Who can find a virtuous woman? For her price is far above rubies. So long as the rubies are attached directly to a concealing dress, and not a gaudy ring or neckless or earring.
The heart of her husband doth safely trust in her, so that he shall have no need of spoil. Spoil, however, he always appreciateth.
She will do him good and not evil all the days of her life. Well, perhaps not Tuesdays. Or Thursdays. But Wednesday, man doth she do good and not evil.
She seeketh wool, and flax, and worketh willingly with her hands. More often, however, she worketh deep in the pelvis with Vicryl and Catgut.
She is like the merchants’ ships; she bringeth her food from afar. Often, she is known to utiliseth the Cruiser of the Land when she visiteth Alimentation Etoile. That food she doth usually import from Arabia of Saudi.
She riseth also while it is yet night, and giveth meat to her household, and a portion to her maidens. Or at least usually by 7-ish, and she prepareth veggie meat. Or at least she directeth Zachee to thus prepare and giveth to the others who worketh for her.
She considereth a field, and buyeth it: with the fruit of her hands she planteth a vineyard. Well, she supporteth her husband while he planteth the vineyard. She doth the rest of the garden.
She girdeth her loins with strength, and strengtheneth her arms. She retaineth her limber stature and doth impress all those around with her ability to flippeth, spinneth, wheeleth the cart and springeth back the hand.
She perceiveth that her merchandise is good: her candle goeth not out by night. If the candle goeth out by night, she sendeth her husband or Jamie to flippeth the switch of the generator.
She layeth her hands to the spindle, and her hands hold the distaff. She also pusheth the pedal that runneth the machine. Thus, she seweth.
She stretcheth out her hand to the poor; yea, she reacheth forth her hands to the needy. She giveth and giveth some more, even when her husband explaineth the lack in her own household and the need to liveth within the means of their missionary budget. Thus, her husband moonlighteth.
She is not afraid of the snow for her household: for all her household are clothed with scarlet. Nor doth she fear the heat of the sun, for her children scurrieth about nude with the Tchadians.
She maketh herself coverings of tapestry; her clothing is silk and purple. When in need, she knoweth where she can findeth a Gap. There she searcheth the clothing of orange.
Her husband is known in the gates, when he sitteth among the elders of the land, although he despiseth the committees and the work thereof.
She maketh fine linen, and selleth it; and delivereth girdles unto the merchant. She maketh pelvic girdles to grow surprisingly, so that the foetus might pass therethrough.
Strength and honour are her clothing; and she shall rejoice in time to come. Her clothing is often also scrubs, and she rejoiceth in the comfort they provideth.
She openeth her mouth with wisdom; and in her tongue is the law of kindness. Unless thou givest thine newborn the water. Then she shall thee lash with her tongue and scoldeth thee with her mouth.
She looketh well to the ways of her household, and eateth not the bread of idleness. She looketh very very very well to the eyes of her husband.
Her children arise up, and call her blessed; her husband also, and he praiseth her. Her children still have difficulty pronouncing ‘blessed,’ but they worketh thereon. For now, they settleth for ‘Mommy.’
Many daughters have done virtuously, but thou excellest them all. No daughter hath ever been more attractive than this 33-year-old mother-of-two daughter.
Favour is deceitful, and beauty is vain: but a woman that feareth the Lord, she shall be praised. And if that same woman who feareth the Lord also happeneth to be beautiful, and happeneth to be my wife also, well, then, I shalt be extremely lucky.
Give her of the fruit of her hands; and let her own works praise her in the gates. And on her birthday, she shall receive the adulation of her husband.
Monday, January 23, 2012
#90 Dust and Ashes
God,
I’m tired.
I’m discouraged.
I’m ticked off.
I don’t know how much more I can take.
I never viewed myself as the most morally sound missionary, but I trusted You to see me through. Is this Your challenge?
What am I supposed to do?
My head is spinning.
I need the world to slow down for a few hours. A full day, even.
Christophe got caught asking for bribes from patients again. Nothing new for him. He’s promised to straighten up and never do it again several times already.
Honore asked for a bribe from the same patient. When they wouldn’t fork it over, he made them wait all day to be seen. Finally they paid.
Giscar showed up drunk. Again.
So did Etienne.
And DeGaulle built himself a compound on hospital land without asking permission or paying rent. What’s more, he showed up enough at the hospital to get on payroll. And he doesn’t do anything but grow a garden at the hospital that he takes home to feed his family.
What am I supposed to do?
Can you not give me an honest, sober employee to help me out here?
Honore finally convinced some that it was just a tip and he never showed preference for it and never asked for it. He just accepted it. I still don’t buy it.
Christophe threw the whole lab under the bus and insisted that all four lab guys were in on it and pooling together the bribes they extorted from patients and then splitting it at the end of every day.
Really?
So we held our mighty hospital committee today.
Nobody wanted to fire anybody. I pointed out that the rulebook said we needed to fire him. Finally they relented.
So to support their colleague, the other lab guys went on strike. To publicly say that they support demanding bribes from patients to do the job they are already paid to do, they went on strike.
Really? I let them. I told them I’d rather fire them all than support thievery. They went back to work. Except the guy I fired.
So I told the committee, If you’re really serious about catching these people, and we all have admitted already that there’s a bunch of employees extorting from the patients, how about one of you just go around with me and ask patients and their families if they’ve been asked for money by anybody besides the cashier.
And they laughed at me, God. The committee you gave me to direct this hospital to a future of glorifying you. They laughed at the idea of catching the thieves. Why, God?
Are they stealing too, and they’re afraid?
Can You not give me one honest employee to trust and to work with?
Every employee tells me, I’m not stealing, but so-and-so is. The rumors are more than I can process. Everybody is implicated.
God, how does this glorify You? We’re here for You, right? So people come to the Adventist hospital from all over the country, just to find that we extort money? What does that say about our God?
