Monday, May 28, 2012

May Madness

We are a missionary band.....

Okay, so it’s usually March Madness.  But hey, March was crazy too, so... we’ll throw May in as well.

So the month of May.

April showers bring May flowers, right?  Well, not exactly... Though the dry month of April here did start to bring May showers.

The month of May also brought more fevers for Zane.  And I think everyone is tired of hearing about Zane’s fevers.  We are too.

Zane has now finished a 2 week course of Metronidazole for Giardia.  The last several days he was fever free, playing, eating, and doing very well.

Then he had a fever of 102.4.  Madness!  This is Crazy.

Can you ask your friends for too many prayers?  When a good chunk of them think you are doing the wrong thing by being here?

The best possible explanation for this is relapsed typhoid fever.  He had a negative malaria test, a negative stool test and a negative typhoid test.  The typhoid test, like the malaria test, is far from perfect.

Zane now has another IV on his head.  It’s quite amazing really that the same IV had lasted for 4 days already.  I thought we’d be happy if it lasted for 3, but we are thankful for less times that we have to poke him.  Today he just got another IV.  Since we haven’t taken out the first one, he has an IV sticking out of both temples.  He looks... odd.  We are giving him IV ceftriaxone, an IV antibiotic that has a once a day dosing for typhoid fever.  The plan is to continue it for 10 days.

So far Zane seems to be responding very well.  We haven’t noticed a fever for the past 2 days.  He’s eating better and playing much better now too.

Please continue to provide prayer cover for this prolonged and tiring sickness.

Thursday, May 24, 2012

Not This One

“Not this one,” I said to myself.    

“Please God, not this one.  There are enough women who die in Chad,” I prayed a silent prayer to our all-powerful God as I watched a pregnant woman have her second seizure in the past 5 minutes.  

Eclamptic patient in crowded maternity ward
Photo by Adam Hernandez

Seriously, are we having a special on eclampsia this week?  Eclampsia is a condition in pregnancy with high blood pressure and seizures.  This is the third eclamptic patient in one week here at our 70 bed hospital.  Often, the mother will become comatose and develop pulmonary edema.  There is a high risk of death.  The cure for eclampsia is to deliver the baby. 

I tried to get some of the patient history as I helped hold down the actively seizing patient.  Two family members accompanied the patient.  It was her first baby.  While listening, I thought to myself that the history didn’t really matter.  I knew what I had to do.  Deliver the baby.  

That’s what I do.  

I deliver babies.  That’s my job, easy right?  

In the States, it goes like this... Oh... you’re here to have a baby... boy or girl?... Oh, so happy, happy ending for both mom and baby.  No, not always, but more often than here.

Here it goes like this... you have been in labor for HOW many days?  Who was helping you at the health center and didn’t refer you earlier?  The baby died, but we are just happy that the mother is living.  

So it’s not always easy to deliver babies.  But by God’s grace, we do our best.  

I do an exam.  Yay, she’s fully dilated.  But it’s her first baby... and she’s mostly comatose after that seizure.  Most women push for two hours on their first baby.  Fully conscious.  Do I dare wait the two hours with an eclamptic patient?

The head is not as low as I would like it, but a cesarean section is not ideal in subsaharan Africa for many reasons.  

I decide to do a vaginal operative delivery.   

We give 2 large injections in the buttocks of magnesium to prevent more seizures.  I give Simeon a call on the phone to come to the operating room in case I need a spinal for a c-section.  

Once in the bloc (operating room), we say a prayer before beginning.  This time out loud.  We think about a spinal for pain control, but she is pretty comatose.  I have Simeon, and 2 other nurses help hold her legs back.  

I splash some iodine on her and apply one forceps, then the other.  There isn’t much room, so I give some local anesthesia and cut an episiotomy.  Forceps look like giant salad tongs.  They surround the head of the infant so you can pull him or her out.  It sounds barbaric, but you’d be surprised what a baby will do to be born and get out into the world.  

I pull.  Nothing.  

“Please God,” I pray again, “not this one.” 

