Sunday, March 27, 2011

Aunt Bekki's pictures of a 2-year-old mission kid


Hippo watching! note those log-looking things.




Waiting for Gramma's Call












Riding home
Going on visits with Tammy (Mrs. Dorcas).  The other lady in the picture is blind and needed a new grass roof that we plan to rebuild.  Mrs. Dorcas loves me :-)
I take drumming Tch 101
God provides me with playmates and play things, rocks!  But I do get a big dirty.

OK, my parents are interested in my learning how to use this contraption.  I do use it most of the time and am dry at night.

I dine like a king, well I think so. I have
my fan mail, mom's cell phone, books,
and yummy Tchadian food.
Come visit me, I'll show you how to drum.
Yes, even a king needs a bath!


Saturday, March 26, 2011

More of Aunt Bekki's Bere Hospital Pictures






















Mobus, the pharmacist
Old microscope they want to replace with a stronger light










Enoch, the Hospital director










Very large spider in the maternity ward





Urine samples, note the weaving of the sticks in the leaves which signifies a stool specimen also

Wednesday, March 23, 2011

Pictures from Olen's Aunt Bekki Gardner



 Bere Adventist Hospital church & service
Olen and Lyol at the watering hole
Meeting at the Mango Tree church




Family cooking for their sick relatives
Sample of the variety of medical work


ER at 7:30 AM
Hospital parking lot

Tuesday, March 22, 2011

#34 The Grossest Thing

I’ve seen a lot of gross things here so far.  I deal with Lyol’s poop and pee.  Cloth diapers are not all they are cracked up to be....and lately the dogs’ poop because they are too scared to go outside.  I see poop and nasty fluid all the time.  I am an OB/GYN afterall.  Not to much can gross us out!  

When Olen said he had a Fornier’s Gangrene for me to see, I didn’t realize how awful it would be.  

“Hurry up dear!, This guy’s got crepitus into his thighs.” (when you push on the skin and it crackles because there is air under it).  “Do I need to say necrotizing fasciitis?  Would that make you come over to Urgence faster?  Every surgeon in the states would be jumping on this case like lightening!”  

Fornier’s Gangrene is a problem with men.  We don’t use the term in GYN land because women don’t have scrotums.  Necrotizing fasciitis occurs when some insult happens on the skin and flesh-eating bacteria go to town.  In this case it happens on the scrotum.  

This young Arabic man is 25 years old.  Tall, slender, and muscular.  You could smell the stench of rotting flesh from outside his urgence room.  One week before he had gone to a traditional village doctor for hemorroids.  A few days later, he noticed a small pimple on his scrotum.  It got bigger and after 4 days, he presented here, with his whole scrotum rotten.  

Off to the OR!

Samedi and I put on a protective gown, mask, and gloves.  We even poured some betadine on him and put down some sterile blue towels.  But this field was far from sterile.  The goal:  get rid of the rotten tissue and find the living tissue.

With the slightest bit of pressure I put on his scrotum, it disinigrated like mud.  I must have quite the touch!  (Olen’s even scared of me now!)  Everything liquified before my very eyes.  Samedi and I used gauze to wipe away rotten tissue.  Then we kept cutting.  His penis was spared, but we ended up taking his testicles.  His left thigh was spared, but his right thigh was far from it.  I used the scissors to fillet the skin on his thigh.   I had to keep cutting deeper into tissue because all the subcutaneous fat was liquified.  I cut down and eventually found the muscle to be nice and pink.  I had to extend about 10 cm down his thigh.  Even down right next to his rectum and up onto his abdomen.  

Samedi and I finished and when we took off our lightweight trauma gowns, we were both drenched in sweat!  It’s not so cool in our OR! even with the only air conditioner in Bere on.


We put him on our big gun antibiotics (Amp, Gent, and Flagyl) and prayed.  I was happy when he lived through the first night.  The first few days we brought him to the OR to have his dressing changed.  One huge compress (like a lap sponge) fit in one of the craters next to his rectum (before I opened it up more).  The 2nd day he was getting up to walk by himself.  His only pain meds are ibuprofen and tylenol!  This guy is a fighter!  Over the next week I cut off infected areas 2 more times to get to good tissue again.  His dressing was changed daily.  Each time he would unwrap the dressing himself and watch the dressing changes! 

