Wednesday, February 29, 2012

#96 Sodom

And Olen said, Because the cry of Bere Adventist Hospital is great, and because their sin is very grievous; come down now, and see whether they have done altogether according to the cry of it, which is come unto You; and if not, You will know.

But the Lord stood yet before Olen. And the Lord drew near, and said, Wilt thou that I destroy the righteous with the wicked? Peradventure there be fifty righteous within Bere Adventist Hospital: Wilt thou that I destroy and not spare Bere Adventist Hospital for the fifty righteous that are therein? That be far from Me to do after this manner, to slay the righteous with the wicked: and that the righteous should be as the wicked, that be far from Me: Shall not the Judge of all the earth do right?

And Olen said, If You find at Bere Adventist Hospital fifty righteous within the hospital, then You can spare all the hospital for their sakes.

And the Lord answered and said, Behold now, I have taken upon me to speak unto you, a human, dust and ashes, while I am only the Creator and Sustainer of the Universe, the Omniscient, the Omnipotent, the Omnipresent, the Alpha and the Omega, the Beginning and the End: Peradventure there shall lack five of the fifty righteous: wilt thou that I destroy all of Bere Adventist Hospital for lack of five?

And Olen said, If You find forty and five, You can hold off.

And the Lord spake unto Olen yet again, and said, Peradventure there shall be forty found at Bere Adventist Hospital.

And Olen said, Okay, okay. If You can find forty in the hospital, You can leave it alone. But ten bucks says You won’t.

And the Lord said unto Olen, Oh let not the little humanoid get perturbed, but I’m gonna lay down some religious smack on your righteous indignation: Peradventure You figure out what ‘peradventure’ means, and what if there shall be thirty on the hospital grounds?

And Olen said, You’re on. You can even count all the patients and their families. Even the unconscious patients. You can even count my chaplain. You don’t have a chance. You won’t find thirty there.

And the Lord said, Behold now, I have stooped down to barter with the pitiful earthling; What say I can dredge up just twenty?

And Olen said, ‘Dredge’ would be the operative word. I still think You’re out of luck on that one.

And the Lord said, Oh let not my little creation lose his little temper. I’ll make this a bit more obvious for you. Say there are only ten righteous in your hospital. Do you really want Me to destroy the whole place, do you really want Me to give up on them, do you really want Me to turn my back on them, do you really want to just abandon ship, tuck your tail between your legs and run back to America? Do you think you’re too good to serve My children? Do you think they don’t deserve our time, our love, our energy? You’re talking about giving up on them for eternity. You’re talking about souls lost. You’re talking about... Hey, are you listening to Me?

And lo, Olen spake, saying, Yeah, sorry. I just don’t think I can look You in the eye. I’m kind of ashamed of the attitude I’ve had. Can You help me out?

Monday, February 27, 2012

#95 February Updates

Ok, so I caused a bit of a stir when I said that I tested for HIV and it was positive. It was NOT my test. I just ordered it. The test was for the patient in the previous blog. The one with the picture of the leg. If you haven’t seen it, glance at the picture of the leg down a couple blogs and take your best stab at a diagnosis. The real diagnosis will be at the bottom of this blog.

Some people keep abreast of James’ blog and read the story of the depressed skull fracture. Amazingly, the man is walking and talking. He’s not quite all there yet, but he’s currently able to name his wife and do other rudimentary long-term memory exercises.

Other successes lately (I know we usually just write when we’re upset, but we have successes too!)... Friday night we did two emergent OR cases. Danae might write about it, so I won’t steal her thunder. But both of those patients are doing great!

We’ve also had a couple heartbreakers. Today I lost a 14-year-old boy from respiratory failure of unknown cause. He came in last night with an O2 saturation of 76% and extremely labored breathing. He could only relax slightly if he was kneeling with his head between his knees. His lungs here chuck full of fluid. I took him to the office and did an ultrasound, praying for a pericardial or pleural effusion. I would have settled for ascites. Anything to drain! But alas, it wasn’t to be. I ordered a TB test and put him on dexamethasone, gentamicin, ampicillin, quinine and I don’t even remember what all else. This morning he was worse so I even gave Lasix a try. He eventually died. No x-rays, no lab tests, no ventilators... this case was particularly frustrating because I feel he could have lived in America if he could have ridden a vent for a few days. It was touching that the uncle came and asked me to pray for the family, as the father isn’t a Christian. He was in obvious, and expected, pain.