This one is stubborn.  I palpate her abdomen so I can feel for a contraction.  At least the contraction can help me even if she isn’t pushing.  

I wait a minute.  Even though she’s mostly out of it, she shifts around on the bed when the contraction builds.  The 2 nurses hold her in place.  

We have got to get the baby out! I think to myself.  

I firmly grasp the handles of the forceps and pull down and out.  I need to start working out, I think to myself.  

I put my foot up on the bed to get more force,  “Not this one.”  This is the world’s worst game of tug of war.  

Then, it comes.  I feel the forceps give a bit and out comes the baby’s head.  It’s a little wriggly with some tone.  That is good.  I remove the forceps blades and pull out the rest of the baby boy.  

He cries.  Praise God.  

Now for the mom.  After delivering the placenta, I sew up my huge episiotomy site that had ripped up further into the vagina.  

We take her back to our maternity ward and I trip over patients sleeping on the floor while trying to carry her, unconscious, to the corner bed.  All eight patients, along with several family members each, stand up to gawk at the newcomer.  After discussing at length the diagnosis and treatment, I negotiate my way through the maze of thirty people crammed into our 10 x 20 foot maternity room, stopping to make sure each baby was breastfeeding well on my way out.

Eclamptic mom and her baby
Photo by Adam Hernandez
The next day, her seizures continue.  I make sure that the family understand the gravity of the situation and reinforce to them the power of prayer.

Two days later, I walk in to a smile I had never seen before.  My patient is sitting up, eating and jabbering to me (in a local dialect I can’t understand), the doctor she has never seen before.

Here in Tchad, named worst country in the world for women, due to a maternal mortality rate through the roof, women face a one-in-eleven lifetime risk of dying from complications of pregnancy and childbirth.  But not this one!

Tuesday, May 15, 2012

It was just the heat

“Comment vont les enfants?” (How are the kids?)

“Zane a une fievre encore. (Zane has a fever again),” I say.

“This will pass, it’s just the heat,” a chadian comforts me.

It’s been in the 100’s and down to the 90’s during the night.  Zane’s room is quite hot too.

I want to explain all about infections, disease processes, and how yes, Zane does sweat... it’s not just the heat.  But I just smile and say thank you.  


Last wednesday I got a stool test for Zane.

Giardia lamblia.

What?  Giardia?  Amoebas?  That’s what the villagers get.  That’s what stupid Appalachian Trail hikers who don’t purify their drinking water that they get out of the stream while admiring the ‘nature’ that is a deer taking a dump in the same stream upriver get.  That’s not what we get.  Our water is clean.

I studied in med school.  No really.  I remember it distinctly.  It was a Tuesday in 2003.  That wasn’t on the tests.  People don’t get fevers with giardia.

I search our books.  “17% of people with giardia get fevers.”

It still could be something else WITH giardia.  But for now we treat the giardia.

He’s been on metronidazole for 4 days now.  Today is the first day he’s been without a fever in 13 days.

Zane’s playing, eating well again, and laughing at his older brother playing.

Of course it’s cooled off too.  The rains started a couple days ago.  We slept with a top sheet.  Today it was down to 73 in our house.  It was drizzling outside all morning.  It feels cold to take a shower again.  Zane’s fevers are gone (at least for a day).

It was just the heat.  (Husband’s editorial note: This last sentence was delightfully tongue-in-cheek. It wasn’t just the heat.)

PS. Zane is now 2 days without a fever as this is a day late getting sent.  Thanks for continued prayers.

Checking out the swimming pool with Daddy and brother Lyol
Swimming with Brya's son, Benjamin

Monday, May 7, 2012


As you may be visiting this blog for the first time, I’ll take a moment to bring you up to speed as to who we are, what we’re doing and where we’re going.

We are the Netteburgs. Danae (gynecologist and mother), Olen (ER doc and father), Lyol (three-year-old) and Zane (ten-month-old). We are American Seventh-day Adventist missionaries to Tchad (or Chad, if you prefer), Africa. We all take turns writing blogs (even Zane) and Olen happens to be writing this one.