After a week and a half, he wanted to know when he could go home.  I explained that it would take a long time to heal, and it would be better if we could graft his skin.  You know, since I’m the expert on skin grafts and all (Hey, I did see it one time in medical school).  We are supposed to have a French surgeon coming in another month, so I explained to the patient that if it was not infected, we may try to graft his skin then.  For now we should take it day by day and keep the area clean.  

A couple days ago (2 weeks after the first surgery), Olen said, “Hey, you sent that scrotal guy home?”

“No.”  

“Oh, well someone else sent him home then, they said you did.”  

So I guess he’s in the village now and coming back for dressing changes.  He is very independent and determined.  Please pray that his health continues.  

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!!!

Saturday, March 19, 2011

#33 Merci a Dieu

“Thank you to God and thank you to you, Doctor.”

It didn’t make sense.  She should be mad, upset, angry...anything but thankful.  

She is a young 18 year old and on her first pregnancy.  9 months.  She started contractions the night before (but I later found out it was 3 days before), and had just started pushing when she got here.  

She was fully dilated and seemed to be pushing well, although she looked very tired.  The baby’s heart rate was good at 135 with a doppler.  I went off to see patients in the office.  After 2 more hours, I thought I should check on her just in case she hadn’t delivered.  Nope, not yet.  

I ask the nurse how the baby was.  

“Ca va”, he said, or fine.  

“How do you know? Did you listen to the heart since I last did?”

“No.”

I listened.  175.  No fever.  This can’t be good.  Three hours of pushing and not much more progress.  I should have checked on her earlier.  

I feel the baby is low enough for a possible vacuum delivery, so I have the mother go buy a syringe so I can give her some local anesthesia.  Too many patients waiting at the pharmacy.  So I run to the OR, open a padlock, 2 doors with keys, and find a syringe and lidocaine.  

Back to the mom, I cut an episiotomy for space and have her push some more.  She is too tired.  I pull out the next to last remaining kiwi vacuum from the drawer and deliver the baby.  Lots of soupy meconium.  

“DeLee!”  Nobody knows what I’m talking about.  I take the precious 20 seconds to grab the suction device myself from a drawer with my gloved dirty hands.  I clamp and cut the cord and bring the baby to a different table.  I suction the baby, but no breathing yet.  I fumble for the ambubag (without oxygen of course) and start breathing for the baby.  Heart beat above 100.  He starts to get some tone after I breath for him.  I give him dextrose in his mouth.  He’s living, but just not breathing on his own.  I don’t want to give up.  After 10 minutes I call Olen to help out with the baby so I can suture up the mom.  My allstar nurse (actually she is, a new nurse came on now) is suturing up the episiotomy site, but needs help.  

Mom has a huge vaginal extension in part from the episiotomy, and also the baby delivered with his hand by his face.  I’m just using lidocaine, and I know it doesn’t work that well.  Still she barely even flinches.  She’s so strong.  All of this and her baby is not even breathing!  

Olen’s breathing for the baby.  In the states this baby would be wisked up to nicu and intubated.  How long should we breath for the baby?  Olen gives him dextrose several more times intravenously.  We pinch his foot and he pulls it back. He still has some tone. 

I went to get the oxygen sensor from our office.  High 80’s and even 95% while using the ambubag.  1 hour.  He still wouldn’t breath.  

I realize how hot is was in our little delivery room.  Sweat had been pouring down my face and huge drops were falling on the table.  My scrubs were soaked with sweat.  None of this mattered if this little one would just breath.  

1 1/2 hours.  Olen and I discuss that we had to stop sometime, somehow.  This little boy is so perfect though.  He is a fighter.  He just wont breath on his own!  He is full term!  This is not supposed to happen!  

We explained through our nurse that when we stopped breathing for this little boy that he would not live more than a few minutes.  I wrapped him in a brightly colored cloth the family gave me, then we put him gently in his mother’s arms.  He died shortly after.  

