#26 Can’t Sleep

Everyone who knows me well knows that I can fall asleep anywhere, and easily.  No, I’m not depressed.  In fact quite the opposite.  I’m loving it here.  But the sleep issue is  even worse with pregnancy!  Twenty two weeks now and the little baby is taking half of my energy.  I fall asleep every night when I’m putting Lyol to sleep in our bedroom at 8 pm!  My poor husband.

So if I can’t sleep, or if I sleep restlessly, there’s usually a good reason.  One of our new nurses, Albertine (who is excellent), came to tell me about a pregnant patient before I put Lyol to bed.  

It was the patient’s first pregnancy.  Who knows how far along, but she was measuring 31cm fundal height (maybe about 7 or 8 months?).  She had broken her water and was about 1-2 cm dilated.  Albertine felt a hand or a foot.  She wasn’t having contractions.  

“Start antibiotics and come get me if she goes into labor.”  

I thought I should go check on her after I put Lyol to bed, but I didn’t go over there.  I kept waking up, and was sleeping very restlessly.  

At 2 am, when there was a knock on the door, I knew it was for me somehow.  Grabbing my wrap, I oozed out of bed.  One of the other nurses had come to get me and said,  “Acouchement avec pieds.”  (Delivery with feet)

I knew that meant the patient was in the middle of her delivery, feet first.  I ran to the hospital, forgetting my headlamp and keys.  

Entering maternity, the baby was already delivered, small (2.3 kg or about 5 pounds) and not breathing.  She had just delivered and the nurse was trying to stimulate the baby by rubbing the back and feet.  

There was NO suction and NO Ambu-Bag.  The nurse had used an old and used kit that had been laying on the counter to cut the cord.  Remember my lock box that I put necessary supplies in?  Well, it doesn’t work if you don’t have a KEY!  I have a key (but I forgot it at home), and the day nurse has a key (but she didn’t give it to the night nurse!).  So, we had nothing to work with!  So frustrating!  

I told the other nurse to run and find an Ambu-Bag so I could help the baby breath.  He went to pediatrics to look.  We found a unclean, used bulb suction to help suction the baby’s mouth.  All of this was taking time.  The baby still wasn’t breathing, but had a heartbeat.  If I didn’t breath for the baby, she would die.  I’m tired of babies dying here!  

So, I breathed for her.  Just a few breaths.  She whimpered.  A few more breaths of air into her lungs.  She actually cried a weak cry.  It was working.  

By this time, the other nurse returned with an Ambu-Bag, and I breathed some more with the Ambu-Bag.  No oxygen, but it worked.  The baby made several good outbursts, bringing fresh air into her tiny virgin lungs.  We had no suture to tie off the umbilical cord because it was locked in the lockbox.  

I went home to get my keys.  I looked up at the beautiful stars that were even visible with the bright moonlight tonight.  Thank you God for another life.  The devil tried to take this one, but You have snatched her back into this life.  Thank You!  

I found the keys and returned to see if the baby could start breastfeeding.  She seemed to have a suck reflex.  While I was helping this first time mom give her premature infant her first milk, Albertine told me how she delivered.  The mother had progressed very rapidly in labor.  The feet and one arm delivered at the same time, but thankfully Albertine knew enough to grab the feet and deliver her breech.    

I went home with a grateful heart and gave my husband a big kiss (of course after I washed my mouth off with bleach water).  I fell asleep peacefully.

This 5 pound baby girl was eating very well her first day, but had a fever in the afternoon.  I wrote for antibiotics to start.  The nurses know that if the parents don’t have the money then they should search for one of us to sign a “free form” for medications when it is something urgent (any baby under 3 months of age with a fever is ALWAYS urgent).  I bragged to Olen that night that another good nurse was working and I didn’t have to go back and check to see if this new baby was getting antibiotics because I trusted him.  

The next morning I was livid to find out that the antibiotics had not been started!  It seems that these little ones keep getting strikes against them.  We started them on her second day, but they should have been started earlier.  Frustrating, but God is still watching out for them even with our human downfalls.  

