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 rknetteburg@yahoo.com

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, missionarydoctors.blogspot.com, 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!!!