bring him over to the examining table and I kicked the patient out. Stuff usually happens slow here. You usually have to write for meds in someone’s patient book, then the family member brings it over to the cashier. You pay, then bring it to the pharmacy, then the family members bring it to the nurses.....all before giving it to the patient.

But somehow, people just went to the pharmacy and got stuff for me thank goodness!

Nurses came from all places. One got an IV. I called for dextrose. Olen hadn’t eaten anything except a banana, so he was probably hypoglycemic. After one ampule of dextrose, we got a sugar which was normal by now if he had been low.

He looked white. Very white. Juliette took his BP. 70/40. By now he had IV fluids running.

“Please someone squeeze that bag to get it in faster. And get another IV line.”

Janna retook the BP. “It really is 70/40 Danae. And his pulse is thready.”

I start to freak out a little. Olen wakes up a little, but falls back asleep. He’s eyelids are very heavy. He just looks like he doesn’t have a care in the world.

Another nurse gets another IV started. We give a second dextrose. This is NOT my field. I’m NOT an ER doctor.

I ran to the office to find the pulse ox, but couldn’t find it. So I ran into the OR where they were doing a case to ask Simeon for one. I didn’t even put a mask/hat on.

Back at Urgence Olen started to improve. I asked him how he is. “I’m fine,” he would say sounding very slow and drunk. By now his BP had improved to 90/50.

I send Tammy a text to feed Zane formula if he was hungry because I was very late getting home now. He hasn’t needed to get formula yet, but I can’t store breast milk reliably here, so I had some formula saved for emergencies. But, the phone services aren’t working right now. I send Anna over to her house to relay the message.

After the 2nd 1/2 liter of IVF’s, he remained conscious. Tammy came over to tell me that Zane was asleep and fine. No need to worry.

Olen continued to say that he was ‘fine.’ At least his color was mostly back by now. We started him on the third bag.

It had been quite crowded outside of the ER consultation office. It’s not too often patients come to Bere Hospital and their doctor crashes on them.

The nurses said they heard people saying that they might as well leave. If their doctor got this sick, what hope was there for them? But somehow they stayed.

Janna and I walked Olen home. I’m greatful that we had been in the hospital where I could easily ask for help even though the phone services were down.

After a short break at home and making sure Olen was okay, I went back to see more patients. I saw maybe 10 or so more patients in our office. Then I found someone who needed a D&C for an incomplete miscarriage. Since the phones were down I did my own anesthesia without Simeon. I asked one nurse to help me who was already here. I gave her a shot of ketamine and then did the D&C.

By the time I got home again it was almost 6 pm.

Olen’s feeling better now. He ate a little rice and sauce for supper. He’s also forcing himself to drink some lemonade I mixed up for him.

God still has a plan for us. Please continue to pray for our health. Especially Olen having malaria right now. This was one scary day for me!