Danae spent a year in Zambia. I spent a year in Korea/Africa. We decided that we wanted to be missionary physicians to Africa before we ever met. I fell in love with Danae before I ever knew she wanted to be a missionary physician to Africa. Danae fell in love with me... sometime after that. But fall in love with me she did.

We arrived in Tchad December 12, 2010, a date that is now part of the very definition of our family.

So why do we write?

I wish I could give some noble reason, like... We write to inspire, or We write to give spiritual lessons, or We write to raise awareness of the plight of the Africans, or We write to create the next generation of missionaries, or We write to... well, pretty much any reason would be more impressive than the real one, but...

We write because there’s no psychologist in Tchad. Writing blogs is cheaper than flying back to the states or talking it over with a shrink on the phone. It’s also cheaper than taking medicines, so we write blogs.

If you talk to a shrink and you’re not honest, you’re just throwing your money (or your insurance’s money) out the window. So we are honest in our blogs. Always and completely honest. Which means our blogs aren’t always uplifting. Not all of our blogs leave you feeling good about the state of the world. In fact, I dare venture that few of them will. The simple truth is that when we’re most in need of writing, it’s because we’re ticked off at the state of affairs here. When do you most need to talk to your shrink? When you’re in a bad place, mentally or emotionally or spiritually. (If you find yourself telling your psychiatrist how very happy you have been, you either don’t need him anymore, or you are being forced to see him, likely by state-ordered legal decree, and you’re not really all there just yet.) Thus, our blog has a similar bent.

So you, in effect, have become our psychologists, psychiatrists, mental health professionals. Thank you. But be warned. Don’t read on unless you’re ready to take on that responsibility and are prepared to share this burden with us. Because we will take no shame nor hesitation in thrusting it at you.

Our complete honesty has drawn us a hefty amount of criticism. Don’t feel free to continue this. There are those who feel it’s our responsibility to be more cheerful and uplifting and God-glorifying. There are those who feel that we should withhold some honesty for legal defense purposes. There are those who feel that... well, anyway, there are people who don’t like our blog and don’t want us to continue it in it’s current form, but it is what it is and it will follow our family’s spiritual thermometer as it climbs and falls in season.

We will share with you our successes (really God’s successes), our failures, our feelings of abandonment and our feelings of inadequacy. If you have been in the mission field before, it will sound familiar. If you have thought about the mission field, it will bring those thoughts home and make you second-guess them. If you’ve never thought about the mission field, it will force you to.

But the honest truth is that we’re not the world’s most talented writers. And even the best writers out there, the best orators in the annals of history, the best actors of screen and stage, the best playwrights not named Shakespeare, could not make you understand what Tchad is. You have to live it. Whatever you think it is, it is worse.

And that is why we chose to come. Nobody sent us here. Nobody ever even gave us the option of coming here. We ended up visiting this place in 2009 because our visas for Cameroon were nonexistent and it seemed like more fun than staying in the capital for a week. We saw the need and saw that we could help. So we asked the church for permission to come to Bere, Tchad.

We work in a place where the only person who speaks my language is my spouse. And where very few of our patients speak French, the language we learned before we came. We work where virtually none of the tests we’re used to ordering in the states are available, where very few supplies are available and where most of the medications we prescribe from day-to-day are medicines that we never gave in the states.

We come home to a house that is 103 degrees at the coolest point of it’s 1000 square feet, where our children don’t understand what it’s like to be normal because all the other children just stare at them all day long. And the adults.

We live in a district where we are the only physicians for 200,000 people and there are no paved roads, no public water or sewer, where there is no electrical grid and no cyber cafe.

And we’ve become accustomed to death. Two other Adventist missionary families have lost their sons to malaria in Bere, Tchad in the last three years. Another lost a 20-plus-week pregnancy. We’ve learned that babies, toddlers, children, adolescents, adults and the elderly die, and we’ve had the opportunity to hold them all as they breathe their last. And we’ve become attached to many of them. Perhaps you’ve read the story of Emmanuel. Perhaps you’ll read the story of Zeke, a little boy who lived in our house for a short 19 days. They each represent a fresh wound in our mind and on our heart and that scab is torn away and starts healing every other day, which is how often a child dies in our hospital.

