Cat in a tree?

Bad Missionary, Part 2

I think the previous post deserves a follow-up. Or maybe it would be better termed a prequel. Either way…

Let me ask you a question…

Do evil spirits live in trees?

No cheating! Give me an answer before you go on reading.

I’d like to take you with me (as I usually do) to Tchad. At least in your imagination. (But those interested in coming literally should contact us at danae.netteburg@gmail.com )

I live in a country that reports itself to be about 65% Muslim and 35% Christian.

And in my experience, it’s 100% animist. Animism is the attribution of a soul to plants, inanimate objects and natural phenomena.

If you undress a Tchadian, even a Christian pastor or a very good Muslim, you will find under their clothing an array of trinkets, fetishes, charms, etc, all meant to keep away the evil spirits or offer some sort of spiritual protection.

A Tchadian might find it completely rational to believe that an evil spirit lives in a tree.

Do you?

A Tchadian might believe that they require protection from that evil spirit whenever they pass by that tree. They pass the tree in fear. Perhaps they can get a trinket from the traditional healer (politically correct for ‘witch doctor’) that will protect them. Perhaps they need to sacrifice a chicken when they pass by the tree.

Now let me ask you… if a Tchadian believes that an evil spirit possesses a tree, and he lives in fear of that tree and of that evil spirit, and he puts his faith in a trinket obtained from the witch doctor to protect him from said tree… who wins?

Does God?

Does Satan?

You bet Satan wins! He has convinced that man to put his faith in something besides God!

Let me ask you another question…

Is Satan alone?

No!

Who is with him?

We read that ⅓ of all the angels are with him!

Is ⅓ insignificant?

Thirty-three percent is a lot!!!

So would it serve Satan well if he sent out his angels to possess trees and convince the people living nearby to place their faith in a string tied around their baby’s wrist to protect them?

Let me ask you again… Do evil spirits live in trees?

So why don’t evil spirits live in American trees? Japanese beetle ran him out?

Well, let me ask you… Did you scoff when first asked the question, Do evil spirits live in trees?

Why would an American scoff at that question?

We presume that inanimate things are inherently and infinitely inanimate. And a majority of Americans suffer from atheism, agnosticism, apathy or a mix of the above.

If you don’t believe in the spiritual, has Satan won?

You bet! Why would he want to continually remind you that there are spiritual forces at battle behind the veil? You would likely put your faith in God!

So why the difference between the American and the African? Is it genetic? No, absolutely not.

African culture has not had the slide away from the spiritual that American culture has had. African culture has not had the luxury of self-dependence that 21^st century Americans have had. Africans have had to rely on spiritual sources for their survival. And they have on occasion made the mistake of selling out to Satan via witch doctors. And it’s often been wholesale on the scale of entire tribes.

For centuries, Africans have put their faith in things other than Christ, despite having heard the good news of the cross.

Do you believe God is omnipotent? Do you believe God is all-loving?

If you believe that your God is all-loving and all-powerful, do you need anything else in this world? Do you have any reason to fear? Do you have any use for a witch doctor and his potions to ward off evil?

So what is my job as a missionary in this culture?

Do I come swooping in and start teaching them the doctrine of the Sabbath? Will they be saved by Sabbath-keeping? Will their lives become significantly better upon learning of the true seventh-day Sabbath?

Imagine going from a life of fear, a life of appeasing evil spirits, a life of indebtedness to a witch doctor… to a life lived as a child of the omnipotent, all-loving Creator and King of the Universe.

What an immense blessing we have to live under this understanding and promise.

So now… How do I bring them to know the joys open to them, the freedom from fear?

Well, first of all, I risk being mocked by my American contemporaries and I acknowledge the spirit in the tree.

Do you?

Bad Missionary???

Bad Missionary

We’ve now been missionaries for two years. It seems like some random sort of milestone. We’ve heard it said that it takes two years just to figure out what you’re doing in the culture, etc, before you actually start your missionary work. So I guess we’re now ready to start. Then why do I feel so tired already?

We often joke that we are bad missionaries. If the General Conference knew our viewpoints on mission work, they’d probably bring us home permanently and send out better missionaries in our place. (Fortunately for us, there’s not a lot of competition to come to Tchad!)

Caffeine has passed our lips. We’ve been known to expose knees and shoulders in public. When in the states, Danae’s even been known to wear a bikini to the beach.

But I don’t think those are our major offenses. Our dark secret is this: We are Adventist missionaries. And we don’t really feel a strong urge to preach doctrine. Don’t tell.

As Adventists, we pride ourselves so much on having the ‘right’ doctrine. We are the church with the ‘truth’. You won’t find an Adventist evangelistic campaign that’s not strongly focused on doctrine. And yes, if I sat down with a Bible in a locked room and created what I thought was the ‘correct’ theological doctrine, it would probably very closely resemble the 28 fundamental beliefs of the Seventh-day Adventist church. (I really liked the number 27 better. Three cubed is just such a nice, symmetric number.)