#25 Timing

Most nights I sleep through the night with only Lyol waking me up or the occasional knock on the door for Olen (one of his nightly visitors usually--ha ha....something medical in the hospital).  Thursday night was special because I had a laboring OB patient that wasn’t going anywhere fast with her progression towards delivery.  

She came in the afternoon.  I had my suspicions that she wouldn’t deliver vaginally when I looked at her feet, which were short and stubby (OB superstitions).  She was only 16 and on her first baby.  Full term-ish.  It was difficult because she didn’t speak French.  I gave her a LONG try at a vaginal delivery.  I couldn’t start oxytocin on her (medicine to give your stronger contractions) because many of her contractions were lasting 7 minutes as it was!  Somehow, the baby seemed to be tolerating it.  Finally, after a much too long try at a vaginal delivery (cesareans are not so good in Africa if you want to have 10 children, especially on your FIRST delivery), at 2:30 am, I called the OR team to the Bloc (the term we use here for operating room).  Simeon (our anesthesiologist, really a nurse who learned spinals here) was called and came from home.  Ndilbe came from home (nurse in OR).  Abre was already working that night, so he scrubbed with me.  

I felt bad doing a c-section since it was her first baby, but it was necessary since her cervix wasn’t dilated all the way.  There had been a lot of meconium (fetal bowel movements), and since we don’t have NICU here, I deLee suctioned the baby’s nose/mouth just after delivering the head.  Simeon handed me the part for the baby sterilely, and he suctioned with his mouth to provide suction.  

Healthy mom and baby.  For now it seems.  After we brought her back to the ward (no post-op recovery unit here), I milked her breast and colostrum came!  I put the baby on her breast and she started sucking!  Trust me, that is a HUGE step towards surviving the first week here in Tchad.  Eventually I will MAKE the nurse on maternity make sure that the mothers are feeding their children.  For now, when I ask why they haven’t eaten the whole night, it seems like the nurses just laugh or shake their head in disgust!  (It should be part of their job to help the mothers nurse their newborn babies).  However, the night nurse is taking care of maternity (5-7 patients) and all of surgery (about 20) patients.  

Needless to say the next day I was tired.  I got home about 4 a.m. and didn’t go into the hospital until 9am.  

I skipped doing surgery rounds so I could do an inguinal hernia with our Uncle Scott, a general surgeon.  I want to learn different ways to do them, and he does a nice bikini cut that we don’t do here.  During and after the inguinal hernia, I was feeling kind of nauseated and my 2nd day of diarrhea was getting to me.  Don’t worry I’ll spare you the details unlike Olen’s malaria blog!  

I went back to the house for a 15 minute break.  I lay on the bed and decided to only do one more surgery that day.  We had an abdominal hysterectomy lined up to follow.  

Finally, I went back.  Our hysterectomy patient got her spinal and I re-examined her.  I was doing the surgery for pelvic pain.  Her uterus was small and felt quite mobile with anesthesia. 

”I should really be doing this one vaginally.”

“Well, why don’t you?” Scott asked.

I already had the abdominal hysterectomy kit opened, but wasn’t scrubbed yet.  I don’t even have a vaginal hysterectomy kit put together yet.  But minimally invasive is much better than a huge abdominal incision that could easily get infected here. 

I decided we could use the instruments in our abdominal kit and just get a weighted speculum in addition.  So...it took a few more minutes to put up the leg stirrups and move the patient to her new position.  

Just then the maternity nurse, Juliette, rushes in to see if I’m available.  

She pulls me into the pre-op area.  There laying on the gurney is a pregnant woman.  Not just any pregnant full term-looking patient.  But this woman has a full term baby’s arm sticking out of her vagina.  

“When did it happen?”  I ask in French.  

“Today.”  (That’s better than 2 days, I think back to the last arm presentation I had in the second week I was here).

I run to the office to get the ultrasound.  It’s small and portable, so I unplug it and bring it into the OR prep room.  

Meanwhile, the vaginal hysterectomy lady has her spinal and is prepped, but not draped.  

I put the ultrasound on and find the baby’s heart.  It’s there!  The baby is alive!