The next day on rounds she explained that she had been in labor for 3 days and had been so tired before she even came to the hospital.  

“I thought I was going to die,” she said.  Everyone feels like that when they are in labor I think.  I felt awful when I was pushing, and I had an epidural!  In the states, you may feel like you are going to die, but it’s rarely a reality.  Here, especially if you deliver at home, it often is a reality.  I don’t think anyone really knows the statistics on maternal mortality here.  At least I don’t trust any statistics here after Olen went to a recent meeting on such things and they weren’t even doing basic math correctly!  Not that they can’t here, but somehow the people who were adding up the national numbers couldn’t add correctly (and Olen was a nerdy math major so he happened to catch it).

She was just thankful to be alive.  It’s probably harder for me to accept death here because I have seen how different healthcare can be.  Pregnant mothers who come to the hospital with living babies are not supposed to go home to the funeral of their first baby.  

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!!!

Friday, March 18, 2011

#32 Lactation consult

That’s what I need.  I need a lactation consultant here!  24-7!!!  

Maternity rounds consist usually of 2 to 6 patients.  I have one long termer patient that has been here for almost 2 months, but I’ll save her for another story.  I just pray that she lives.  Maternity rounds seem to take longer than surgery (with 20 patients) because until recently I have had less than great maternity nurses.  Now I have a new nurse who is excellent and I am thrilled to death!  

This morning on rounds I had had my long-termer, 2 normal postpartum patients with babies, one laboring patient, and one postpartum patient whose baby died.  To the first time mom who delivered yesterday I asked, “Is the baby eating well?”  (Often I get the answer that the baby hasn’t eaten yet in 1 day, but I have been making the baby eat right away in my presence now if I deliver them.)

“Yes, very well.”

“The baby is eating milk from the breast well?”

“Yes.”

“How many times have you given your baby water?”, I ask in a normal tone.

If you’re not a parent, you may not know that you’re not supposed to give an infant plain water anywhere.  It will throw off the baby’s electrolytes, and the baby will eventually die.  Let alone that the water here has giardia in it half the time.  And there are no nutrients at all in water!  Malnutrition is a killer here!

I used to think that my questions were answered wrong because of my bad French.  “Du lait” or milk is pretty similar to “de l’eau” or water.  But I now realize that there is actually a problem.

“Four times already,” the father pipes up.  

I about lose it.  “What?”  I go into a detailed speech as to why you should not give water to your infant baby.  Well, okay, as detailed as can be with beginner’s French and then translated into the local language by the nurse.

Next mother.  She delivered 2 weeks ago, but had something (uterus or bladder) that prolapsed from her vagina.  People come from far away, and if it’s late they stay in the hospital until the next day when I can see them.  She had nothing prolapsing from her vagina now.  So I said if anything comes out again, come back.  

“Cute baby girl!”  “How is she eating?”  

Again, “Very well.”

“Breast milk?”

“Yes,” she said.

“How many times do you give her water?”

“Several times a day.”

This time I don’t lose it, but explain again somehow calmly how bad giving water to an infant is.  I feel like a broken record.  

Olen tells me often that... it’s the culture.  When the kids run into our yard and take all of the brown paper that was used to wrap furniture in our container, “It’s the culture dear”.  

“Ya, well, they didn’t ask, they are stealing!”

“It’s the culture, to them it’s not stealing!”  

“So when I eventually plant a garden and they come in to take my vegetables, it’s not stealing?  It’s just the culture?”  

Culture cannot be changed I suppose.  But we can educate women to help their babies live somehow.  It’s a simple step.  Only give breastmilk to your babies for the first 4-6 months of their life.  It’s too expensive for the women here to buy formula, though it’s available.  

I would love to have a lactation consultant!  Even nicer if she (yes I said she, it would be weird to have a male consultant here, you know the whole culture thing...) spoke French, Nangerie, Arabic, and all of the other local tribal languages.  

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!!!

Wednesday, March 16, 2011

#31 Immunity

I know I should know this guy from somewhere. I vaguely recognize his face. And he sure acts like he knows me. (Of course, being one of only a couple American doctors in Tchad gives everybody the impression they know you.) I have only a couple more seconds to place his face before he walks up to me.