I believe doctrine exists. I believe there is correct and false doctrine. I believe theology exists. I believe there is correct and false theology. I believe ‘truth’ exists.

But how important is doctrine? I mean, if God came down to this earth and had a limited time to explain to us what was really important in life, what would He tell us? If only there was a way to know! Oh wait! That’s right! There IS a way to know! Jesus came to the earth, spent thirty years living life right and then three years in ministry. Three years is a long time to preach. That’s a lot of sermons. Surely He covered all the important stuff. All the really necessary doctrine. Right?

So I grab my red-letter Bible and read Matthew, just the words of Jesus. The most comprehensive account of the great Sermon on the Mount. And I’m astonished. I find no doctrine. No state of the dead. No nothing like that.

But I know the church has a published version of the fundamental beliefs of the Adventist church. So I grab my older version (just the original 27!) and start to leaf through it. Wow. So little of what we believe is based on the actual words that came out of Jesus’ mouth. As it turns out, I’m more a follower of the apostle Paul than I am of Jesus Christ! Could this be right? I believe in the entire Bible as the inspired Word of God, right? So is it all equal? Why didn’t Jesus talk about all this doctrine that Paul taught? What did Jesus actually talk about?

So I read through the red letters of Matthew again. It’s all about relationships! How to relate to God and how to relate to fellow man. Is that doctrine? I don’t know. It’s not the doctrine I find in the 28 fundamental beliefs.

Here’s a doctrine I believe in: The doctrine of Salvation by Faith. But faith in what? Faith in doctrine? I believe the Adventist belief that those who die are in a state like a sleep and know nothing. I don’t believe that my deceased grandparents are up in Heaven looking down on me. I don’t believe I can communicate with their spirits. I also believe the Adventist stance regarding the mortality of the soul. I believe that God is Love. And as such, I can’t understand why God would allow somebody to burn in hell forever. Who would benefit from that? Me? God? Satan? So is it my faith in this doctrine that saves me? Faith in another doctrine? Faith in all the doctrines?

I don’t know. My beliefs could be wrong. Is admitting that showing a lack of faith? I know some things. I know God loves me. I know He sent Jesus to take away my sins. I know that I’m saved only by the grace, love and sacrifice of Christ. I know God loves you. I know God did the same for you. I know I love you. I know I want you to understand God’s love for you. I know I want you to love and understand and know God as I do.

Is that doctrine?

So now I’m a little distraught. What am I doing? What’s my job? What does it mean to be a missionary?

I get help from Webster: A missionary is a person sent on a religious mission.

Well that begs the question: What is religion?

I get help from the Bible… James 1:27, Religion that God our Father accepts as pure and faultless is this: To look after orphans and widows in their distress and to keep oneself from being polluted by the world. (Incidentally, all of James 1 is awesome. You should read it.)

So if I put these two definitions together, as a missionary, I am sent on a mission to look after orphans and widows in their distress and to keep myself from being polluted by the world.

Hey, you know what? I kinda like that!

And the better news is I’m not alone. There are lots of people who like to do that. Not just church-credentialed missionaries. And not just Adventists. And not just Christians. I’m in good company!

Do you? I suspect that if you’re reading this blog, you do!

Cold in Virginia with Cousins

FYI

We are on vacation and in the states until December 26. If you should need to contact us, our temporary phone number is 301-412-1737 (Olen) and 301-412-0038 (Danae).

1.0

He wasn’t supposed to live.  He was only 1.0 kg when he was born.   

1.0?  What kind of weight is that to start off with in the raw land of Tchad?  There’s no way.  

The smallest so far that I’ve had live is 1.4kg.  Even that was pushing it, but miracles still happen.  And that cute, little, precious baby lived…and is still living.  Getting treated for malaria every now and then just like every other little kid in Tchad.  

But this one?  There’s no way.  

Normally if they are premature, I try to give them some iv antibiotics for a couple of days.  Plus it’s a way to keep them here to keep an eye on them in case I could help with anything.  I encourage putting warm water in bottles and make an incubator out of a box.  If they are not eating, we put in an NG tube and give breast milk through this.  But that’s about all we can do here.  

This one was too small to even try here in Tchad.  

He had already proven himself to be a fighter.  You see, he was a twin.  He had something called twin to twin transfusion syndrome, at least that’s what I think he had.  His sister was bigger at 1.5kg, but she died when she was born.  But the small one lived.  

At first I just encouraged the mom to hold him and be with him.  We had another premature baby at the same time and she saw me making a box with warm water bottles in it for the other baby.  So she did the same for her baby.  

The next day the small 1.0 kg (a little over 2 pounds) tyke was still living.  Amazing.  He was even trying to breast feed from his mother.  I could not believe my eyes.  

He stayed on the maternity service for a little over a week.  I didn’t know what else to do, so I discharged them.  She came back every week for the first month to weigh him.  Every week I couldn’t believe my eyes that he was still alive.  