I have an 18-year-old girl who came in Friday. She weighs 37 pounds. She was coughing to beat the band. She’s doing better today, but her HIV test came back positive. Her mom died ten years ago, so I checked her dad. His test came back positive too. Surprisingly, for a girl who’s so obviously not thriving, her WBC were 4000 and 41% lymphocytes. We have no CD4 machine here.

Another tough case is the 15-month-old girl who’s ‘brother’ for the year is a student missionary at the airport. She has never crawled. She’s also failing to thrive, to say the least. She has been treated for malaria and has a negative test, she has clean stool. She’s taken metronidazole, amoxicillin and Bactrim for good measure. She’s received all possible worm medications. She’s just not thriving. She has a WBC of 11,000 and 57% lymphocytes. Hepatitis B negative and HIV negative. I’m wondering if she could have mononucleosis or Epstein-Barr virus. It seems like it’s probably some sort of chronic viral infection. The deck is certainly stacked against her, and it will be no small miracle for her to live.

As for the case with the pictures below. Now’s your last chance to look at the pictures and take your best shot before I tell you the answer... Ok, so in all honesty, I don’t know what it is. I can’t prove it, but I think it’s Kaposi’s sarcoma. A skin cancer common in people with AIDS. Actually, an AIDS-defining illness. I’ve never seen it localized to the leg though, and it’s possible that it’s something else. Scrofula, or ganglionic TB, is almost always in the cervical chain and would at least follow lymph nodes, which this doesn’t seem to.


Friday, February 24, 2012

#94 Blog hint

Blog hint:
I ordered an HIV test. It was positive.

olen and danae

Olen phone: +235 62 16 04 93
Danae phone: +235 62 17 04 80

Olen et Danae Netteburg
Hopital Adventiste de Bere
52 Boite Postale
Kelo, Tchad

Volunteers Welcome!!!

#93 Diagnose this

Sunday, February 12, 2012

#92 Are you my Nana? by Zane Netteburg

Nana and Papa are coming! Nana and Papa are coming, I thought to myself. I couldn’t quite get the words to come out. But, who would expect me to since I’m only 7 months old!

Where is my Nana? I looked for her. I looked up. I did not see her. I looked down. I did not see her. I went to look for her. But I could not walk. I needed Mommy.

Mommy packed the little green backpack with water, a change of clothes, and some expensive throw away diapers for me. She told me we were going to the big city to get Nana and Papa. The big city is where mommy likes to buy all sorts of things. We were just there last week and loaded up.

Daddy promised mommy that if she did some work in the hospital before she left, he would take her to get a good bus in Kelo if she missed the one from here. She likes to help daddy, so she said yes.

Of course we missed the bus from Bere, and someone else needed to use the car. So we decided to Klondo it to Kelo. I’ve always wanted to be in a motorcycle gang...ever since that social worker from New Jersey (when I was born) wrote us up for being from Africa and not getting “proper prenatal care.” Boy if she could see me now. I don’t even own a carseat here!

So a Klondo is really just a motorcycle, but it sounds way cooler. Maybe Nana would be driving the Klondo?

I did not remember what my Nana looked like.

Are you my Nana?

The man on the Klondo just looked and looked. He did not say a thing. Nana was not on the Klondo. The man on the Klondo was not my Nana, so I went on.

Mommy wrapped me on really tight against her chest and hopped on the back of a moto. That was around 10am. Klondo driver, mommy, and me.

The road was really sandy. I could feel mommy’s teeth gritting from the tension. Bump after bump we went over. Up and down, up and down. Oh, I guess I fell asleep. Wait! Did I miss Nana? Nope, up and down some more....Up and down, oh, deep sand. Then our moto went 90 degrees in the road and stopped as the driver put his foot down to help us not fall over. Oh, this was exciting! Oh, I guess I fell asleep again.

And hour later we got to Kelo and found a nice bus! And now a paved road. Oh how very exciting. Would we find Nana on the bus? We got on the bus and sat next to a young looking fellow. He had a cool tool box made from a big plastic jug. The side was cut out and a lid fashioned out of the flap. Inside was all kinds of cool tools.

Are you my Nana with all of those cool tools?

“No,” said the man. That was just the "bus repair man" that we would use way too often on this trip. Mommy was so excited about the fancy leg room that she didn’t notice the well used toolbox, the rotting tires, or the pool of oil that was probably as big as a lake under the bus.