And we like our jobs. No, we love our jobs. We love these patients, our patients. They are our friends and our neighbors. It’s hard to understand and impossible to explain. It’s the most frustrating thing in the world and the most rewarding thing in the world. While we beg and plead for your prayers, we don’t want your pity. We don’t even deserve your pity. We’re doing what we love to do, what we were called to do, what we were created to do. We know that we are doing exactly what God wants to do, where He wants us to do it and when He wants us to do it. How many people can look you in the eye and say that? We are blessed beyond measure.

We agreed to come to Tchad for six years, although we’ve always said that we’d stay until God took us elsewhere. We were prepared to stay longer. Dr Hart, a man I deeply admire and respect, once said to me, ‘Who knows? Maybe you’ll be one of the career missionaries.’ I want to be that.

We came here thinking long term. We’ve had plans drawn up for new buildings and expansion. We’ve built walls. We’ve built buildings. We’ve raised money. We’ve invested thousands of dollars of our own money. We’re now ready to build a private ward, an OR/delivery room/lab buildings and a house for the physician we recruited to come (my father-in-law, not exactly selling snow to an Eskimo). We’ve drafted plans for a nursing school and recruited a nurse to come start the school. We’ve helped bring in a volunteer to create a radio station. We’ve started a $10,000 public health initiative. We have plans to build health centers. We have plans to build housing for more staff. We have plans to build entirely new patient wards.

We’ve had a lot of plans. They all seemed like God’s plans. This all seemed like God’s leading. This all seemed like God’s guidance.

And we seemed immune. Our family seemed insulated. We seemed healthy. I’ve had malaria several times. I’ve passed out from it and come to with IVs in my arms and crowds hovering over me. Danae’s had malaria. Lyol’s had it. But we didn’t care. We got better.

We had our dream jobs, our dream family, our dream life.

And then Zane got sick. And didn’t get better. After a fever for over a month, refractory to more medications than I care to delineate for the millionth time, Zane and his mother went home. Home home. To the states. Where he magically got better. Without intervention. For a month. Then he returned home. Home home. To Bere. And six days later, he got a fever again. And now he’s had a fever for a week.

And now we’re tired.

We’re tired of Zane being sick. We’re tired of worrying about him. We’re tired of being up at night with him. We’re tired of the hospital nurses banging on our door all night, every night. We’re tired of people coming to our house all the time. We’re tired of neighbors stealing our mangoes. We’re tired of people saying, ‘You’re white. You should give me money.’ We’re tired of people lying to us. We’re tired of people trying to take advantage of us. We’re tired of nurses not following orders. We’re tired of nurses lying on the nursing forms. We’re tired of essential, life-saving equipment disappearing from the hospital. We’re tired of local church politics. We’re tired of national church politics. We’re tired of union church politics. We’re tired of division church politics. We’re tired of general conference church politics. We’re tired of our local district medical officers. We’re tired of the heat. We’re tired of the dust. We’re tired of the dirt. We’re tired of sweating.

All this has been here all the time, and we’ve been enjoying the challenges, until Zane got sick. Now everything is turned on its head. We did all the right things. We tried all the right treatments. We took him to the states and got all the right tests. They were all negative. And now he’s sick again. Will it ever end? Are there any options? Is there anything we haven’t tried or done yet?

Yes. We haven’t left. Yet. We haven’t yet tried leaving. Permanently. Yet. We haven’t yet moved to a place where he’ll always be healthy. Yet.

We have many friends and relatives who have gone to the mission field for six or nine months. One year. Two years. Three years. We laughed at them. You can’t make a difference in that short of time. Yup, we were going to be long-termers. Six years was just going to be a start. We would be the people truly accepted into the tribe we served. We would be the missionaries that changed the world. We’d be the missionaries they wrote books about.