Last week at 5 weeks he had quite a lot of edema in his feet.  I wasn’t sure what to make of it, but thought it was probably some sign of kidney or heart failure.  

I was wondering what happened to him this week, but happened to run into the mom visiting another patient.  I asked her how her son was.  She told me that the edema was better and that he was alive and well.  I told her he was a miracle baby and that I wanted her to bring him in so I could see him with my very own eyes.  

Miracles still happen here.

Misdiagnosis

Okay, so this one will be a little humbling for me.  If you are an OB/GYN or an ultrasound tech, yes, you can make fun of me.  However, you are not here, and I have no idea how I missed this.  I’ve done many, many d&c’s and many, many ultrasounds before.  Thankfully God was gracious.  

She first presented last week.  G2P1000 at “9 months pregnant” and heavy vaginal bleeding a couple days ago.  The bleeding had subsided and was very minimal now.  She came into my office alone.  She had no family with her.  She showed me her carnet (medical booklet).  She actually had labwork done already from Kelo (a rarity).  Positive pregnancy test.  A little anemic with a hemoglobin of 8.  Someone else had done an ultrasound too and found a molar pregnancy.  She came to us because she didn’t have any money or maybe they referred her to us, I couldn’t really tell.  

Okay, this shouldn’t be too hard.  We have lots of these.  I’ll just confirm with an ultrasound.  A molar pregnancy is an abnormal pregnancy that doesn’t develop into a baby.  It’s a gelatinous tumor that grows inside of the uterus.  To fix it, you do a d&c (scrape out the uterus) and make sure she doesn’t get pregnant for a year or else it can come back again.  

I put the ultrasound probe on her belly.  Sure enough, it looked exactly like a molar pregnancy.  We see them at very advanced gestational ages here (9 months), so they can look truly pregnant.  

I noticed that her first pregnancy was a c-section, but the baby had died at delivery.  So she had no living children.  

The next day I started the d&c.  I had a really hard time getting her cervix dilated.  It didn’t help that my dilators are not increasing in size very well.  One of them is broken in two also, so you can easily puncture your glove if you are not careful putting it in with your thumb.  I couldn’t get her dilated very far, but managed to get a small curette in.  I was showing Samedi how to use the manual suction curette set, so also used this to help get some of the liquid out.  I found a few pieces of placenta and fluid, but did not get the satisfying grape-like gelatinous material that is common to classic molar pregnancies to come out.  I guessed that it was old and possibly attached to the uterine wall.  

Try as I might I could NOT get all of the material out of the uterus.  I was nervous I had perforated her uterus because it just didn’t feel right.  I decided to quit because her cervix was tearing and I couldn‘t get all of the tumor to come out.  I was worried about a perforation also, but decided not to open her abdomen.  

The next day she was doing  okay.  She had a little more pain than I wanted after a d&c, so I kept her.  The following day I repeated the ultrasound.  The tumor seemed to have grown.  It was bigger and the fluid seemed to have come back.  There was still a lot of tissue that needed to come out.  

I discussed her options.  I could try again with a d&c again, but she would probably need a hysterectomy because the tumor was so attached to her uterus, and I doubted I could get it out.  This was sad because she had no children.

She went home for the weekend and came back early on Sunday with a little more pain.  

Today on Monday we operated.  I had my dad help me to see what he thought. The spinal didn‘t work very well, so we had to change her to ketamine.  It took us forever to get her dilated as her cervix was already fragile from the other surgery too.  Finally we were able to get a curette inside her uterus.  I used the ultrasound probe to look also at our position.  That is definitely not in the uterus (where it is supposed to be).

It looked like we perforated this time anteriorly.  Dad agreed that something just didn’t feel right.  Dad asked, “what is this mass that feels separate higher up?” 

We decided to open her abdomen .  This was the best decision all week.  We cut out her old midline scar.  Cut down to the fascia and entered the peritoneum.  I wasn’t expecting what I saw.  

Just below the fascia was dark, blood stained omentum.  It looked angry, possibly like cancer.  Oh, that’s sad.  How could I have missed cancer?  

I stuck my hand through the fragile peritoneum to enter the abdomen.  As I stuck my hand in, out popped something that I could not believe my eyes.  It was a baby hand.  Don’t get happy, it wasn’t alive, but it was so unbelievable.  How did I miss THAT on the ultrasound?  I have no idea.

What we found in her abdomen was an abdominal ectopic pregnancy of about 7 months.  The baby had been dead a while, but weighed 1.3 kg already (about 3 pounds).  The uterus was actually a normal SMALL size.  The placenta was slightly attached to the right tube, over the uterine fundus (top of the uterus), and attached to the colon and small intestines.  It was so old and degenerated that it didn’t bleed much.  

We took out the baby, placenta, and right tube, and oversewed the colon.  There was a small perforation anteriorly in the uterus and through the fundus.  I oversewed these small places and irrigated a lot.  