The Klondo man was not my Nana. The bus repair man was not my Nana. So I went on.

And we were off! I decided to scream to get everyone on the bus to notice me. As if we didn’t stand out enough already. Boy did my mommy get some looks! This made me scream all the more. It was so hot I couldn’t help it.

“Give him water.” “Give him milk.” “Give him to me.” “Control your child...” And many more helpful words of advice were offered to mommy to help me calm down.

I had to find my Nana! But where? Where was she? Where could she be?

Eventually I nodded off for 5 minutes. The fancy bus started to slow down. Then stopped. Where were we? We weren’t in Bongor yet (the halfway point). We were 10 km’s away. What was going on? Was Nana here on the side of the road?

We all unloaded off the bus. A tall Arabic man in a light green robe with a white turban on his head was talking to our mechanic.

“Are you my Nana?” I thought to myself trying to send him a telepathic message.

“I am not your Nana. I am the driver,” said the man.

He was observing the situation. The situation was that we RAN OUT of GAS!

We waited and waited for more gasoline to arrive on a klondo from Bongor.

The Klondo man was not my Nana. The bus repair man was not my Nana. The driver was not my Nana. So I went on. Then we were off again to find Nana and Papa.

In Bongor there were lots of pretty women with trays of bananas, carrots, and soap on their heads. Surely one of them was Nana.

Are you my Nana?, I tried to say to a young girl with bananas.

“How could I be your Nana?” said the young girl with bananas. “I am a young girl with bananas.”

The Klondo man and the bus repair man were not my Nana. The driver and the young girl were not my Nana. Did I have a Nana?

“I did have a Nana,” I said. “I know I did. I have to find her. I will. I WILL!”

Back on the bus, we settled back into the screaming thing. I tried to scrub my eyes harder to keep myself from falling asleep. Each giant pothole we hit helped me stay awake longer. But then it happened. I fell asleep again.

Then a loud Thwub, Thwub, Thwub woke me up. The bus jolted, slowed, and pulled over to the side of the road again.

We got off and had a look under the bus. Could that old thing be my Nana?

No! It could not! That was a blown tire!

Mechanic to the rescue. Meanwhile we found shade from the trees that grew up by the side of the road.

We were soon on the bumpety road again. I wondered what Nana would look like.
Would she remember me from this last summer? A baby can change in 5 months you know.

It soon grew dark.

Again, our bus stopped to look for Nana. Oh wait, I thought that’s why it stopped. I don’t know why it stopped. Neither does mommy, but we were stopped for several hours with the mechanic guy hanging out under the bus. Maybe he was looking for Nana too, but we didn’t find her under the bus. No, Nana was not under the bus. Nana would be in the big city. And we were NOT!

Mommy entertained kids by the side of the road by teaching gymnastics in the dark. One kid had already learned to do a back handspring by teaching himself. There was some real talent in the village of Lumier.

We finally pulled into NDJ at 10pm. TWELVE hours after we left Bere. This trip usually takes 6 hours!

Off to the airport in a taxi! Mommy considered a Klondo, but the roads in capaital (NDJ) are far too dangerous.

The arrivals of airplanes are interesting here. You see, you never really know what time they will arrive. Nothing is computerized, so you just ask around. The flight was scheduled to land at 7pm, but on Sundays it takes another stop, so actually gets in much later. So we were in luck. We weren’t late!

After another 2 hour wait at the airport, I heard a loud roar! Maybe that was Nana? Something really big came roaring from out of the sky. It pulled up to our building.

Are you my Nana? I called to the airplane. I giggled even though it was the middle of the night. The temperature was finally cooling off, so I was much happier than on that hot bus.

No, that was not my Nana. That was an airplane.

Mommy talked to the security guard just outside the arrival hallway. He was nice enough and let us go into the baggage claim area.

Soon lots of people were flooding the area. Two very white people came over and hugged Mommy.

“Well hi Zane!”, one of them said and gave me a kiss. “Do you know who I am?” she said to me. “Yes, I know who you are,” I said. “You are not a Klondo man. You are not a bus repair man. You are not a driver. You are not a young girl with bananas. You are not a blown tire or an airplane.”

“You are a Nana, and you are my Nana.”

PS. The next day we took the bus ride back with Nana and Papa. It was uneventful and only took us 6 hours. We were so happy to be back home!