Should I close the hospital? If You tell me that’s what I need to do, I’ll do it. I’d rather close a hospital than continue dirtying the name of Jesus. I’ll fire them all and just see a couple patients a day myself.
Is this stupid pride or righteous indignation? Am I rising above or am I stooping to their recalcitrance? Am I being culturally insensitive? Should I really allow the nurses at Your hospital to continue stealing from patients and the hospital in the name of cultural sensitivity?
Help me out here, God.
Last night I went to bed at midnight. The night before was 2am. The night before was midnight. I have hours and hours of administrative work every night, instead of playing with my children and spending quality time with my wife. Is this really what you called me to? I’m not an administrator. I’m not political. I’m not a fundraiser. Am I really the best You can do? Seriously, I’ll abide by the whole, ‘Here am I, send me’ thing, but couldn’t You find somebody better at this?
I’m trying to fence in the whole property, all 0.8 miles of it. I’m trying to stop the annual fights with neighbors over where they can grow their rice. I’m trying to stop the cows from roaming through. I’m trying to control foot traffic to/from church and school. I’m trying to keep people from building their private compounds and houses and goat pens on our property.
I’m trying to fence in an extra courtyard for a private ward, something to increase our capacity and increase our revenue. No, Your revenue.
I’m trying to build a new OR. One built to be efficient and sterile. One with a delivery suite. One with a lab attached. Something that can be air conditioned.
I’m trying to build a house for my in-laws, who are moving here to be our third doctor. And I’m trying to fence in their house.
I’m trying to start a nursing school. One that requires a year of theology training as a prerequisite to the course. One that filters out the money-seekers. One that teaches ethics from the very beginning. One that will produce honorable nurses who don’t steal and who work hard and who are kind and who glorify You.
I’m trying to start a radio station to spread Your Gospel.
I’m trying to build a hotel for people here for chronic problems or visitors who just need to stay a night or family of patients.
I’m trying to open health centers which will glorify You.
I’m trying to recruit a fourth physician, a construction expert, an accountant, an administrator... anybody honest!
I’m trying to build a new maternity ward.
I’m trying to build medicine wards and surgical wards.
I’m trying to build new toilets for sanitation.
I’m trying to manage current and future volunteers.
I’m trying to keep donors happy.
I’m trying, God. Help me out here. Give me a break. Send me some help. Real help. Not, please let me play surgeon in the OR help. I can’t take any more of that help.
I know the right answers. I know all about how I’m not supposed to be trying it on my own. I know all about how I’m supposed to leave it in Your hands. But I see them take that attitude here all the time. And it’s just an excuse for laziness. Is that really what You want from me? I know all about how it’s not my strength, but Yours. God, seriously, I’m not doing it to glorify myself. Seriously, try me. Test me. Take all the credit. Give me none. See if I complain.
We’re talking crisis point here, God. Give me something.
So what do we do now, God? I’d love some explicit instructions.
You are not a God created by human hands.
You are not a God dependent on any mortal man.
You are not a God in need of anything I can give.
By Your plan, that’s just the way it is.
You are God alone.
From before time began, You are on Your throne.
You are God alone.
And right now, in the good times and bad, You are on Your throne.
You are God alone.
Unchangeable, unshakable, unstoppable. That’s what You are.
I know that You’re up there on Your throne. I know that You see and understand from the East to the West, from the North to the South, from the Depths to the Heights, from Millennia past to the Present to the Future. I know that Your understanding is not limited to my finite three-dimensional reality. I know that Tchad in 2012 is but a speck of physical space in just a moment of quantifiable time. I know that You have reasons beyond my reasoning.
But these people are suffering. This is a country and a people forgotten by the world for so long. These are children of Yours that are so ripe for the harvest. All they need are some leaders to show them the way. God, send me kind, honest, hard-working men and women to lead this hospital to You.
I’m tired.
I’m discouraged.
I’m ticked off.
I don’t know how much more I can take.
I’m tired.
I’m discouraged.
I’m ticked off.
I don’t know how much more I can take.
I never viewed myself as the most morally sound missionary, but I trusted You to see me through. Is this Your challenge?
What am I supposed to do?
My head is spinning.
I need the world to slow down for a few hours. A full day, even.
Christophe got caught asking for bribes from patients again. Nothing new for him. He’s promised to straighten up and never do it again several times already.
Honore asked for a bribe from the same patient. When they wouldn’t fork it over, he made them wait all day to be seen. Finally they paid.
Giscar showed up drunk. Again.
So did Etienne.
And DeGaulle built himself a compound on hospital land without asking permission or paying rent. What’s more, he showed up enough at the hospital to get on payroll. And he doesn’t do anything but grow a garden at the hospital that he takes home to feed his family.
What am I supposed to do?
Can you not give me an honest, sober employee to help me out here?
Honore finally convinced some that it was just a tip and he never showed preference for it and never asked for it. He just accepted it. I still don’t buy it.
Christophe threw the whole lab under the bus and insisted that all four lab guys were in on it and pooling together the bribes they extorted from patients and then splitting it at the end of every day.
Really?
So we held our mighty hospital committee today.
Nobody wanted to fire anybody. I pointed out that the rulebook said we needed to fire him. Finally they relented.
So to support their colleague, the other lab guys went on strike. To publicly say that they support demanding bribes from patients to do the job they are already paid to do, they went on strike.
Really? I let them. I told them I’d rather fire them all than support thievery. They went back to work. Except the guy I fired.
So I told the committee, If you’re really serious about catching these people, and we all have admitted already that there’s a bunch of employees extorting from the patients, how about one of you just go around with me and ask patients and their families if they’ve been asked for money by anybody besides the cashier.
And they laughed at me, God. The committee you gave me to direct this hospital to a future of glorifying you. They laughed at the idea of catching the thieves. Why, God?
Are they stealing too, and they’re afraid?
Can You not give me one honest employee to trust and to work with?
Every employee tells me, I’m not stealing, but so-and-so is. The rumors are more than I can process. Everybody is implicated.