“We have to do a c-section, now!”

Will the team let me switch patient’s, or do I have to do it out here?.  I go and discuss with Simeon, and we decide to switch the patients.  We re-wrap the hysterectomy kit and put it aside for after the c-section.  

We quickly switch patients.  In goes the foley urinary catheter.  Betadine (for cleansing) for the abdomen.  Not enough time for a spinal, so we decide to start with lidocaine (anesthesia similar to what the dentist uses) locally and then ketamine IV after the baby is out.  

Quick prayer.  I inject 10cc of local anesthesia and make the first cut down to the fascia for a low transverse incision.  Her fascia is really tense and she starts to move.  Simeon gives her a little ketamine and she quits moving.  Her muscle is still tense, but we make it in quickly to the uterus.  Bladder flap.  I make the uterine incision and open the uterus. 

“Oh my, now wear is the head?”  I search for the head and finally find it over on the patient’s left side, midway up. I switch hands from my right to my left to get better leverage on the head.  

“This is going to be difficult.”  I grab the scalpel and incise about 3 more inches on the skin and muscle to make more room.  

Finally, we were able to bring the head over to the uterine incision and deliver the head, followed by the baby.  

I handed the baby over to the nurse and Olen.  Olen resuscitated the baby with the Ambu-Bag and squirted dextrose in the baby’s mouth.  After a few short minutes, the baby boy let out a small cry.  

We sutured up the uterus, fascia, and skin.  Mom and baby alive!  Two in one day.  

If we would have started our other case any earlier, we would not have been able to do the c-section, while keeping the other patient’s safety in mind at the same time.  Praise God for another life!  

Scott and I wanted to take a short break to eat.  I was already feeling sick today, but somehow adrenaline was now running through my body.  We move the vaginal hysterectomy patient into the OR after cleaning it, so that she will be ready after lunch.  Simeon convinces us to just start and eat lunch afterwards.  

So....we do.  It was successful and not much blood loss.  Even though I did not have a vaginal hysterectomy kit made up yet.  I made due with MANY missing instruments.  At least I had 2 curved Heaney clamps.  It would have been nice to have some straight ones.  I was happy though since it was my first successful vaginal hysterectomy (2nd attempted, the other turned abdominal--see previous blogs), and it went well.  Poor lighting for a vaginal case, poor tools for a vaginal case, but no complications. 

The day was almost over.  Just a few more ultrasounds and GYN consults in the office (mostly infertility or painful and irregular periods).  I stopped by maternity to put the new baby boy on his mother’s breast (otherwise it won’t get done till the next day!).  He started sucking well!  It was her 2nd baby and he too was alive.  He’s not moving his arm, so I’m pretty sure it’s broken. 

That night I was able to relax in Jamie and Tammy’s house singing songs to bring in the Sabbath.   We sang mostly kids songs until I brought Lyol home to sleep....also an excuse for me to go to sleep early.  Sweet sleep again, until the diarrhea hit again in the morning. 

#24 Attached

I knew from the moment I saw him that he would die. I wasn’t going to get attached.

Emmanuel was eight years old. He had just been burned. His ‘brother’ accidentally dumped boiling porridge on him. A big enough pot to feed the whole family. Porridge doesn’t come off easily. He cooked under a thick layer of sticky porridge for quite some time before his ‘parents’ could wipe it all off.

I use quotation marks only because they aren’t really his brother and parents. He was orphaned some years ago, apparently from some accident. Both mom and dad died. He was semi-adopted by some semi-family. They called themselves aunt and uncle, but I’m told that they weren’t really.

Now orphaned and burned. A burned orphan. I’m not getting attached.

I’m an Emergency Medicine physician. I know the statistics. A child with second and third-degree burns over 10% of his body or more has the odds stacked against. In the best burn center in the world. Hopital Adventiste de Bere is not the best burn center in the world.

Emmanuel is covered by what will soon become third-degree burns over close to 40% of his body. His neck, his chest, his arms, his abdomen, his groin, his penis and his thighs. All burned. All eventually third-degree. Emmanuel will die in ten out of the ten best burn centers in the world. He has no chance. All the money in all the world can’t save him. I’m not getting attached.