The good news is that she should do fine.  And she should be able to have another pregnancy and a chance to have a live baby.  God also protected her intestines from my sharp curette and my suction curette (it’s normally supposed to stay in the uterus and not go outside of the uterus where the intestines are).  The placenta was in the way of the intestines the whole time, which explains why I was able to get placenta fragments during the d&c.  There was no perforated bowel.  

The bad news is that I’m an idiot sometimes.  This time in particular with her late diagnosis of a 7 month old ectopic abdominal pregnancy.  This is something truly very rare and only exists in 3^rd world countries I believe.  The other good news is that nobody sues here and therefore I can share my stories with you.  They are just happy to have help.  

This patient later shared with me that she had felt her baby moving earlier in the pregnancy.  She got into a fight with another woman who hit her abdomen.  She didn’t feel her baby move after that.  That had been 3 months earlier.  So her baby had probably been dead for 3 months.  

You just never know what’s going to come in here.    

Floods and friends

Wendy and Danae look over the
flooded fields at the Bere sign.

Zane enjoys his private rice paddy pool

Lyol enjoys Brichelle, his neighbor and babysitter

Rain and help

In case it’s not a hot topic on the nightly news where you live, filling your airwaves and enthralling listeners curious about this corner of the world, I thought I’d tell you...

We are at war here, complete with airplanes and bombs!

Well, one airplane, a single-engine four-passenger Cessna. And the bombs are not actually weapons, although some of them are heavy. But we do have our very own refugees, trudging barefoot and everything! Just like National Geographic pictures. Like Darfur, but without the violent government issues.

The rains, unaware that this should be the end of rainy season, are continuing here. The waters recede, then advance again, swallowing up entire villages and leaving roads completely underwater. Currents, slow but distinct, run vaguely from south to north, although the river, normally 30 yards across, is now closer to 30 miles across, flowing from rice paddy to rice paddy, from hut to hut, simply blowing across the entire plain with nothing to stop it.

Villages from all around the district have been displaced to Bere, most of them living on the floors of the local schools, often more people than there is floor space. Remember, a school here does not have running water. So toileting/drinking water are a real danger.

But there are other villages who can’t or won’t come to Bere. They try to make a place above the water to sleep and cook and they stubbornly eke out an existence for a month or two. Sanitation is even a bigger problem in those places, where the well is under water, as is the toilet. Whatever you’ve put into that toilet during the last year is now free to float up through the hole and drift over to your open and underwater drinking well. The risk for water-borne illness is no longer a risk. It’s an inescapable certainty.

To us, it’s a little inconceivable that people would stay in their homes. Their homes are mudbrick, built without cement and with a thatch roof. Their homes are prone to collapsing every year anyway. Besides, they could probably carry all their earthly belongings on their heads. I don’t understand why they stay in their village, except that they feel forced to.

So how do we help the flooded folks? We don’t have boats. Our cars can’t go there. Our motos can’t go there. It’s too far to walk with supplies.

Then Gary and Wendy Roberts had an idea. How about bombing the families from the air? Not real bombs. The villagers aren’t THAT desperate yet! But wrapped up packages of food and supplies.

Wendy and Gary gathered supplies of millet, rice, peanuts and other food items to put in one watertight bundle. They got together another bundle of bleach, to treat water, and charcoal and lighters, to cook their food with.

We tried convincing Gary and Wendy to put little notes inside the bundles, saying, ‘From your friends at the Seventh-day Adventist church.’ But then we wondered, ‘What happens if the package dropped from the plane crashes through their roof. Or bonks a kid on the head. Or lands on a spoon which has a pebble balancing on the handle, causing the pebble to soar into the air, striking a passing butterfly, causing the butterfly to get disoriented and vomit, at which the vomit strikes the family’s favorite goat in the eye, causing the goat such severe pain that he goes delirious and runs headlong into a tree, falling unconscious into the swirling floodwaters and drowning.’ You gotta consider all possibilities.

After a lot of reflection, we decided that we didn’t want to be ‘That church of goat-killers,’ so we opted out on the idea of notes in the bundles, choosing the more Chicken-Soup-for-the-Soul-worthy random acts of kindness approach. Anonymous is hip. Plus, everybody here knows that the only plane around belongs to the Adventists. And when you’re only 30 feet off the ground, people can just read ‘Aviation Medicale Adventiste’ on the side of the plane.

Now for loading the airplane...

Zane assisted Gary to take the passenger’s door off and remove all the seats save the pilot’s. Lyol assisted Cherise with carrying the bundles of goods to the airplane. They loaded up and strapped everything down, including Wendy, so she wouldn’t fall out the open door.

Gary and Wendy flew over many flooded villages. They had 30 drops of 2 bundles each. Wendy’s target was somewhere close to the hut, most likely a water landing.