God, how does this glorify You? We’re here for You, right? So people come to the Adventist hospital from all over the country, just to find that we extort money? What does that say about our God?
Should I close the hospital? If You tell me that’s what I need to do, I’ll do it. I’d rather close a hospital than continue dirtying the name of Jesus. I’ll fire them all and just see a couple patients a day myself.
Is this stupid pride or righteous indignation? Am I rising above or am I stooping to their recalcitrance? Am I being culturally insensitive? Should I really allow the nurses at Your hospital to continue stealing from patients and the hospital in the name of cultural sensitivity?
Help me out here, God.
Last night I went to bed at midnight. The night before was 2am. The night before was midnight. I have hours and hours of administrative work every night, instead of playing with my children and spending quality time with my wife. Is this really what you called me to? I’m not an administrator. I’m not political. I’m not a fundraiser. Am I really the best You can do? Seriously, I’ll abide by the whole, ‘Here am I, send me’ thing, but couldn’t You find somebody better at this?
I’m trying to fence in the whole property, all 0.8 miles of it. I’m trying to stop the annual fights with neighbors over where they can grow their rice. I’m trying to stop the cows from roaming through. I’m trying to control foot traffic to/from church and school. I’m trying to keep people from building their private compounds and houses and goat pens on our property.
I’m trying to fence in an extra courtyard for a private ward, something to increase our capacity and increase our revenue. No, Your revenue.
I’m trying to build a new OR. One built to be efficient and sterile. One with a delivery suite. One with a lab attached. Something that can be air conditioned.
I’m trying to build a house for my in-laws, who are moving here to be our third doctor. And I’m trying to fence in their house.
I’m trying to start a nursing school. One that requires a year of theology training as a prerequisite to the course. One that filters out the money-seekers. One that teaches ethics from the very beginning. One that will produce honorable nurses who don’t steal and who work hard and who are kind and who glorify You.
I’m trying to start a radio station to spread Your Gospel.
I’m trying to build a hotel for people here for chronic problems or visitors who just need to stay a night or family of patients.
I’m trying to open health centers which will glorify You.
I’m trying to recruit a fourth physician, a construction expert, an accountant, an administrator... anybody honest!
I’m trying to build a new maternity ward.
I’m trying to build medicine wards and surgical wards.
I’m trying to build new toilets for sanitation.
I’m trying to manage current and future volunteers.
I’m trying to keep donors happy.
I’m trying, God. Help me out here. Give me a break. Send me some help. Real help. Not, please let me play surgeon in the OR help. I can’t take any more of that help.
I know the right answers. I know all about how I’m not supposed to be trying it on my own. I know all about how I’m supposed to leave it in Your hands. But I see them take that attitude here all the time. And it’s just an excuse for laziness. Is that really what You want from me? I know all about how it’s not my strength, but Yours. God, seriously, I’m not doing it to glorify myself. Seriously, try me. Test me. Take all the credit. Give me none. See if I complain.
We’re talking crisis point here, God. Give me something.
So what do we do now, God? I’d love some explicit instructions.
You are not a God created by human hands.
You are not a God dependent on any mortal man.
You are not a God in need of anything I can give.
By Your plan, that’s just the way it is.
You are God alone.
From before time began, You are on Your throne.
You are God alone.
And right now, in the good times and bad, You are on Your throne.
You are God alone.
Unchangeable, unshakable, unstoppable. That’s what You are.
I know that You’re up there on Your throne. I know that You see and understand from the East to the West, from the North to the South, from the Depths to the Heights, from Millennia past to the Present to the Future. I know that Your understanding is not limited to my finite three-dimensional reality. I know that Tchad in 2012 is but a speck of physical space in just a moment of quantifiable time. I know that You have reasons beyond my reasoning.
But these people are suffering. This is a country and a people forgotten by the world for so long. These are children of Yours that are so ripe for the harvest. All they need are some leaders to show them the way. God, send me kind, honest, hard-working men and women to lead this hospital to You.
I’m tired.
I’m discouraged.
I’m ticked off.
I don’t know how much more I can take.
Sunday, January 22, 2012
#89 The Gunk
That’s a medical term, right?
So “the Gunk” is what I’m labeling Lyol and Zane’s sickness that they are finally getting over.
Last Monday Zane was feeling a little warm. I took his temperature, but he just had a mild temperature. 100.4. Not even a technical fever. That night I made Olen help me poke his finger and did a home malaria test. I’m so thankful Wendy and Gary gave us a bunch of them. Now I don’t have to wait for the lab to open. (It’s only open from 8:30 to noon). He screamed. Lyol watched all of this while taking his bath. Even if he doesn’t say anything, he takes everything in.
Later he likes to tell Tammy and Jamie all of our secrets. He tell them when the cat brings in a half-eaten bat. When mommy screams because it is so gross. When we eat brownies or candy. When we poke Baby Zane’s finger...Really everything.
His malaria test was negative. So I wait. The next day his nose starts to run and he gets the cough that is going around.
Lyol also wakes up with eye gunk. It’s an eye infection that produces nasty yellow discharge. This then makes his eyes stick together.
At this he screams and cries and is miserable. We heat up some water on the stove and put a warm washcloth on his face to soak his eyes. They eventually open. I start him on amoxicillin just because it’s so nasty. Luckily he takes pills pretty well.
Tuesday evening Lyol is really acting clingy. Olen’s in a fancy four-hour-long hospital board meeting, so I’m left with two sick kids at home. Although honestly I’d rather be at home with the sick kids than in the board meeting. They are so painful (the meetings).
Lyol has been feeling hot today. I know it’s the eye gunk thing, but I’m ALWAYS worried about malaria here. We have Lyol on pills for prophylaxis, but it’s always a concern. I give him some Tylenol and Motrin.
An hour later, his temperature is still 102 F. I decide I need to do a malaria test. Lyol has had his finger poked before, so I decided that I need to sneak up on him and just do it or he’ll never sit still to let me do it.