I fail.

‘Remember, I said I’d bring my daughter to see you?’

‘No. Who are you? Who’s your daughter?’

‘I’m the guy from Lai. We met last week at the meetings. My daughter was the one operated on in Kelo. The neck? The abscess? You don’t remember?’

‘Of course, I remember,’ I lie. I don’t remember him. I met a lot of important people last week at the meetings in Lai. (I don’t particularly like important people.) I don’t remember the story about his daughter. ‘Has she been seen by the nurses?’

‘She was already seen yesterday. She’s outside the OR. She’s ready for her surgery. They’ll be taking her back any minute now.’

‘Great. I hope my wife has the opportunity to do the procedure. She’ll be in good hands.’ I hope I’m not the one who saw her yesterday. I’ve forgotten her already.

About thirty minutes later, while walking by the OR, I see a woman sitting with a big mass on her neck. ‘Must be her,’ I think to myself. She looks ok.

Another hour later, I’m in the office holding my stomach. I know I should be doing ultrasounds. There’s a ton of carnets and bulletins sitting in front of me staring at me, paper-proof that patients have already paid for my services and are waiting on the other side of the door. If I don’t do them, that will just be more work at the end of the day for Danae to do. A good husband doesn’t leave a load of pelvic pain patients for his pregnant wife at the end of the day. I know I should stand up, grab a carnet, walk over to the door, swing it wide and call out the first name. Oh, and do it with a cheery, Christian, missionary smile. And I know as soon as I do, a dozen more people will ask me if they can go next. I sit. I turn around. I turn on the ultrasound. ‘The machine will take a while to turn on anyway. I’ll just sit here a bit longer,’ I think.

I try to sip some water. Then I try not to vomit. Same routine for the last four days. It started with muscle aches, joint aches, back pain, headache and vertigo. By the end of the first day I had nausea and diarrhea... and a negative malaria test. The next day my diarrhea turned bloody. I learned some things though. #1) If you’re about to get a bout of some random diarrheal illness, do not under any circumstances wolf down a load of fiery-hot salsa the night before. You will regret it every time. #2) It’s humanly impossible to swallow two grams of Flagyl at once. You’ll vomit every time.

By now I’ve completed three days of injections to treat malaria, plus a one-time dose of several Fansidar pills. I’ve taken my two grams of Flagyl at once (in four separate swallows) without vomiting. I think I feel worse. I thought I was better earlier in the day. Maybe I’m just overdoing it. It’s 105 outside, at least. Oh, and everywhere here is outside. Our house is usually hotter than it is outside. Our hospital has only screen windows, no air conditioners (save for the OR). I’ve still rounded every day. Oh, and this morning the scale said 159, a weight I haven’t seen since 2002. Two weeks ago, when our container arrived (and the scale with it), I weighed 172. This morning, I thought it was wrong. Then I confirmed it on a hospital scale. I remember weighing 197. I have an excuse to be weak.

Guilt gets the best of me and I stand up to call in the first patient. My phone rings. It’s Danae.

‘There’s a woman not breathing well in the OR.’

‘Ok.’

We’ve learned to be brief on the phone, since we’re literally charged by the second.

I walk to the OR. I don’t have the strength to run, plus, the longer I worked in an ER, the less likely I was to run anywhere. Running just makes everybody around you, including the patient, nervous.

I push open the door. The first thing I smell is pus. The first thing I see is the oxygen saturation monitor. It tells me that only 74% of her red blood cells are actually carrying oxygen. The squiggly line looks normal, meaning that it’s probably a true reading. 74% can’t last. Either she’ll get better or she’ll die. She won’t stay at 74% forever. I grab an ambu-bag and start breathing along with her, giving her supplemental... well, supplemental room air. Still no oxygen tanks at the hospital. Or oxygen in the country. I’ve heard we can get some medical-grade oxygen from our neighboring country, Cameroon.

Actually, I’m just suffocating her. Somehow, the pop-off valve on this thing is set at virtually nothing. All the air I squeeze is just shooting out the side. Finally I get that problem fixed and get some air into her lungs. Between forcing air into her lungs and giving her a good strong jaw thrust, she comes up into the 80s. That’s better.