People fell into one of two categories. The first and more plentiful group, the half-full sort of Tchadian villagers, would run out into the water and pull the bundles triumphantly out of the water. It had all the makings of "The Gods Must be Crazy 3." They would then re-evaluate the last dance they had done and forever cement it into their local culture as the Dance of the Rains of the Metal Bird. And that day would forever be known in their village as the Day the Sky Poured Watertight Care Packages. I think that’s how you’d translate it. Well, except for the villages with satellite dishes. They just called it Friday.

The second category of Tchadian villagers were of the more timid, fearful and half-empty sort. They would go into MacGyver-like slow motion when they saw the plane dropping packages, running away and leaping headlong behind bushes at the exact split second the package touched down. Unlike the A-Team, however, the packages weren’t accompanied by awesome exploding special effects. Just a little bit embarrassed, they would hesitanty go poke the package with sticks until they felt confident enough to pick it up, open it and look inside.

All in all, a pretty awesome ministry opportunity for Gary and Wendy down there at the airport. Just so long as you’re not making butterflies vomit on anybody’s favorite goat.

Olen and Lyol, Gary/Wendy/Cherise check on the flooding
Today it is not raining.

A village in need of help received a "drop"  Their mud huts dissolve during the rain.
It is blurry as Wendy had to lean out of the plane to take this picture.

Gary, Lyol and Olen remove the plane door to prepare for the "drops."

They pack the plane

Lyol helps pack the plane

Almost full, except for the "drop lady"

Wendy is seat belted but without a seat.
She is the "dropper" for the flooded villagers.

PROGRESS!!!!

We have some very exciting news that we’ve been doing our best to keep under wraps. But I think it’s now time to make it public.

When we arrived December 12, 2010, we recognized certain things. We recognized that James Appel had taken the Bere Health Center, a run-down chicken coop, and turned it into Bere Adventist Hospital, a fully functional 24/7 hospital well-respected for surgical expertise and caring staff.

And we recognized that there was still room for improvement. The operating room left much to be desired and was just one room. The maternity ward was no place to have a baby. And there was no private ward, causing much of our clientele to refuse hospitalization in our dilapidated wards and decide to go elsewhere for their care. There was a huge lack in nursing education evident in our staff. There was a huge lack of surgical training for Tchadian doctors expected to be do-it-all doctors in remote areas. We recognized a lack of space for family to sleep with their sick patients, a lack of places to cook, a lack of places for nurses to treat their patients, an inefficient system of payment/pharmacy/lab, a lack of shelter from the elements of Tchadian sun and rain, a lack of places for volunteers to live, a lack of dental facilities, administrative space, space to educate, space for public health/HIV/TB issues and many other needs.

So we started to attack the needs piecemeal. We found funding for a new private ward and for a new operating room (in fact, a complex with two operating rooms), thanks to A Better World-Canada and the Springfield First Adventist church. Construction here is very expensive. Cement costs more than it does in the States. And everything is done with mud brick, which is not insulating, nor strong, nor particularly cheap. There were many construction challenges, not least of which was that Jamie is my only man who knows what he’s doing, and he’s just one man, unable to run multiple complicated construction projects at once.

And then we got a visit. The people that have made One-Day Churches, One-Day Schools and One-Day Houses happened to stop by and they saw the immense need at our hospital, a need that is repeated often throughout the third-world at myriad Adventist hospitals. And they developed the dream of One-Day Hospitals. Bere would gladly be the guinea pig. And so the last several months has been a whirlwind of designing and redesigning buildings, something I have never done before and am completely untrained to do. However, with help from the people at One-Day and with help from Jamie, we have very exciting plans to report.

The One-Day Structures are better quality structures than anything that we can get locally. And since it’s all sponsored (actually, we’re all stepping out in faith, as it hasn’t really been paid for yet), it’s not costing the hospital anything. We will have metal-framed, metal-roofed, metal-siding structures, with insulation in the walls and in the ceiling, with vented ceilings/roofs, with indestructible windows, with roof overhang to provide shade on the walls, etc. And we have experts coming to erect them through Maranatha.

So far, we have planned an operating room complex, two private wards, a delivery suite, a maternity ward, a lab/pharmacy/cashier complex, a ton of new housing for ex-patriot volunteer staff like student missionaries and others, a dental clinic, a public health clinic to service things like midwifery training and HIV and many other things, open-air buildings, etc.

We are hopeful that funding will be found for buildings for a nursing school and for a surgical residency training program. This is such an incredible opportunity that we want to take every advantage we can.

There are so many exciting aspects to this project, that I’m bound to forget some. The One-Day folks have found ways to use their framing materials to construct sturdy hospital beds on wheels. These will be a huge advantage over our current beds. They are also constructing sinks and counters from stainless steel. They have found ideal mosquito screening, netting, fans, etc etc etc. Also, they have found materials for curtain rods between beds. I’ve seen these curtain rods and they will be the best in the world, I can guarantee. They’re just awesome. And we’re getting new systems for our electricity here. And we haven’t given up hope that things like refrigerators, etc will find their way into the hands of the folks at the One-Day operations.

