#17 Medical Update

There have been a few questions for follow-up:

1. ‘Did the baby I stuffed under my shirt live?’

Yes and no. The baby lived for a few days. The family refused to feed him. It’s very common here to not feed the baby for three or four days after birth. Then, they feed the child water only. No matter how hard we try to convince them otherwise, it’s often useless.

This particular child wasn’t fed, so I ordered for a tube to be placed through his nose and into his stomach. The neighboring patient agreed to donate milk to be put through the tube to feed the child. The next day, the tube still hadn’t been placed by the nurses. Danae put it in herself. The next day, the neighbor still hadn’t given milk. The next day, Danae found the nasogastric tube laying on the bed and nobody around.

This is an ongoing problem. It’s unbelievable that they won’t feed newborns and when they finally do, it’s water only.

A similar child was born shortly thereafter. Danae gave them a bottle from our house filled with formula from our house. The next day, the baby was dead, the patient was gone, the bottle gone with the patient, apparently.

2. ‘Was the baby with the neck abscess cured?’

Yes and no. A week after our incision, he spiked a temperature. The day after that, his father found me and told me his son was suffering. I found him with his trachea pushed over the left. The place where the trachea should be was now also occupied by abscess. I put a needle into his neck and pulled out 20cc of pus. The baby could still barely breathe.

With no anesthetic, I made a new incision a half inch behind Danae’s first incision. The baby didn’t budge. All his strength was going into breathing and he couldn’t be bothered to move to avoid the pain caused by my scalpel. I used an 11-blade (pointed) scalpel and just pushed farther and farther. I came in behind the carotid artery and internal jugular vein (but not before I nicked the external jugular vein). At one point, I removed the scalpel and held it in front of the boy’s neck. The length of how far I was putting in the scalpel was far enough to reach the boy’s trachea and esophagus.

I looked at Samedi and said, ‘If we can’t find the pus, the boy will die. We have nothing to lose.’ He agreed, we said a quick prayer and I plunged the scalpel into the neck once more. I pushed it in farther and farther. Eventually, the entire scalpel was in the neck and I could only see the handle anymore. After pushing three inches of scalpel and handle into the neck of an eight-month-old infant, I saw the satisfying rush of pus. It just kept coming and coming. When it finally stopped, we pushed on his neck and more and more pus kept coming out. He immediately breathed better. We packed the deep hole with gauze.

The next morning, I heard that he had cried all night. His father and I rejoiced together. This was the first time in three weeks that he had the strength to cry.

It’s been almost a week since then. He’s still in the hospital, having his gauze changed every day or every other day. Pus still comes out, but at least it now has an exit. He smiles, he eats, he breathes. His fever’s gone. He will be here a long time yet until the hole in his neck heals from the inside out. But he will go home on his mother’s back someday, not wrapped up in a colorful, sad cloth like so many others.

3. We have a 15-year-old boy from a neighboring village, about six or seven kilometers away. We had an abdominal wall abscess, about 4x6 inches. It gets packed with fresh gauze every day or every other day. He’s been here a month. He’ll be here at least another month. He doesn’t speak French or the local language, Nangjere. After all, his village is far, about four miles.

Danae brought him a jigsaw puzzle. The next day, it was finished. With a big smile.

He hasn’t been in school for a long time (I don’t know if he ever was). He won’t be for a long time. Danae and I asked how much the private school costs, the one right next to the hospital.

‘Oh, it’s too expensive. Nobody can afford to go there.’

‘How much?’

‘It’s 5,000 francs.’ $10.

‘A month?’

‘A year.’

Danae and I bought him a uniform and paid his tuition. He started yesterday.

4. A man brought in his sister-in-law because she had funny spots on her arms, legs and trunk. They were relatively circular darkenings about 2-7cm across. Something clicked in the back of my brain. I pinched her. She said it hurt. I pinched a circle. She could feel it. I touched her lightly. She could feel it. I lightly touched a circle. She couldn’t feel it. It’s been going on for a long time. I think she has leprosy.