I gather all of my supplies. The alcohol pad, the finger jabber, the little plastic thing to suck some drops of blood in (pipette), the malaria test itself, and the solution to add to the malaria test and blood.
I had let Lyol watch VeggieTales on the computer, so he was comfortably sitting watching it.
I take his finger, wipe it quick, and poked it. He starts to scream. I don’t let go because I need the blood now. I quickly suck up the blood into the pipette so I can do the exam.
He’s continuing to scream and crying, “Mommy poke Lyol!” I try to comfort him as I finish the malaria exam.
Negative. So how well do you trust an exam? The control was well lit up, so I know it worked.
Olen gets home later and we both agree that it’s just the viral eye gunk. We try to think of what else it could be. He has all of his vaccinations, but maybe it’s something else?
At 11pm or so Lyol comes to bed with us. He’s burning up. I hold him in our bed and get scared. I pray. I cry.
Olen, what should we do?
He is really hot, and though it’s most likely the eye gunk, it could still be malaria. So I send Olen up to the hospital at midnight to get some quinine. Olen comes back with the pills and a glass of water and wakes up Lyol. It’s nasty tasting, but he’s a champ and takes the pills.
The whole rest of the night he screamed and cried every thirty minutes, “NO POKE LYOL FINGER!!!” Olen finally held and rocked him to sleep.
The next morning he kept telling Olen that Mommy poked his finger.
We both decided that sneaking up on him was not the way to go. He was afraid we were going to sneak up on him to poke his finger. We have to reassure him that we are not going to sneak up on him again.
It’s now a week later. Lyol finished his probably unnecessary oral quinine and amoxicillin. Zane is better too with no meds, but has a little cough still. He went through the eye gunk thing too.
Both are now finally waking up without their eyes being crusted together.
Lyol is still talking about his finger getting poked.
We are grateful for the daily prayers!
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!!!
Friday, January 20, 2012
# 88 Struggle
I probably already have a blog named struggle since it’s such a fitting name here in Tchad.
But I tell you, the women really struggle here.
January is our busiest month, so the work at the hospital has been very busy. Tuesday we did something like 8 or so operations. Thankfully James came to take out a femoral rod, so I coaxed him into helping with several operations as Samedi (the usual assistant) was sick. We saw some really interesting stuff. Who am I kidding? It’s ALWAYS interesting here. We took out a tumor on the foot and groin that looked just like mud. Really, so weird. I’m sure it’s cancer, but we have no pathology. I talked to the family yesterday and they were just so greatful that we did something. They had been to several other hospitals already.
Last week I did 6 or 7 c-sections and 2 hysterectomies with c-sections. One of them was a ruptured uterus that was very difficult. The baby had died already. She was referred from a health center after they had tried a vacuum. I CANNOT believe we are allowing vacuums to be done at the health centers in this country. I will eventually change this! (probably not, but will put up a stink trying.) The other one was a woman who was “11 months” pregnant. She measured 7 1/2 months, but hadn’t felt the baby move for 2 months. So in reality the baby had been dead for quite some time. I tried for FIVE days to induce her, but just couldn’t get the cervix to dilate. Anna even found me a new stash of misoprostol. Some expired meds had been donated from Baystate and she found the stash while going through stuff in the OR! After miso, foley bulb, laminaria, foley bulb and oxytoxin to induce her, I reluctantly brought her to the OR to remove the dead baby by c-section. It ended in a hysterectomy because the uterus wouldn’t contract and the inside part of her uterus was dead. Her uterus was malformed too and her cervix could have never dilated. So she’ll never have kids. But she’s alive and doing well.
Yesterday I did 4 surgeries. I put on my big girl pants and did an inguinal hernia without Samedi. Abel and I made a good team.
The stories of the women who struggle go on and on. We don’t mean to be depressing in our blogs, but life is hard here! They were going over the statistics for last year and we had reported ZERO maternal mortalities in our hospital. Well, I KNOW that is not correct because I could name at least TEN women who died as a result of pregnancy that I know this past year (turns out there were at least 17). Someone said that they didn’t report it because the women hadn’t actually died during the process of childbirth. We’ll fix our reporting, but I don’t trust ANY statistics that are reported here in Tchad. The numbers are all off. The reporting is all off. And who knows about the neonatal mortality rate. All I know is it’s VERY high.
I was just called in at 3 am for a woman who came with “labor”. The nurses couldn’t find the heartbeat. She also had no prenatal care. I don’t judge people who didn’t have prenatal care. I know what it’s like for someone to label you with “no prenatal care.” (See Zane’s birth story.) Plus the prenatal care here is very minimal. I rarely see a blood pressure recorded if it’s done at the health centers.
I bring the ultrasound machine over to the delivery room and confirm that the baby was dead already.
Her history though is so typical. G4P3001. That’s our OB secret language. Translated it means that she’s had 3 other deliveries and only has ONE living child. Here, I take histories all the time and find that often only half of the children are living. A lot of times the babies die before or with labor.
She is fully dilated, breech, and the presenting part is the placenta. Great, that always means a lot of blood will be lost.
She had been in labor since yesterday and had pushed for who knows how long. I always take the history lightly because no one really knows what is true.
Joe, a student nurse, and I bring her to the OR. I give her fluids and call Simeon in to do a spinal for the hopeful vaginal extraction.
We’ve done this often. He knows the routine. He does the spinal, then I try my hardest to find a foot so I can get the baby out. If I fail, I have to do a c-section. I hate to fail. I especially hate to fail when the baby is dead. I hate to fail when having a c-section means a higher risk for delivery the next time. I hate to fail when so many c-section incisions get infected here.
We wait for some more IV fluid to go in so that her BP doesn’t drop with the spinal. That’s been happening a lot with c-sections lately and I’m having to worry whether my patient will die or not due to anesthesia. Seriously, it’s getting old. It seems to happen half of the time. We do not intubate here. We have no oxygen.