The One-Day is just the outside frame, so we will still have a lot of costs to finish the insides of the buildings, interior walls, hospital equipment, plumbing, electricity, etc, but now we’re able to stretch those donations that were made for the operating room and private wards and those monies will be able to go so much farther now! Those monies will be used to finish several buildings, whereas before it would have been enough for just one. These projects have been a couple years in the making, but now we’re getting it done right, with the best materials at the most efficient cost. We really are so blessed.

Anyway, we just wanted to express our excitement and share our blessing with you. Already, most of the buildings have had their foundations prepared. We’ve even started pouring cement! With this collaboration and everybody working so hard to make this a reality and find every way possible to bless the people here with the best possible materials... we will be turning our 40-year plan into a one-year plan!!! It’s just news that’s too exciting to keep to ourselves any longer.

love
olen and danae

missionarydoctors.blogspot.com

danae.netteburg@gmail.com.

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
Afrique

Volunteers Welcome!!!

Merci

Like I’ve said before, I’m not that good with names.  However, It’s the tough cases, the ones that die or the ones that come close to dying, that you remember better than the others.  And thus, you learn the individual’s name.

Merci first came to me in full blown labor.  She was well over 50 kg (over 110 pounds) at that point.  A typical story.  She had labored a long time at home.  Her baby was dead already.  Thankfully she was fully dilated.  

I brought her to the operating room for a forceps extraction of the baby.  I put in a foley catheter to empty her bladder and then applied the forcep blades on the head of her already dead baby.  Carlie, a nurse who has now been here several months, was new to africa at the time, but was helping us that particular evening.  I remember feeling bad for Carlie because it was a particular horrid delivery to get the fetus delivered.  Finally, however, I was able to deliver the baby.  

After her delivery, I attempted to move the foley a little, but it was not placed properly.  The balloon had been blown up in her urethra (causing her urethra to be dilated).  So after finding the right path of the urethra, I planned to leave the foley in for a week.  

Merci recovered after all of this.  We took her foley out, and she urinated normally.  Just to be sure her urethra was functioning normally, I instructed for her to come back in a week.  

She did not come back, however.  She lives about 30 km’s away, and road conditions were not optimal.

She went to a health center to look at her stitches I had put in.  She also had started to leak urine.  They weren’t familiar with different types of urinary leakage.  She was having trouble urinating because of her dilated urethra, so her bladder became full, and then would leak from time to time because of the fullness.  This is called overflow incontinence.  Since she was complaining of leaking urine, they referred her to the fistula hospital a long, long ways away.  She of course did not go.  

She stayed at home with her husband.  I’m not sure how it all started, but what eventually occurred was nothing short of neglect!  Maybe the urinary leakage caused the husband to think she was now worthless.  Maybe it would have happened anyways.    Maybe he is like other men who think because her baby died with the delivery, she is not a good woman.  Maybe her husband is just a selfish pig.  

Men always eat first here.  It’s polite.  It’s the culture.  Women and children eat last.  The children, who should get the best nutrition as they have the least defense, always get what’s leftover.  Always the non-nutritious rice, never the sauce that might have a little nutrition in it.  

But a urine smelling, dead-baby mama?  What does she deserve?  From the way the story panned out, he obviously thought she deserved nothing.  

After a while she just lay in her cold, dark hut....starving.  He refused to give her anything.  She may have felt a little sick and not wanted to eat at first, and this continued with him not feeding her.  Maybe she was depressed from losing her full term baby.  That would be normal.  But to leave her in a cold, dark hut with nothing to eat? Excuse me, but that is neglect! 

Almost 2 months later, her mother took her in.  She stayed with her mother for a week and then they came back to us.  

Merci!  She wasn’t even recognizable anymore.  She was only 33 kg (73 pounds)!  She had lost so much weight!  She was a starving skeleton.  I was sooooooo angry at them for letting her get like this.  She didn’t even speak a common language, so we had to get another patient to translate the whole story.  There’s nothing much to say, except it was neglect.  You get tired of getting angry over and over again here.  But this just makes you furious!  

Even more than the anger, were the thoughts like....”Was this my fault?”  “If I would have put in the foley correctly, maybe she wouldn’t have had overflow incontinence, and maybe her husband would have continued to love her without her smelling like urine.”  In reality, I know it was not my fault, but when I take on a patient...to do surgery or help with a delivery, they then become mine.  If they don’t recover, then it is my fault.  I want to help be in control of their recovery.  And now I want to beat her husband’s face in the dirt. 