I look at him. I touch him. I talk to him. He’s alive. He’s breathing. He’s thinking. He’s moving. He’s talking. What am I supposed to do? Keep injecting potassium into his veins until I stop his heart? Keep injecting him with morphine until he falls asleep and doesn’t wake up? I don’t have morphine. I can’t put him to sleep with morphine even if I wanted to.

The only thing I can do is treat him. That’s what I’m trained to do. That’s why I’m a doctor. That’s what I enjoy doing, right? Patient comes in. I give treatment. Patient gets better. I feel good about myself. I remember to give credit to God... sometimes.

I can’t treat him partly. I need to treat him fully. It’s expensive. ‘Family’ can’t pay for it. Luckily the government mandates we treat them for free. I order up fluids, antibiotics, cimetidine, a clean sheet and clean bandages. Oh, and of course pain medications. Tylenol and Motrin. What else can I do? I’m in Nowheresville, Tchad. Of course, I couldn’t really do much in the States either.

The nurses begin to clean him up and I go do other things. I come back a few minutes later and the few bits of skin he had are all gone. The nurses rubbed off all of his skin. I’m livid. That was his last fragile, pathetic defense against hypothermia, dehydration and infection. They just don’t get it. We’ve been down this road before.

He literally has no dermis or epidermis around his neck, from his shoulders to his fingers, from his nipples to his thighs. Nothing.

I’m going home. I’m not getting attached to Emmanuel. I gotta stop using his name if I’m going to remain objective. He’s just another patient. Just another kid who’s going to die in Tchad.

The next day Emmanuel looks pretty uncomfortable. I suppose I can use his name and still remain unattached.

The third day, he’s still pretty uncomfortable.

The fourth day, he’s still alive. Well, he probably won’t die from pulmonary/airway problems at this point.

The fifth day, he’s still alive. You know, maybe he’ll pull through. You’re an idiot. Forty percent third-degree burns. He’s gonna die.

After a week, he’s still alive. Even if he lives, he’ll aesthetically be horrifically deformed. He’ll have terrible contractures. He’ll never be able to use his hands. He’ll need to have his skin continually cut just so he can continue to grow. That scar (if it ever forms) won’t let the skin stretch and grow. He won’t live. He’s going to die. And I’m not getting attached.

It’s been two weeks. I keep hearing words like ‘miracle.’ I’ve even caught myself using it once or twice. What a crock. A miracle would be letting this kid die. He’s suffering terribly, crying nonstop, whenever he has the energy.

During the third week, he gets a fever. It’s malaria. His hemoglobin’s two. We transfuse him. We give him quinine. We prolong the inevitable.

He gets better. From a malaria standpoint. The fever goes away.

We run out of Bacitracin to put on his wounds. We never had silver nitrate. We run out of zinc oxide. It’s a few days before somebody can pick up some more to put on his skin. Eventually, our hygiene/AIDS/tuberculosis director goes to get some. Seriously? We need to send an administrator to get some? Doesn’t he know how futile this is?

The fourth week somebody has the brilliant idea to bring a bucket of water to the bedside to wash him in. We try to tell the staff that it’s not necessary, but what do we know. He cries every time they put him in the water. I can’t imagine his pain. He thinks washing is what’s good for him, so he bravely scrubs away at his body where he has no skin. He whimpers while inflicting pain on himself. He’s so brave. No. I’m not getting attached to Emmanuel. I can’t.

The hospital runs out of free products for Emmanuel. The family can’t pay. The same administrator starts paying the bill himself. What’s wrong with this guy? Isn’t enough enough already? I know his salary. He doesn’t earn but $200-$300 in a month! How can he sink all his money into this hopeless case?

Today makes week five. At 7AM, the same administrator drags me to Emmanuel’s bedside. He’s out of it. He’s barely breathing. They still want everything done. I sit down on the bed across from him and notice how pale he is. I scribble on a piece of paper the orders for an IV, dextrose, a blood transfusion, quinine, ampicillin, gentamicin, metronidazole and cimetidine.