I start to take a better assessment of the situation. Heart rate in the 140s, which isn’t an unreasonable response. Plus everybody here gets atropine with their ketamine, and I’m guessing that she got ketamine. I would have preferred they do this without ketamine. Why take an unstable airway and make it more unstable?

I look at her neck. Wow, that’s certainly not normal. She has several holes in her neck, possibly all surgical. One is packed already. Samedi is packing another. I tell him to stop. I rip out all the packing. ‘I don’t want any more pressure in the neck.’ Samedi agrees. Samedi is the kind that will always take a doctor’s orders. He might do something else after you leave, but if you’re there, he’ll support you. He’ll never tell other people that you’re wrong. He’ll never tell you that you’re wrong in public. He’ll only give his opinion in public when asked. And he’ll talk to you in private if he disagrees with you. Always calm. And I almost always want his opinion. He’s been around forever and knows the sicknesses and surgeries of Africa better than any other nurse.

Now that I have a moment to let it settle in, the smell is the first and strongest thing to settle in. That’s terrible. I’m still not wearing a mask. (I actually don’t have a chance to wear a mask throughout any of this. And most of it’s without gloves. My skin-intact hands can’t infect pus and gloves don’t stop needle sticks.)

A bit of the story comes out. She went to Kelo and had a neck abscess drained. She was coughing up pus and blood. She came to our hospital because it was worse. That was enough story for me. (I went into ER because of my short attention span. What?)

Her oxygen saturation starts dropping back into the 70s again. I run the options in my head. I could intubate her (put a tube into the mouth and direct it into her windpipe, thus giving me surefire access directly to her lungs), leaving a family member to squeeze the bag for who knows how long, leaving her to choke on an endotracheal tube for who knows how long and then hope and pray we can extubate her. I could perform a tracheostomy (put a tube through her skin and into her windpipe, totally as easy as it sounds). Infected skin and abnormal anatomy are contraindications (no-nos), but it’s also a contraindication to let a patient die.

Danae suggests an LMA. Laryngeal-mask airway. Pretty much the dummy’s intubation. Fool-proof. I go to the stock room, find an adult LMA amongst all the pediatric ones (this is a fat, but long neck) and return. I rip it open, grab a syringe and check the balloon. The ballon works great. They keep trying to hand me a laryngoscope. I keep refusing. Standing over her head, I take my left index finger and thumb and scissor open her mouth. With my right index finger, I smash the LMA into the roof of her mouth and push it back, getting well behind and below the tongue. I put up the balloon and the LMA lifts a bit, just like it’s supposed to. I bag. Air comes out her neck. Blood shoots up through her mouth. Her belly doesn’t rise. Her chest doesn’t rise. This is weird. I reposition several time, deflating and inflating the balloon. Nothing. It’s like I just can’t find good tissue to seal against.

I rip the LMA out of her mouth and we bag her up... to the 80s again.

I think of the options again. If I can get a trach through that nasty neck, maybe I can get below all of her problems and get right into the healthy part of her windpipe. Our volunteers just found a couple needle trach kits.

After fumbling through some pedi kits, I find an adult kit and go back to the OR. Sizing her up, this trach kit looks inadequate. As her sat falls back into the 70s, then 60s, I rip it open and make sure it’s compatible with our ambu-bag. As I’m familiarizing Danae with the kit and what order I’ll need things handed to me (needle, wire, knife, trach with dilator), I tell the nurse to Betadine the neck. He keeps asking questions. Where? With gauze? The wounds? I grab the bottle and squirt a health dose of betadine all over the neck. He takes the gauze in his hand and pushes the betadine around. It’s all a filthy, pussy, infected mess anyways, so whatever.

I feel for anatomy. The skin is all so hard and indurated. I can’t make out trachea, let alone thyroid cartilage and cricoid cartilage. With a pulse ox in the 60s, I put the syringe in her neck, half expecting pus to fill the syringe. I go straight down until I’ve buried the needle to the hub. I’d be in esophagus by now if this were a normal anatomy. I have no air coming back into my syringe. Maybe the pus has pushed her trachea laterally. I feel again. I’m guessing it’s still medial, but since I got nothing there, I try laterally, both directions. Nothing.

