#10 Tomorrow

We'll just write this for the fourth time, since the first three time I crashed my Mac when I tried to save it.

We know that you are continuing to pray for us. Tomorrow, we ask for a very specific prayer.

This morning, we met with our nurses and asked what we could do to make their jobs easier. They asked that after morning worship and morning report, we immediately begin rounds (myself in medicine and pediatrics, Danae in surgery and maternity), then I begin ultrasounds, ER visits and outpatient visits while Danae joins the OR team. The OR will begin with the simple surgeries (hernias, hydroceles, breast masses, etc) while Danae is rounding and save the difficult cases for after she joins them. I believe it is a good plan. (Although immediately after the meeting, the nurse in charge of the ER asked me to see several ER patients before I began rounds!)

Today was four or five major cases with Danae and several other minor ones without her.

Tomorrow we have even more surgeries planned.

For the last couple weeks, we've had an eight-month-old with a neck abscess in our pediatric ward. The first day, I aspirated 10cc of pus out of his anterior lateral neck. He's been on ampicillin and gentamicin since. Today, I pulled a fresh 10cc of pus out. The antibiotics aren't working. He needs to have his neck cut open. The presents a couple potential pitfalls.

The first issue is... This is his neck!!! If this eight-month-old moves while we have a scalpel in his neck, there are nerves, blood vessels, muscles, a trachea and various other vital structures in the immediate vicinity waiting to be cut. I'm nervous enough about putting a needle in his neck, let alone a scalpel.

The second issue is his airway. Normally, this child would be intubated and sedated for this. However, I can't find an endotracheal tube small enough to fit into an eight-month-old trachea. We don't have laryngeal mask airways. Even if I could intubate him, we have no ventilators and no oxygen. The family would need to squeeze the bag filled with room air at a very specific rate and depth for 24 hours a day for several days. If they fell asleep or forgot, the child would die. He would also need to be sedated for days (our only options are ketamine and diazepam). I think it would take days for the swelling on his neck to go down. He has been struggling desperately for every last breath for the last two weeks. After two weeks of retractions and gasping, I'm not sure how much longer he can go and I'm not sure how long he would need for the mass in his airway to go down. I'm not even sure I could bag around the bulge in his airway. Ideally, I would perform a tracheostomy, but I can't find any tube small enough for his tiny airway.

So tomorrow, under far less than ideal conditions, but with your prayers, we will incise and drain the neck of an eight-month-old with only local anesthetic.

Waiting in the wings, I have another pediatric neck abscess for incision and drainage. I drained another pediatric neck abscess with a syringe today because the father wouldn't let me incise and drain it. I have been incising and draining face abscesses, three or four abdominal wall abscesses, hip abscesses (actually had to go to the OR) and various others. It's pus central in this district!!!

Yesterday, I sutured up a woman's great toe and tried to relocate her open fracture/dislocation in the toe (local anesthesia, very dirty wound after a motorcycle accident, no Ancef around, held it in place by gauzing tongue depressors around it). I also put her dislocated shoulder back in place (no medications), which she mentioned as an aside after I finished her toe.

We sutured up a one-year-old tongue laceration, which had completely bisected the tongue. Done under ketamine.

I sent a man home who stroked and is paralyzed on his dominant right side.

I performed about my sixth lumbar puncture positive for bacterial meningitis this week.

Anyways, keep us in your prayers, especially with the little boy. And if you want to see/do things you'll never get to see/do again, come lend us a hand. It's where the world needs you the most.

You Might be in Tchad if...

You find it really hard to get any good reading done because you don't own a toilet seat.

You will notice on our blog, missionarydoctors.blogspot.com, that we have a link for donations. This is through Adventist Health International’s website. Please keep in mind that AHI takes 10% of the donation for administrative costs. However, AHI also provides us with invaluable support, and we believe strongly in the mission of AHI. We feel that AHI is an organization worth supporting. And remember that your gift is 100% tax-deductible.

As always, we can be reached at danae.netteburg@gmail.com.

Olen Tigo: 98 07 46 28

Olen Zain: 62 16 04 93

Danae Tigo: 98 07 46 27

Danae Zain: 62 17 04 80

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