As I wait, our patient is sitting on the OR table. She is young. There is blood running down her leg, adding to the dried blood already there. Her feet are cracked and dusty. She lives a hard life.
I’m tired. I’m sitting on the floor waiting. I should go touch her hand and comfort her.
I force myself to get up to be by her side.
A liter of fluid goes in.
Simeon does the spinal. I put on gloves that are not long enough and start the process.
Even with the spinal I know it is not comfortable for me to manually turn and extract the baby. The patient is strong. She doesn’t say a word.
With time, the baby girl delivers.
Her uterus contracts nicely. Her bleeding stops. She is exhausted and falls asleep.
For the moment, her struggle is over.
Back at maternity I make sure the family knows to look and see if she starts bleeding again. I can’t trust my nurses to look. Well, there is 1 nurse for 30 patients...and there are 2 women in early labor that recently came in.
I head home after 4 in the morning.
I haven’t been sleeping well lately. After you’ve been here for a while sometimes you just start hearing knocks on your door. Usually that means it’s time for a break in sleep. Olen promises to take me to NDJ (the capital) Monday and Tuesday for my birthday, so it will be a much needed break.
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!!!
But I tell you, the women really struggle here.
January is our busiest month, so the work at the hospital has been very busy. Tuesday we did something like 8 or so operations. Thankfully James came to take out a femoral rod, so I coaxed him into helping with several operations as Samedi (the usual assistant) was sick. We saw some really interesting stuff. Who am I kidding? It’s ALWAYS interesting here. We took out a tumor on the foot and groin that looked just like mud. Really, so weird. I’m sure it’s cancer, but we have no pathology. I talked to the family yesterday and they were just so greatful that we did something. They had been to several other hospitals already.
Last week I did 6 or 7 c-sections and 2 hysterectomies with c-sections. One of them was a ruptured uterus that was very difficult. The baby had died already. She was referred from a health center after they had tried a vacuum. I CANNOT believe we are allowing vacuums to be done at the health centers in this country. I will eventually change this! (probably not, but will put up a stink trying.) The other one was a woman who was “11 months” pregnant. She measured 7 1/2 months, but hadn’t felt the baby move for 2 months. So in reality the baby had been dead for quite some time. I tried for FIVE days to induce her, but just couldn’t get the cervix to dilate. Anna even found me a new stash of misoprostol. Some expired meds had been donated from Baystate and she found the stash while going through stuff in the OR! After miso, foley bulb, laminaria, foley bulb and oxytoxin to induce her, I reluctantly brought her to the OR to remove the dead baby by c-section. It ended in a hysterectomy because the uterus wouldn’t contract and the inside part of her uterus was dead. Her uterus was malformed too and her cervix could have never dilated. So she’ll never have kids. But she’s alive and doing well.
Yesterday I did 4 surgeries. I put on my big girl pants and did an inguinal hernia without Samedi. Abel and I made a good team.
The stories of the women who struggle go on and on. We don’t mean to be depressing in our blogs, but life is hard here! They were going over the statistics for last year and we had reported ZERO maternal mortalities in our hospital. Well, I KNOW that is not correct because I could name at least TEN women who died as a result of pregnancy that I know this past year (turns out there were at least 17). Someone said that they didn’t report it because the women hadn’t actually died during the process of childbirth. We’ll fix our reporting, but I don’t trust ANY statistics that are reported here in Tchad. The numbers are all off. The reporting is all off. And who knows about the neonatal mortality rate. All I know is it’s VERY high.
I was just called in at 3 am for a woman who came with “labor”. The nurses couldn’t find the heartbeat. She also had no prenatal care. I don’t judge people who didn’t have prenatal care. I know what it’s like for someone to label you with “no prenatal care.” (See Zane’s birth story.) Plus the prenatal care here is very minimal. I rarely see a blood pressure recorded if it’s done at the health centers.
I bring the ultrasound machine over to the delivery room and confirm that the baby was dead already.
Her history though is so typical. G4P3001. That’s our OB secret language. Translated it means that she’s had 3 other deliveries and only has ONE living child. Here, I take histories all the time and find that often only half of the children are living. A lot of times the babies die before or with labor.
She is fully dilated, breech, and the presenting part is the placenta. Great, that always means a lot of blood will be lost.
She had been in labor since yesterday and had pushed for who knows how long. I always take the history lightly because no one really knows what is true.
Joe, a student nurse, and I bring her to the OR. I give her fluids and call Simeon in to do a spinal for the hopeful vaginal extraction.
We’ve done this often. He knows the routine. He does the spinal, then I try my hardest to find a foot so I can get the baby out. If I fail, I have to do a c-section. I hate to fail. I especially hate to fail when the baby is dead. I hate to fail when having a c-section means a higher risk for delivery the next time. I hate to fail when so many c-section incisions get infected here.
We wait for some more IV fluid to go in so that her BP doesn’t drop with the spinal. That’s been happening a lot with c-sections lately and I’m having to worry whether my patient will die or not due to anesthesia. Seriously, it’s getting old. It seems to happen half of the time. We do not intubate here. We have no oxygen.
As I wait, our patient is sitting on the OR table. She is young. There is blood running down her leg, adding to the dried blood already there. Her feet are cracked and dusty. She lives a hard life.
I’m tired. I’m sitting on the floor waiting. I should go touch her hand and comfort her.
I force myself to get up to be by her side.
A liter of fluid goes in.
Simeon does the spinal. I put on gloves that are not long enough and start the process.
Even with the spinal I know it is not comfortable for me to manually turn and extract the baby. The patient is strong. She doesn’t say a word.
With time, the baby girl delivers.
Her uterus contracts nicely. Her bleeding stops. She is exhausted and falls asleep.
For the moment, her struggle is over.
Back at maternity I make sure the family knows to look and see if she starts bleeding again. I can’t trust my nurses to look. Well, there is 1 nurse for 30 patients...and there are 2 women in early labor that recently came in.