I grab the scalpel and cut straight down her neck. Great, I’ve got the only person in Tchad with centimeters of fat on their neck. Blunt dissection. This is unreal. How can I not even find trachea? I’ve heard of trouble finding thyroid cartilage and cricoid cartilage, but come on. This is ridiculous. From deep inside my incision, I start the same process with the needle. Center. Left. Right. Nowhere do I get any return of air into my syringe (meaning that I’m in the windpipe). I dissect bluntly again. I think I’ve found something. My fingers touch what feels like cartilaginous rings. I put the needle in again. No air. How can that not be trachea? I put my finger in again.

Oh my. How can that be? How can that be trachea? How can a trachea be that eroded? That’s not the front of the tracheal rings. That’s the back of them. The front is completely eroded.

I shove an endotracheal tube in. It’s too hard to bag. Too many gurgling noises. Too much blood and pus coming out of the neck. That must not be trachea. I don’t think of trying to suction before I pull out the tube.

I realize that the endotracheal tubes don’t have stylets. Danae goes to find something stiff. The nurse hands me a pediatric laryngoscope handle to match the Miller 3 blade. This would be a perfect set-up... if she was a four-year-old. They can’t find anything bigger. I lay the blade from her chin to her neck. It barely reaches. ‘There’s no way,’ I think. The saturation goes to the 50s. I can’t wait. I try to intubate with my pediatric set-up. I’m shocked that I can actually hook epiglottis and see cords. But I stand no chance at hooking this 6.5mm endotracheal tube into her short-chin anterior vocal cords without a stylet to stiffen up the floppy endotracheal tube. Her sat stops picking up. I had recently noticed that her pulse was irregular. He heart was ticked it wasn’t getting enough oxygen for too long. Danae returns just then with something that will work. I intubate her.

She’s impossibly hard to bag again, but I saw the tube go through the cords. I know I’m in. I ask for chest compressions. Danae starts. I think to ask for suction this time. Disconnecting the ambu-bag, blood and pus shoot out the end of the endotracheal tube and onto my face. I shrug my shoulder up and tilt down my face to wipe it off on my sleeve. We suction out a load of blood and pus that has filled her trachea and lungs. Maybe that’s why I couldn’t find air with my syringe. All that was in her trachea was blood clots.

She has good chest rise. The nurses confirm that she has bilateral breath sounds and no breath sounds over the stomach. I’m still bagging, but I ask Simeon to give a milligram of epinephrine. Later I ask for atropine. Abel relieves my pregnant, short wife from doing chest compressions. Suddenly the monitor picks up a heart rate of 130. I tell Abel to slow it down a bit. The oxygen sat eventually comes up to the 80s again. She gets a pulse. I tell them to keep doing compressions. Simeon bags for me and I tape the tube in place.

Time to reassess. She has a major neck abscess and loads of holes in her neck. Her tracheal cartilage and soft tissue is eroded. She’s intubated in a place without a ventilator and where the electricity goes off every night anyway. We’ve spent an LMA, a trach kit, an endotracheal tube, epinephrine and atropine. We don’t have unlimited resources.

Her sat starts a slow and steady decline. She’s still losing blood into her lungs. We won’t have electricity to suction her all night. She’s already on her third blood transfusion of precious type-O blood from our tiny fridge. Her sat now doesn’t pick up. We can’t find a pulse. We continue chest compressions.

I send for the family.

Her Dad and Mom come in. I remove all the staff from the patient, except the two bagging and doing chest compressions. I bring the parents to their daughter’s side.

‘You understand?’

‘Her Mom is a midwife and I, well, you know who I am. We understand.’

‘Simeon.’ He looks up. Our eyes meet. He understands. He stops chest compressions and ushers Ndilbe away so he’ll stop bagging. We get some stools for the parents.

We understand?!?!?! What does that mean?!?!?!

I don’t.

I don’t know who he is still.

And I don’t understand.

I don’t understand why there’s an entire underdeveloped (in reality, undeveloped) world who suffers like this when there’s an entirely differently world who doesn’t.