How do we fight the war against hate?  The war against inequality?  It is so great here.  We cannot fight it with anger.  Not with violence.  We are all children of God.  Why can’t the men see here that women are also daughters of God?  Jesus loved each person equally.  He didn’t treat men better than women.  He healed women and men.  Why is there such a stark contrast with how women and men are treated here?  Even within the church?  Last year Tchad was ranked as the worst country in the WORLD for women to live.  It didn’t get that rank just by talking.  Women are treated BADLY here.  It’s okay to beat a woman here....so long as there is no blood.  It’s okay to withhold food from your wife or wives here.  Hey, the husband is the one that earned the money.  His wife is his possession, he can do with her as he pleases.  As a woman here, you cannot tell your husband (and probably any man) no if he wants to have sex.  Everything is permissible.  And, men usually have 2 or 4 wives here, so he can have sex every single night of the week or twice a night.  Everything is about pleasing the man here.  Never about pleasing a woman.  

So, to all of you who think that women’s rights are awful in the states...Please reconsider, and also be happy for what you have.  I have heard that women’s equality is big time talk for the upcoming elections.  I am still thankful to be an American citizen and have rights.  If I had to personally deal with these dumb laws and rules here, I’m certain I would be killed already... or I would be the president.  

Merci came back to us in her emaciated state.  She could not walk.  She could not eat.  She could barely speak.  She had awful diarrhea, and she was lying in it.  I thought for sure she was going to die within a few days.  She looked like a corpse that breathed and had a heartbeat.  

But she lived.  God showed us another miracle here.  We treated her for everything we could think of.  I left her foley in for a long time.  

Julie, our nutritionist from the states, immensely helped to save her life in those first few days.  She started out with a milk/sugar/oil mixture and gave it to her every 2 hours.  If we could only trust our nurses in the night to give it, Julie could have stayed at home and gotten some sleep.  But we don’t trust our nurses in the night, and thus, Julie came in several nights in a row to give Merci the much needed nutrient rich, yet gentle mixture every 2 hours.  

After several nights of this, we felt it was wiser to transfer Merci to Wendy’s Mother and Child Nutrition Place (still un-named).  Olen and I loaded Merci, her mother, and her first child, into the 4Runner and headed down to Bendele.  She still was unable to walk, and had to be propped up in the backseat by her mother.  The road was filled with huge craters of mud puddles.  Merci got a little car sick and vomited in the car.  It landed mostly in her lap.  Okay, maybe a little on Olen’s back.  But that was nothing compared to the diarrhea. 

Wendy's girls at Bendele nursed her back to heath, slowly by slowly.  Bronwyn, Athens, Carlie, and Wendy.  Day and night.  At one point she got an NG tube because she couldn’t eat or keep the food down.  Then they figured out that Merci liked bananas.  When she was strong enough to eat bananas, they would bribe her to eat the other nutritious mixtures by giving her bananas.  

She had to be hospitalized one more time with IV quinine for malaria.  Afterwards, we transferred her back to Wendy’s.  Slowly by slowly she started walking.  

Danae, Merci and Bronwyn

Finally, we took out her foley and she could urinate normally again.  

Last week she was discharged home.  Well, not home, home.  Not home to her husband.  Home to her mother’s home.  At least that is what they say.  She was over 40 kg (88 pounds).  There’s only so much you can do here.  You do what you can, and you ask your friends to pray.  

Please pray for Merci.  She’s been through so much and I pray that God will continue to make her stronger.  Pray that she comes back for follow up also.  

PS.  I am not a man-hater.  I love my husband, and I am so very greatful that he views me as an equal child of God.  I just loathe social injustice, to men, women, and children.  

To the tune of Three Blind Mice:

Two sick men.  Two sick men.  

Dad and Olen.  Dad and Olen.

My dad was in agony writhing away.  While Olen passed out on the couch for 2 days.  Hydrocodone and Quinine IV were the drugs for these Two Sick Men.  Two Sick Men.  

Two sick men.  Two sick men.

See how they lay.  See how they lay.  

My dad was in a fetal position.  In between pretending to be-ee okay.  Olen lay back with his mouth dropped wide open, an arm propped up attached to a drip.  Oh, Two sick men.  Two sick men.  

Two sick men.  Two sick men.  

What do they say?  What do they say?

My dad doesn’t have many words, but does say that “this really hurts.”  Olen tries to speak english to the french speaking visitors.  He’s not quite right.  In the head.  Two sick men.  Two sick men.  

Olen’s getting better.  Olen’s getting better.  

My dad’s still in pain.  My dad’s still in pain.  

It’s been 3 days of treatment and Olen’s finally off of IV and onto oral quinine.  My dad is off to better doctors, CT scans, and perhaps lithotripsy.  

Oh, for two well men.  Two well men.  

Follow up:  

I wrote this blog over a month ago while Olen and my Dad were both sick.  Thankfully they both have fully recovered.  Olen, to stay here with me.  And my Dad to go back to the states.  His kidney stone passed sometime in between France and Oklahoma.  My parents have been back in the states a month now.  My mom’s brother has throat cancer and it was very helpful for my mom to be in the states with him for the transition to hospice care this past week.  Mom and Dad are coming back to Bere next week.  Please pray for my mom’s brother, Ron, with his diagnosis of terminal throat cancer.  