I head home after 4 in the morning.
I haven’t been sleeping well lately. After you’ve been here for a while sometimes you just start hearing knocks on your door. Usually that means it’s time for a break in sleep. Olen promises to take me to NDJ (the capital) Monday and Tuesday for my birthday, so it will be a much needed break.
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
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Monday, January 2, 2012
I Remember
I’m lying in bed, unable to sleep. I still can’t make sense of the last 42 hours.
I remember some of the facts. I remember sounds and images. I remember that it involved singing, prayer, the Bible. I remember hearing lots of Nanjere songs. I remember a steady stream of Tchadians coming to our compound, somber. I remember a lot of hand-shaking. Slow hand-shaking. I remember hands continuing their embraces long after what would normally be socially acceptable in the states. I remember people standing really closely together. I remember people talking quietly. I remember a lot of hugs. I remember a lot of tears. I remember my own tears. I don’t want to.
And then I remember the hole in the ground. I remember the shovel. I remember putting the shovel on the ground, putting my foot on the blade, digging up the dirt and moving it to the side. I remember repeating that process over and over as the hole became deeper and deeper. Deep enough to put something in. A small body.
I remember the grave.
I remember Zeke’s grave.
This is not Zeke’s grave.
I don’t want to keep remembering this.
But I do.
Sleep still won’t come.
I’m exhausted.
I remember the casket. Baby blue. White sheet inside. Empty. But ready for a specific baby. Made especially, custom-made, sized for a certain baby just a few hours earlier.
Coffins shouldn’t be this small.
Graves shouldn’t be this small.
Graves and coffins should be one-size-fits-all. They should be for adults. Babies aren’t supposed to die and be placed in coffins and be placed into a hole and have dirt thrown on top of them by the shovelful. Parents should not bury their children. Children should bury their parents.
I remember the mound of dirt. I remember seeing the flowers on top of that mound of freshly-moved, freshly-displaced dirt. I remember picking the flowers that are now on top of the grave. I remember thinking how the curve of the dirt, the shape of the mound, gives away what’s underneath. I remember wondering what we could possibly plant there which could symbolize the preciousness that lies just beneath the surface.
I don’t want to remember this.
But I do.
I can’t sleep.
And so I write.
To nobody. To everybody. To myself. To God.
I’m remembering more. I can’t forget.
I remember my phone ringing at 6am Sabbath morning, New Year’s Eve. ‘Come,’ was all the voice said. I remember putting on pants and shirt, grabbing a stethoscope and keys. I remember running as fast as I could to the hospital.
I remember James coming to the hospital Friday afternoon. I remember that his kids, his two perfect kids, both had positive malaria tests. I remember thinking to myself, ‘Man, these kids are really cute and happy and playful and giggly and squirmy for being sick. And they just get cuter every time I see them.’
I remember thinking while running to the hospital, ‘Adam or Miriam?’ The only reason James would be calling me in at 6am is if one of them is dying. James is a completely competent doctor himself, having seen far more malaria than I have.
I remember entering the room and seeing James performing CPR on his own six-month-old son, with his hands encircling the chest and his thumbs pumping down on Adam’s sternum. I remember that my first thought was that this father is performing flawless CPR on his own son. I remember seeing Sarah, helping James while also caring for their daughter, Adam’s twin.
We moved Adam to the hard wooden bed from the soft mattress. We gave him glucose. We got an Ambu-bag to breathe for him. We gave him epinephrine.
I remember seeing his agonal breaths. I remember hearing his agonal heartbeats, eerily slow and irregular. I remember his grimaces. I remember his groans as the air seeped out of his lungs. I remember him vomiting. I remember suctioning out his lungs. I remember all this. I don’t want to.
And then I remember, more vividly and more clearly than I should ever be forced to, I remember over the course of the next hour incrementally increasing his doses of epinephrine with no effect, his pupils dilating and becoming unreactive, him losing corneal and gag reflexes and his limbs becoming cooler.
I remember my forearms burning from the mixed exertion of squeezing the Ambu-bag to force air into his lungs and squeezing his chest to push the blood throughout his body. I remember kissing his forehead and being surprised at how cold it was. I remember begging him to cooperate with me and start breathing on his own. I remember seeing how alive and peaceful and comfortable and natural he looked, despite all the evidence to the contrary.
And I remember doing something I hope I never need to do again. I remember saying to my friend, ‘Ok, we’re going to give one more dose of epinephrine, continue CPR for two more minutes and then check for a pulse one last time.’ I remember Sarah, knowing this was the last shot, drawing up and administering the medicine. I remember James, knowing there were only two more minutes, continuing his flawless chest compressions, more an act of love than of medicine. And I remember calling the code of the six-month-old son of one of my best friends. I don’t like remembering this.
I remember putting down the Ambu-bag and wrapping my arms around James as tightly as I could. I remember James, frozen in shock. And then the pain. I remember the pain. I remember seeing the pain in James’ face. I remember hearing the pain in James’ sobs. I remember the pain that only a mother can express, a pain of experiencing the greatest loss a mother can experience.
Yes, I remember that this started the parade of condolences, the silent handshakes doled out by those who know this pain all too well. Those who have experienced it themselves. Those who live in a country where 21% of children don’t live to the age of five. This kicked off the Nanjere hymns. This is why I dug a grave three paces from my front door.
This is why I can’t sleep. I remember. And I don’t want to.
I don’t want to because I have two sons. Why do I have two healthy children and James and Sarah now have just one? Why do I have two healthy children and Gary and Wendy now have just one, having buried their four-year-old Caleb here just two years ago?
Gary and Wendy lost their son. James and Sarah lost their son. Two of the six missionary kids under age 12 are now dead. What will happen to my sons?
When will I ever be able to sleep again?
I’ve hugged my children as often as I could the last two days. But they’re asleep now. I should be able to sleep too. But I can’t. I remember.
But I remember other things too.