He has a hemoglobin of two again.

The nurses can’t find a vein. I go to my office and return with an intraosseus needle and five grams of magnesium. I recognize the risk of respiratory depression and give him a couple grams of magnesium intramuscularly anyway. I then set about manual screwing a long metal needle into the shin-bone.

I get my needle into the bone marrow before the nurses get theirs into a vein. We start the medication. I’m still objective. I’ve given my orders. I can’t do anything else. I need to leave before this becomes personal. I’m not getting attached to Emmanuel. Not to this hopeless cause.

I come by later. He’s still alive. He’s breathing with more vigor, which the nurses find encouraging. I just think he’s probably more acidotic and giving it a final go at correcting the acidosis with his lungs.

I’m in the office doing ultrasounds. I hear a wail. I know what’s happened. I see Tammy walking out of the surgical wards. She’s crying. I leave my office and walk outside. Tammy confirms what I already know. Benzaki, that very same foolish administrator who never gave up, walks up. We walk to the patient’s bedside together.

Emmanuel’s already lying on a stretcher, covered by a sheet, ready to be carried to the family’s home.

I ask them to stop and put him back down. I want to look at him again. I want to pull back the sheet. I want to say goodbye to this boy who didn’t speak a word of English or French. I am attached.

I can’t tell them it’s ok to pick him up and walk out. I know the words in French. I even mouth them out. I know my voice will betray me if I try to make a sound.

I ask a nurse to pray in the local language. I have no clue what he says but my vision is pretty blurry when I open my eyes.

I walk outside with Benzaki. His wife is sitting on the concrete slab we treat as a bench. She too, had taken an unusual liking to this boy. She’s crying.

I sit down beside her, unaware that she’s about to pummel me with questions I’m unprepared and unable to answer.

‘Tell me, Dr Olen. Tell me why did he have to die? What is the purpose in his suffering? What is God trying to tell me?’

The story comes out. The Benzakis had agreed to adopt this boy in December. They had already been paying for his schooling. In their 40s and without the children that make you a person of worth in this culture, his story came to them and after much prayerful consideration, they decided to adopt him. They had never thought about adoption before. They signed the papers and were about to take custody.

Then Emmanuel was burned. They visited him every day. They paid for his medical expenses. They drove on their motorcycle long distances to find the medications for him that we had run out of. They showed Emmanuel what the love of a parent is, something he had never known before.

God came to this Earth in human flesh. God watched as His Son suffered, able to intervene, but unwilling to risk all of humanity. God never gave up on a race that the rest of the universe deemed an unworthy cause, a hopeless case. Ugly, deformed, helpless and broken.

And this morning, after waking up early to finish preparing his room for the day in the future when he might be able to come home, Mrs Benzaki visited her future son and took his hand and listened to him call her ‘Mama’ for the first time. And them she lost him.

‘Tell me, Dr Olen. Tell me why? We agreed to adopt him in his perfect form. And after he was so badly burned, we still wanted him. We didn’t care how deformed or ugly he might be. He would still be our son. Why, Dr Olen? Please tell me why?’

I wanted to scream at her, ‘Don’t you get it? It was hopeless! He was a lost cause! And his suffering! Can’t you rejoice that his suffering is finished? I don’t know what God’s reasons are. The rules that govern the battle between good and evil are things that I don’t understand. But maybe God is required to allow the Devil a little leeway in order to be fair. And yet we just turn around and tell God that he isn’t fair. And don’t you know that you’ll see him again in Heaven, with his brand-new perfectly Heavenly skin?’

But I didn’t. Instead, I hugged her. Together, we cried under the mango trees.

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!!!

#23 Lyol Turns Two

“Mooooooo”

Okay, so he didn’t say it when he first saw the cake, but he did eventually say “moo” (only after being prompted by asking “what does a cow say?”)

I had spent a few hours Sunday afternoon making Lyol’s spectacular cake.  Mom had brought a chocolate fudge cake mix and chocolate frosting (my wonderful sister insisted on her bringing it!), and I put it to good use.  Our friends Mindy and Scott had sent us a care package and there was white frosting in it too!  I didn’t have any eggs, so I tried to substitute with corn starch, lime, and a little extra water.  