I don’t understand why God saw fit that I should be born into a life of luxury and that this girl should be born into a life of, well... a life cut short by asphyxia.

I don’t understand why this twenty-year-old daughter of a medical boss of some sort in the neighboring district, with a simple skin infection, develops an abscess, has inadequate surgery and follow-up care and then comes to die in my OR. I don’t understand why that twenty-year-old daughter in the developed world has access to antibiotics and gets better before she ever gets to the abscess stage.

I don’t understand how parents can accept with such grace the death of a fully-developed child, one they spent half of their lives raising, when I can’t imagine losing an unborn child of my own, whom I’ve never even seen.

I don’t understand why the mother of my eleven-month-old patient doesn’t have the twenty cents, the price of two mangos, to pay for two medications proven to decrease her son’s chance of recurrent malaria and recurrent hospitalizations.

I don’t understand why malaria still exists. If there was a single infectious disease responsible for a third of all ER visits in America for decades on end, there would be eradication. If there was a 600-bed hospital in America receiving 200 patients in the ER for decades due to a single infectious disease, there would be eradication. If there was a 600-bed hospital pronouncing over ten children dead every week due to a single infectious disease, there would be eradication.

And I don’t understand my own arrogance.

I don’t understand what makes me think that I can come to their village, live side-by-side with them, eat their food, drink their water, have my children play with their children, treat their sick and not suffer along with them.

I don’t understand what makes me think that I’m immune to their problems.

I don’t understand what makes me think that I’m immune to their sicknesses.

I don’t understand what makes me think that a 12.5% newborn mortality rate doesn’t apply to my family.

I don’t understand what makes me think that my children don’t have a 21% chance of dying before the age of five when theirs do.

I don’t understand what makes me think that my wife doesn’t have a 2% chance of dying every time she gets pregnant when theirs does.

Our closest missionary families have lost newborns and four-year-old children. What makes me think I can be immune from the suffering?

Can’t God offer me a little earthly immunity from suffering? I’m a missionary. Can’t it work this way?

You Might be in Tchad if...
A wet T-shirt contest means that you put on a soaking wet T-shirt and then see who can fall asleep under the fan before the shirt dries and you’re too hot to sleep again.

And for our ritual begging...

Danae is offering that the next person to send us a care package could include VeggieTales DVDs in English or French. People have just been asking what to send, so...

Oh, and if somebody wants to donate the money for a new air-conditioner... it would mean that our staff would stop asking EVERY volunteer who comes through to buy us a new air-conditioner. It would also mean that Danae wouldn’t need to operate pregnant, under a heavy canvas gown, in a 130-degree OR next month.

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!!!

Saturday, March 12, 2011

#30 Supported



I should clarify. Some people have gotten the feeling that the church has left us out here on the dark side of the moon to fend for ourselves. That’s not true.

We are supported emotionally, spiritually, organizationally, and administratively. And we are getting paid. While it’s true that we could make a lot more money in the States, it is hard to beat the cost of living here. We are quite fine as far as finances go. We feel the ‘reward’ for the job is far different than the pay, and there’s no other place we’d rather be – discomforts, frustrations and everything else considered.

Some people have wondered why the church doesn’t give us all the money we need in order to make the hospital services here at Bere free.  We feel that the hospital needs to continue to earn the money for costs that recur, things like buying medications, paying salaries of the hospital help, routine maintenance of the facility. 

We leave open the option you can help Bere Hospital financially, because our dreams are bigger than just recurring costs, more than keeping up the same health work that we’ve been doing.  We dream about a mission bigger than just 60 beds in a hospital that serves the 50 villages near us in southwestern Tchad.

The Adventist Church supports us in a lot of ways, but it doesn’t have unlimited resources.  It has a budget, and it does wise planning.  The Adventist Church also has other hospitals, scores of them, and they dream too.  Who am I to say that our hospital is more worthy of church money than the hospital in Haiti, devastated by an earthquake but still serving patients? God knows where He needs the money, and He’ll see to it that the money gets there. We leave it to the folks with the global view to decide where the budgeted money goes. We just make sure you know about our dreams, and we leave the rest for you and God to decide.  We ask you to funnel any financial support through the church, or Adventist Health International in most cases, because it helps us create accountability for your donations.  We think that’s a good thing. (It also helps any gifts you might share to be tax-deductible!)