Danae, the well doctor :-)

‘Hot and Compassionate.’

There was once a time when I was very attractive to mothers and grandmothers of girls my age. I had served in the mission field, I was on my way to medical school, I came from a great family, etc. I had a lot going for me. For whatever reasons, their daughters/granddaughters were never quite as attracted to me, but I was a hit with the older generation.

So it was that I was frequently asked, ‘What are you looking for in a girl?’ (ie, Why haven’t you asked out my daughter/granddaughter, other than the obvious reason that she’s not interested in you?)

I eventually simplified my answer to a recited knee-jerk response of ‘Hot and Compassionate.’

I figured that if I was physically attracted to them, and they were a compassionate person (and they were attracted to me equally), then all the rest would fall into place. Yes, it was an oversimplified view of things, but at age 22/23, it made sense to me.

So in October of 2003, I found myself sitting in a room full of my medical school colleagues. A girl got up front and started talking about six weeks she had spent in Ethiopia. I could tell that she was really excited about serving the Lord in Africa. And from the back of the room, she looked pretty hot. (Some people look good from far, but far from good. She actually turned out to look even better close up!) I figured that in the few minutes of listening to her, I was now fully capable of judging her to be Hot and Compassionate.

And so, I turned to my friend sitting beside me and said, ‘I’m going to marry that girl.’ That girl turned out to be Danae.

(In the interest of full disclosure, I need to admit that this was not the first time I had said, ‘I’m going to marry that girl,’ the first time I ever saw a girl. In fact, I got the idea from my friend’s father, who had said the same thing about his future wife. I thought it was cool and decided that I would someday say the same thing the moment I laid eyes on my future wife. However, just to cover my bases, whenever I saw a girl who I thought had the potential to be my future wife, I had to tell whoever was standing/sitting next to me that ‘I’m going to marry that girl.’ As you can imagine, this led to many awkward moments, from shaking hands with a girl for the first time to meeting people in the check-out line at Wal-mart, there were many uncomfortable moments.)

Three years after hearing Danae speak for the first time, we exchanged our I-dos and I had my Hot and Compassionate. She had her... well, I’m not really sure what she had, but she had me. I got the better end of the deal, but she’s still making a go of it, bless her heart.

Then I slowly started to learn what the Compassionate part of the deal really meant. Compassionate meant working long hours to make sure all her patients were getting the best care possible. Compassionate meant making sure all her coworkers were ok. Compassionate meant I had to share my wife with others.

Then we came to Africa. It was here where I learned what Compassionate really entails.

Compassionate means that Danae’s hospital bill last time was $2400, paying for the medical care of countless women who wouldn’t otherwise be able to pay for treatments. Compassionate means that Danae is spending as much on her hospital bill as she earns. Compassionate means that I’d be financially almost as well off if Danae DIDN’T work, because then she wouldn’t see the need and wouldn’t agree to pay for all these women.

And then Compassionate hit a climax last Sabbath. We were walking the road to Kassere, to see the destruction the flooding had caused there. We had walked roughly three or four kilometers, mostly through thigh-deep water, when we came to a rise in the road, a spot where the road actually rose about the water and was dry for a few meters. There on the dry spot was a corpse. The body of a young woman in Arab garb, her face covered as they usually do after death. And there wasn’t a soul around with the body. On closer inspection, the corpse was breathing. Danae leaned over and pulled the cloth off her face and started to talk to her in French. She didn’t speak any French, so Danae tried a few words in Arabic. The corpse was able to breathe and talk, but was too weak to sit up.

Danae asked what I thought the problem was. I could see from across the road that her hands and fingernails were extremely pale, so I told her I was guessing severe anemia, most likely from malaria. Danae pulled down her conjunctiva and saw how pale she was and agreed. This girl needed a blood transfusion and IV quinine. But we were several kilometers of underwater road away from the hospital.

And then Compassionate did what Compassionate does. Danae simply bent over, picked the 12-year-old girl up (almost 70 pounds), slung her over her back, wrapped an African cloth around her like the women here carry their infants, and started trudging back to the hospital, through the deep water. In her mind, there was no other option of what to do.

Compassionate meant that we had to cut our walk short. Compassionate meant that Danae also escorted the girl all the way to the emergency room to make certain that she was seen by a nurse. Compassionate meant that Danae stayed to make sure she got the right treatment. And Compassionate meant that Danae went to our hospital blood bank and got a unit of blood to transfuse her emergently while waiting for the family to donate a bag of blood. Compassionate kept Danae and the hospital long enough to learn the girl’s blood type and to find out that her hemoglobin was 2. (Your hemoglobin is probably around 14.)

Nine years after I saw her for the first time, she’s still Hot. And she’s still Compassionate. And I’m still pretty lucky.