5. I had a case of loa loa, confirmed by the lab.

6. I had an infant who couldn’t pee. I ultrasounded a 4x6cm mass in the bladder of a baby. The next day I couldn’t find him. The parents took him home, still not peeing. I hope he comes back.

7. I had a 12-day-old who hadn’t peed for nine days. His belly was firm with a distended bladder. The foreskin had shut and wouldn’t allow the urine to exit. His penis and scrotum were too edematous for a circumcision of his phimosis. Danae was able to force a catheter into his bladder. We’re waiting for his edema to go down before Danae performs a circumcision.

8. Danae sent home the baby she had delivered at 33 weeks.

9. I sent home my patient I diagnosed with HIV/AIDS and syphilis. Our lab proved those infections, as well as a parasitic stool infection, a urinary infection and malaria. I sent him with ciprofloxacin, doxycycline, bactrim, quinine, mebendazole and metronidazole, all antibiotics.

10. A man came in with a swollen, hard, tender, red right calf. I gave him some of our precious stock of expired lovenox and five aspirin a day. After a week, it wasn’t really better. Then I noticed drainage. After cutting open the leg, we found a massive abscess. And he bled a little bit too.

11. I was called to the ER to see a women who was hypotensive, 90/60. They said she was ok otherwise. When I saw her, she was barely breathing. I asked the family if she was walking and talking. They said she hadn’t spoken, eaten or moved her right side for a week. I went to my office to grab a pulse oximeter. I put it on her finger and couldn’t get a reading. I asked the nurse to check the blood pressure again. He couldn’t get one. I noticed she wasn’t breathing. I put my stethoscope on her chest. I hugged her daughter and the family began to stream in, hugging me while beginning the ritualistic mourning wail for those dear ones lost.

12. I had another patient who hadn’t spoken or moved his right side for a week. I asked him to move his left and he complied. He could understand, but he couldn’t talk... or walk or write or... I explained the situation to him and his family, gave him intravenous aspirin and sent him home.

13. I had another couple stroke patients... but you get the idea.

14. I had a child come in with a Burkitt’s Lymphoma tumor. I gave him my last two boxes of cyclophosphamide, free of charge. He refused to pay for the dexamethasone, IV and tubing and hospitalization. So I still have two boxes.  ed.note, Mega thank-you, Global Services in Loma Linda, California for the cyclophosphamide that was Fed Ex'd to Maryland, where Danae's parents took it to Chad, Jan. 16.

15. At morning report one morning they mentioned that the nurses had admitted a 15-year-old boy with malaria seizures. That seemed odd to me. ‘Did he have a fever?’ No. ‘Did he have any other symptoms?’ We don’t know. ‘Did he ever seize before?’ We don’t know. ‘What was the seizure like? Was it full body shaking? Was it a little twitching?’ We don’t know. ‘Why do you think he has malaria?’ He had a seizure.

I see the boy later that day. He’s having a seizure. Tonic-clonic. Incontinence. Check a temperature. Normal. I talk to the parents. Does he have any other problems? Has he ever seized before? Yes. When? Oh, about every week or so. For how long? Since he was little. I stop the quinine. Start Phenobarbital 100mg twice a day. My only other anti-epileptics are Thorazine and Diazepam. If those don’t worry... bummer. If they do work... well, they’ll need to decide if they’re worth the side effects.

Anyways, more than I can recount.

You Might be in Tchad if...

You finally decide it’s time to learn to aim properly because you don’t own a toilet seat.

You’ve decided it’s easier to just spend the day on the toilet instead of making thirteen trips in twelve hours... And you pine for a toilet seat.

Your legs go numb every time you go to the bathroom because you don’t own a toilet seat.

It’s over. Our most recent volunteer, Jessica, brought us 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.

missionarydoctors.blogspot.com

 HYPERLINK "mailto:danae.netteburg@gmail.com" danae.netteburg@gmail.com.

Olen Tigo: +235 98 07 46 28

Olen Zain: +235 62 16 04 93

Danae Tigo: +235 98 07 46 27

Danae Zain: +235 62 17 04 80

Olen et Danae Netteburg

Hopital Adventiste de Bere

52 Boite Postale

Kelo, Tchad

Volunteers Welcome!!!