I remember another grave.
A tomb.
I remember a tomb that held another Son whose life was cut short.
I remember that there’s another Father who knows what it’s like to lose a Son in a foreign land.
I remember that His tomb was not permanent.
I remember that through His tomb, Death is overcome.
I remember that just as Father and Son have been reunited, father and son will be reunited.
1 Thessalonians 4
For if we believe that Jesus died and rose again, even so God will bring with Him those who sleep in Jesus. For this we say to you by the word of the Lord, that we who are alive and remain until the coming of the Lord will by no means precede those who are asleep. For the Lord Himself will descend from heaven with a shout, with the voice of an archangel, and with the trumpet of God. And the dead in Christ will rise first. Then we who are alive and remain shall be caught up together with them in the clouds to meet the Lord in the air. And thus we shall always be with the Lord. Therefore comfort one another with these words.
2 Corinthians 1
Grace to you and peace from God our Father and the Lord Jesus Christ. Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, who comforts us in all our tribulation, that we may be able to comfort those who are in any trouble, with the comfort with which we ourselves are comforted by God. For as the sufferings of Christ abound in us, so our consolation also abounds through Christ. Now if we are afflicted, it is for your consolation and salvation, which is effective for enduring the same sufferings which we also suffer. Or if we are comforted, it is for your consolation and salvation. And our hope for you is steadfast, because we know that as you are partakers of the sufferings, so also you will partake of the consolation.
1 Corinthians 15
So when this corruptible has put on incorruption, and this mortal has put on immortality, then shall be brought to pass the saying that is written: ‘Death is swallowed up in victory.’
‘O Death, where is your sting? O Hades, where is your victory?’
The sting of death is sin, and the strength of sin is the law. But thanks be to God, who gives us the victory through our Lord Jesus Christ. Therefore, my beloved brethren, be steadfast, immovable, always abounding in the work of the Lord, knowing that your labor is not in vain in the Lord.
Isaiah 25
He will swallow up death forever, And the Lord God will wipe away tears from all faces; the rebuke of His people He will take away from all the earth; for the Lord has spoken. And it will be said in that day: ‘Behold, this is our God; we have waited for Him, and He will save us. This is the Lord; we have waited for Him; we will be glad and rejoice in His salvation.’
Psalm 23
The Lord is my shepherd; I shall not want. He makes me to lie down in green pastures; He leads me beside the still waters. He restores my soul; He leads me in the paths of righteousness for His name’s sake. Yea, though I walk through the valley of the shadow of death, I will fear no evil; for You are with me; Your rod and Your staff, they comfort me. You prepare a table before me in the presence of my enemies; You anoint my head with oil; my cup runs over. Surely goodness and mercy shall follow me all the days of my life, and I will dwell in the house of the Lord forever.
Revelation 21
And God will wipe away every tear from their eyes; there shall be no more death, nor sorrow, nor crying; and there shall be no more pain, for the former things have passed away.
Revelation 22
He who testifies to these things says, ‘Surely I am coming quickly.’ Amen. Even so, come, Lord Jesus! The grace of our Lord Jesus Christ be with you all. Amen.
See you soon, Adam.
It still hurts. I still remember. But now, finally, mercifully, peacefully, I can sleep.
I remember some of the facts. I remember sounds and images. I remember that it involved singing, prayer, the Bible. I remember hearing lots of Nanjere songs. I remember a steady stream of Tchadians coming to our compound, somber. I remember a lot of hand-shaking. Slow hand-shaking. I remember hands continuing their embraces long after what would normally be socially acceptable in the states. I remember people standing really closely together. I remember people talking quietly. I remember a lot of hugs. I remember a lot of tears. I remember my own tears. I don’t want to.
And then I remember the hole in the ground. I remember the shovel. I remember putting the shovel on the ground, putting my foot on the blade, digging up the dirt and moving it to the side. I remember repeating that process over and over as the hole became deeper and deeper. Deep enough to put something in. A small body.
I remember the grave.
I remember Zeke’s grave.
This is not Zeke’s grave.
I don’t want to keep remembering this.
But I do.
Sleep still won’t come.
I’m exhausted.
I remember the casket. Baby blue. White sheet inside. Empty. But ready for a specific baby. Made especially, custom-made, sized for a certain baby just a few hours earlier.
Coffins shouldn’t be this small.
Graves shouldn’t be this small.
Graves and coffins should be one-size-fits-all. They should be for adults. Babies aren’t supposed to die and be placed in coffins and be placed into a hole and have dirt thrown on top of them by the shovelful. Parents should not bury their children. Children should bury their parents.
I remember the mound of dirt. I remember seeing the flowers on top of that mound of freshly-moved, freshly-displaced dirt. I remember picking the flowers that are now on top of the grave. I remember thinking how the curve of the dirt, the shape of the mound, gives away what’s underneath. I remember wondering what we could possibly plant there which could symbolize the preciousness that lies just beneath the surface.
I don’t want to remember this.
But I do.
I can’t sleep.
And so I write.
To nobody. To everybody. To myself. To God.
I’m remembering more. I can’t forget.
I remember my phone ringing at 6am Sabbath morning, New Year’s Eve. ‘Come,’ was all the voice said. I remember putting on pants and shirt, grabbing a stethoscope and keys. I remember running as fast as I could to the hospital.
I remember James coming to the hospital Friday afternoon. I remember that his kids, his two perfect kids, both had positive malaria tests. I remember thinking to myself, ‘Man, these kids are really cute and happy and playful and giggly and squirmy for being sick. And they just get cuter every time I see them.’
I remember thinking while running to the hospital, ‘Adam or Miriam?’ The only reason James would be calling me in at 6am is if one of them is dying. James is a completely competent doctor himself, having seen far more malaria than I have.
I remember entering the room and seeing James performing CPR on his own six-month-old son, with his hands encircling the chest and his thumbs pumping down on Adam’s sternum. I remember that my first thought was that this father is performing flawless CPR on his own son. I remember seeing Sarah, helping James while also caring for their daughter, Adam’s twin.