I cleaned off the cover to our stove to use as a cake platter.  When I dumped the cake upside down to put in on the ‘platter’, half of it fell apart.  I don’t know if it was to hot still, or if it really needed eggs.  Oh well....it did make it easier to ‘mold” into it’s new form, a cow’s head.  I couldn’t wait forever for the cake to cool, so it was a little warm when I put on the yummy frosting (bought state side).  The end product was a brown and white cow head, with black danish candy eyes (thanks Sarah) and dried apricots for the nose.  

The only streamers I could find was our pink toilet paper.  I KNOW Lyol will appreciate me some day when he looks back at the pictures and sees all the PINK for his 2nd birthday party, but the mall downtown had completely run out of streamers!  It actually fit in well with the cow theme because the gloves my dad blew up (we didn’t have any balloons) ended up looking like cow udders.  I think they matched nicely with the pink ‘streamers.’  

The Sunday evening party was planned for 5, but started with African style after 6 pm with 16 of us in all.  The theme was of course COWS (barnyard theme).  We lit the 2 candles (well 3 actually because one was a number 2) and sang happy birthday.  

“...Happy birthday dear Lyol, happy birthday to you!”  Little Lyol is growing up!  He’s a big fat 2 years old now.  Potty training, abc’s, counting, learning to read (okay well he thinks he can).  And to think that he was only a whoppin’ 8 pounds 1.5 ounces 2 years ago!  He’s healthy and growing and I am so thankful God has put him into our lives.  What a wonderful gift each day!

I wanted him to get filthy dirty since that didn’t happen last year with his cake.  But, no....it seems our little boy doesn’t like to get dirty for pictures.  Again, not much frosting on his face this year.  Oh well, maybe some year.  He went straight for the candy eyes (Why would I want cake, mom, when there’s candy?).  I eventually took the candy from him so he would eat the cake.  

I made everyone play charades (barnyard theme and things Lyol would do in his 2nd year).  From Olen pretending to be a sheep by laying over to be sheered, to one of our aviation volunteers (Arthur) pretending to wet the bed, at least it was humorous for me to watch everyone make a fool of themselves!  (Hee, hee, hee).

Any reason is good enough to have a party, but it’s especially nice when you get to celebrate your little angel’s birth.  How a person changes in 2 years!

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.

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!!!

#22 The Past, the Present and the Future

I asked a couple weeks ago for help funding our treatments for Burkitt’s Lymphoma. The response was overwhelming. There’s such incredible generosity out there. I now feel that I have enough to treat my Burkitt’s kids for a long time to come. Thank you!!!

(As a quick aside, the medical director for the entire region called me today asking if he could put the word out to all the other directors and start sending me kids from all across the country, since we’re the only hospital in the country who even has the treatment, let alone is giving it away for free.)

I’m now going to push the limits of your generosity...

After lengthy discussions with the Adventist Health International - Tchad board, the president of Adventist Health International in America, multiple local meetings with the administrator, the mayor, the director of the district, the medical director for the district, the medical director for the region, the head nurse, the head of the lab, the accountant, the neighbor's dog (but he didn't speak English OR French), a mosquito in the kitchen (talk about an unproductive conversation!), my two-year-old son (who was too stubborn to consider a second point-of-view), and after talking to a three broken down vehicles (which made for even poorer conversation), I think we have prioritized our projects at this point.

All of our projects have one of two goals: Increase evangelism or increase revenue for the hospital (so we can continue funding projects ourselves to further evangelize). Increasing revenue makes the hospital much more self-sufficient.

We would like to build a private ward with fourteen rooms. We could easily charge 5000 Central African Francs (about $10) for each room for each NIGHT. This is compared to the normal charge for patients of 2000 CFA/week. (That's right, you can be hospitalized in Africa for a WEEK for $4!!!)