So when we ask for your support for projects here at Bere Hospital, please don’t think that the church or Adventist Health International is hanging us out to dry. They have been great support entities for us.  When I have problems, I can go directly to the president of AHI; he has a lot of responsibilities, but he always gets right back to me. We are well-supported in all aspects. Financially, our dreams run beyond our budget, but never beyond God’s budget.

So, if you want to support us, great! If you want to support another organization, great! If you don’t want to support anybody… well, that’s not so great. But don’t think that we’re unsupported. We have plenty of non-financial support. We lean on you for financial support sometimes, because if we can raise funds for our hopes for Bere Hospital and the people in this little corner of the world, then the church’s other donations can fund other projects.

But always remember, YOUR MOST IMPORTANT GIFTS TO US ARE YOUR PRAYERS! If you’re a parent, tell your kids that there are still missionaries in Africa to pray for every night. If you’re not a parent, remind yourself that those stories you read about as a little kid... well, those missionaries are still over there.  But keep on praying.

You will notice on our blog, missionarydoctors.blogspot.com, that we have a link for donations. This is through Adventist Health International’s website, mark it Bere Hospital. 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.


Olen Tigo: +235 98 07 46 2
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!!!

Friday, March 11, 2011

# 29 Twenty-four


Twenty-four.  No, not the T.V. show (if that exists anymore, I don’t even know).  

I AM 24 now.  No, not MY age, though 24 years old was a good age.  It’s the age I was when I met Olen.  Now we’re wiser and much more mature.  Ha.  

And with a second one on the way!  The second one is 24 WEEKS in my belly.  

Being an obstetrician, that’s when things start to get scary.  The age of viability.  It’s when a baby can possibly live outside the womb.  Though no one hopes to deliver a baby so premature.  Still, it’s possible to live at this early gestation.  In the states that is.  Not here in Tchad.  

I’ve never been the nervous type.  I wasn’t really worried with the last pregnancy.  But I probably didn’t really appreciate that we were having a real, live baby until he was out.  I work in OB.  I know the kinds of problems that happen with pregnancies.

I didn’t have problems with Lyol’s pregnancy, even working 70-80 hours a week.  On my feet, long surgeries, running to OB emergencies, etc.  At Baystate I had great OB nurses who forced me to drink water and put my feet up when I was sitting at the desk though.  It sure is hard to stay hydrated here! 

Plus....working 80 hours a week in residency was also great (somehow) because IF I did have any obstetrical problems, I was usually in the PERFECT place to have one....on labor and delivery.  But, nope.  No complications.  I actually went into labor WHILE I was working one Friday night one day before my due date.  I was spoiled.  I had a wonderful OB doctor who came in even though she was not on call! (Thank you Dr. Bell!)

Here, I do find it a little more intimidating that probably the only OB doctor in the COUNTRY is me.  Olen’s delivered like 20 babies probably during his training.  Samedi, the nurse who is a surgeon, can do a c-section.  But....that would be less than ideal for me.  

24 weeks.  Somehow I’m still at peace here in the middle of no where.  

I would like to say thank you to Olen’s mom, Rhogam-lady in the UK, and Scott & Bekki for miraculously getting a shot filled with Rhogam to our fridge here in Bere.  (Yes, we have a fridge.  It’s really a freezer with a timer, that is turned into a fridge, better for when the electricity goes off).  Let me tell you it was not an easy task to get Rhogam here!  But leave it up to moms and they will get the task done.  Yes, that’s right, there’s only one vial of Rhogam in the whole country of Tchad, and it’s in my house!  Saving it for 28 weeks.  

I’m thinking about doing a 1 hour glucose test also with orange Fanta.  I wonder if  it would work.  Maybe if I add more sugar to it???  It would be worth the risk to get a cold, sweet drink from the market. 

Keep us in your prayers (the four of us!). 

Danae

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!!!