We moved Adam to the hard wooden bed from the soft mattress. We gave him glucose. We got an Ambu-bag to breathe for him. We gave him epinephrine.
I remember seeing his agonal breaths. I remember hearing his agonal heartbeats, eerily slow and irregular. I remember his grimaces. I remember his groans as the air seeped out of his lungs. I remember him vomiting. I remember suctioning out his lungs. I remember all this. I don’t want to.
And then I remember, more vividly and more clearly than I should ever be forced to, I remember over the course of the next hour incrementally increasing his doses of epinephrine with no effect, his pupils dilating and becoming unreactive, him losing corneal and gag reflexes and his limbs becoming cooler.
I remember my forearms burning from the mixed exertion of squeezing the Ambu-bag to force air into his lungs and squeezing his chest to push the blood throughout his body. I remember kissing his forehead and being surprised at how cold it was. I remember begging him to cooperate with me and start breathing on his own. I remember seeing how alive and peaceful and comfortable and natural he looked, despite all the evidence to the contrary.
And I remember doing something I hope I never need to do again. I remember saying to my friend, ‘Ok, we’re going to give one more dose of epinephrine, continue CPR for two more minutes and then check for a pulse one last time.’ I remember Sarah, knowing this was the last shot, drawing up and administering the medicine. I remember James, knowing there were only two more minutes, continuing his flawless chest compressions, more an act of love than of medicine. And I remember calling the code of the six-month-old son of one of my best friends. I don’t like remembering this.
I remember putting down the Ambu-bag and wrapping my arms around James as tightly as I could. I remember James, frozen in shock. And then the pain. I remember the pain. I remember seeing the pain in James’ face. I remember hearing the pain in James’ sobs. I remember the pain that only a mother can express, a pain of experiencing the greatest loss a mother can experience.
Yes, I remember that this started the parade of condolences, the silent handshakes doled out by those who know this pain all too well. Those who have experienced it themselves. Those who live in a country where 21% of children don’t live to the age of five. This kicked off the Nanjere hymns. This is why I dug a grave three paces from my front door.
This is why I can’t sleep. I remember. And I don’t want to.
I don’t want to because I have two sons. Why do I have two healthy children and James and Sarah now have just one? Why do I have two healthy children and Gary and Wendy now have just one, having buried their four-year-old Caleb here just two years ago?
Gary and Wendy lost their son. James and Sarah lost their son. Two of the six missionary kids under age 12 are now dead. What will happen to my sons?
When will I ever be able to sleep again?
I’ve hugged my children as often as I could the last two days. But they’re asleep now. I should be able to sleep too. But I can’t. I remember.
But I remember other things too.
I remember another grave.
A tomb.
I remember a tomb that held another Son whose life was cut short.
I remember that there’s another Father who knows what it’s like to lose a Son in a foreign land.
I remember that His tomb was not permanent.
I remember that through His tomb, Death is overcome.
I remember that just as Father and Son have been reunited, father and son will be reunited.
1 Thessalonians 4
For if we believe that Jesus died and rose again, even so God will bring with Him those who sleep in Jesus. For this we say to you by the word of the Lord, that we who are alive and remain until the coming of the Lord will by no means precede those who are asleep. For the Lord Himself will descend from heaven with a shout, with the voice of an archangel, and with the trumpet of God. And the dead in Christ will rise first. Then we who are alive and remain shall be caught up together with them in the clouds to meet the Lord in the air. And thus we shall always be with the Lord. Therefore comfort one another with these words.
2 Corinthians 1
Grace to you and peace from God our Father and the Lord Jesus Christ. Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, who comforts us in all our tribulation, that we may be able to comfort those who are in any trouble, with the comfort with which we ourselves are comforted by God. For as the sufferings of Christ abound in us, so our consolation also abounds through Christ. Now if we are afflicted, it is for your consolation and salvation, which is effective for enduring the same sufferings which we also suffer. Or if we are comforted, it is for your consolation and salvation. And our hope for you is steadfast, because we know that as you are partakers of the sufferings, so also you will partake of the consolation.
1 Corinthians 15
So when this corruptible has put on incorruption, and this mortal has put on immortality, then shall be brought to pass the saying that is written: ‘Death is swallowed up in victory.’
‘O Death, where is your sting? O Hades, where is your victory?’
The sting of death is sin, and the strength of sin is the law. But thanks be to God, who gives us the victory through our Lord Jesus Christ. Therefore, my beloved brethren, be steadfast, immovable, always abounding in the work of the Lord, knowing that your labor is not in vain in the Lord.
Isaiah 25
He will swallow up death forever, And the Lord God will wipe away tears from all faces; the rebuke of His people He will take away from all the earth; for the Lord has spoken. And it will be said in that day: ‘Behold, this is our God; we have waited for Him, and He will save us. This is the Lord; we have waited for Him; we will be glad and rejoice in His salvation.’
Psalm 23
The Lord is my shepherd; I shall not want. He makes me to lie down in green pastures; He leads me beside the still waters. He restores my soul; He leads me in the paths of righteousness for His name’s sake. Yea, though I walk through the valley of the shadow of death, I will fear no evil; for You are with me; Your rod and Your staff, they comfort me. You prepare a table before me in the presence of my enemies; You anoint my head with oil; my cup runs over. Surely goodness and mercy shall follow me all the days of my life, and I will dwell in the house of the Lord forever.
Revelation 21
And God will wipe away every tear from their eyes; there shall be no more death, nor sorrow, nor crying; and there shall be no more pain, for the former things have passed away.
Revelation 22
He who testifies to these things says, ‘Surely I am coming quickly.’ Amen. Even so, come, Lord Jesus! The grace of our Lord Jesus Christ be with you all. Amen.
See you soon, Adam.
It still hurts. I still remember. But now, finally, mercifully, peacefully, I can sleep.
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