The first estimate for the job is 14,825,300 CFA, or $29,650.60. That seems like a lot of money, but when you consider that it could generate another $140/night (14 rooms at $10/night), it would pay for itself in about seven months. And an extra $140/night could pay the salary of an additional cashier, pharmacist, lab tech, a couple security guards and several more nurses. (NONE of our nurses earn more than $5000/year and the other employees all earn even less, except the administrator.)

We are very excited about what's going on here at the hospital. We arrived December 12. At the start we weren't sure how we would stay busy, and we were home by noon most days. In the month of January, we set a record for the most surgeries in a month at the hospital. I haven't seen the numbers, but I'm told that we've had more Emergency Room visits and hospitalized patients on maternity, surgery, medicine and pediatrics than ever before. In fact, we have run out of beds and patients are sleeping on the veranda outside. We have been postponing surgeries for days, because we don't have a bed to put them into after the surgery. Needless to say, we are keeping very busy. Now, we don't know how we'll keep up with things with just two of us and have decided that we will give up Danae's salary for a third doctor, if we can find one.

Patients are coming from all across the country, literally. They're flooding in daily from Moundou (the second-largest city, three hours away), from N'Djamena (six to twelve hours away, the capital and largest city), from Cameroon (a neighboring country), from Sudan (another neighboring country), from Libya/Algeria/Tunisia (but only one patient per each of those countries, unless I'm forgetting some) and from northern and eastern Tchad (a strongly Muslim region several days driving away). They're coming to see the gynecologist (infertility, dysmenorrhea, menorrhagia, metrorrhagia, menometrorrhagia, pregnancy ultrasounds, fistulas, prolapses, etc). They're coming to get ultrasounds. They're coming to receive the medications we give for free. (For example, we're the only place in the country with the medications to treat Burkitts Lymphoma, a highly-aggressive, highly-treatable cancer that quickly kills little kids without a very expensive medication, which is donated to us by many very generous individuals.) They're coming to have prostatectomies, nephrectomies, orthopedics surgeries, herniorrhaphies, hydrocelectomies, orchiectomies, masses removed, and any of the many other surgeries we offer. Word is getting out and many people are coming and telling us that they have arrived because they have heard of all the good things we are doing. (In reality, it's the things that God is doing!!!) We are receiving many patients of great influence, political leaders, religious leaders, business leaders, etc.

Everyone who comes here is shocked at how humble our hospital is. It's not updated or modern. We don't have any fancy equipment. We don't have any amenities. We are frill-less. We're in a tiny village in the middle of nowhere. But they've heard that there's a special healing power here. (We're just beginning to learn how to explain to them from Whom that healing power comes.) And after receiving care here, they are all convinced that the hospital will only continue to grow.

So, I'm fundraising. I'm asking for the money to start building our 14-bed private ward. It's a big number, roughly $2000/room. But it's all in the name of self-sufficiency. Just this week, the staff asked why we couldn't ask for money from America to give them raises. (They are paid less than their government-employed counterparts, who work less.) I explained that we can't ask for donations for ongoing costs, only for one-time projects. And the projects that increase our revenue make us more able to evangelize and to provide higher-quality care.

Perhaps you can't fund the entire project, but perhaps you can help out. Perhaps you can fund an entire room. Or maybe even several. Or maybe you can fund the entire thing. I am going to ask several people/organizations, but please don't assume that the other person/organization will fund it. Obviously, we'd love for the funding to all come from one source and we can name the building after one source. But if need be, we'll be happy to name the rooms individually.

Pray for the most Godly use of His money. Pray that we will spend it wisely. Pray that God finds ways to multiply His money, from the largest gift right down to the widow's mite.

As always, feel free to ask me any questions you have.  Mom's note.  There are many international calling cards that can be used.  Remember that Olen and Danae's phones are cells so that alters the cost/minute.  We call them weekly and it works.  Call after 12 noon EST (will be 6 PM in Bere).  Remember once your calling numbers/pin numbers are dialed...you dial 011 for international, then 235 for Chad.  They would love to hear you.  Email works great, most of the time.  Again, no music, video, pictures , cutesy forwards, etc.  They get messages that are less than 250 k.

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

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!!!