I know we’re not the first missionaries to have a sick kid. In fact, most missionaries have stories about their kids being deathly ill. I know, because I’ve heard all these stories in the last two months. I know there are hoards of missionaries who have lost their children. But that’s different. That’s not my kid. Zane is my kid. This is my son you’re talking about. Not just somebody else’s kid. My kid. My son. My sick, beautiful son. My fragile ten-month-old son. My son I can do something about. My son I can cure by simply taking him away from here. This is my son.

The good missionaries say things like, but even if I lose a child, think of all the other lives we’re saving and all the other souls we’re winning. You’re right. And I know you mean it. And that’s great. I wish I could say the same. But I can’t. This is my son.

I am not God. I did not send my son into the world to die to save many. No, He did that with His Son. Voluntarily. I don’t recall ever volunteering my son to die. No. I don’t care how many people could be helped along the way. I’m selfish. This is my son.

We always thought we’d have more kids. But we don’t think we will now. Do we really want to go through this each time? Or should we do like the Tchadians and have lots of kids and just plan on several of them dying?

God and I had a deal. He keeps my family healthy. I’m a missionary to Tchad. I’m still holding up my end of the bargain.

So what does God want from me now? Does He want me to stick it out? Is He going to end up taking away my son? Does He want me to go home and take care of my family? Try it again later in a few years when my kids are older and less fragile? Try it again in a different place that’s not as hard as Tchad?

Do we leave the place we just recruited my in-laws to? Do we leave the place we’ve invested so much of our time, energy, talents, money, tears, blood and sweat into, the place we moved all our earthly belongings to? Do we accept that we just couldn’t hack more than a year and a half in this place?

I don’t know.

But what will I do if something happens to my son while I’m playing the world-saving missionary? What will I say to all the second-guessers who ask why I came? Why I didn’t leave? What will I say to my wife? What will I say to Lyol when he’s old enough to ask why I didn’t love his brother enough to take him away from the riskiest place in the world? What do I say to Lyol when he asks if I would have taken the same risks with him? When he realizes that I did take the same risks with him?

But we’re still here. For now. We haven’t left. Yet. As for tomorrow, I don’t know. God still wants us here, so it’s the safest place in the world for us to be. But the moment He says, ‘Go,’ I’m out. I’m not the missionary-hero. If that’s what you’re looking for, you’ve come to the wrong blog. And that’s the honest truth.


I haven’t even been back 2 weeks and all I feel like doing is complaining.  It’s never been so hard for me before.  But there are so many if’s now.  

If Zane’s fevers would stay away.  This is the root of my worries.  So it’s no wonder we are being attacked in this area.  I could be sick and not worry so much, but when your children are sick, it’s a different story.  You try to do the right thing.  I honestly think he’s fighting a virus from our trip out here, but still, you worry.  Part of me wants to pack up.

If special people would quit offering non-helpful advice.  You still get annoyed when people that you DON’T EVEN KNOW write to you and tell you maybe “it’s time to move somewhere else.”  There is a special place for those kinds of people.  And I don’t particularly care to hear from that person ever again.  It makes me want to password lock our blog. 

If it were not so DIRTY here!  Everywhere is dirty.  There is no escape!  In our house, the cleanest of places around here, it’s still dirty.  (Well, Wendy’s house has way cleaner floors!)  I came back home last Friday night.  Our house was clean ‘for here.’  You could tell that Zachee had cleaned the windows and floors.  He even cleaned the windows in our bedroom.  Still, there was dust.  I had gotten too used to the clean-ness at my mother-in-law’s house in Maryland.  It’s sooo dirty here!  Don’t even get me started talking about the hospital!

If it were not so hot!  It is stinkin’ hot right now.  I’ve even missed 3 weeks of the hottest time of the year here.  But it’s still stinkin’ hot!  It makes you lazy and unproductive!  

If it would just rain!  Apparently it’s already rained 3 times this year.  But it’s still so hot!  It’s threatened to rain three times this week already.  Last night I REALLY thought it would pour.  There was even beautiful lightening and dark clouds, but it just got all windy and spit several drops.  The wind is beautiful and somewhat of a relief I must say though. 

If I didn’t get this severe diarrhea!  Yesterday I was struck with cholera-like diarrhea.  I probably went 30 or so times.  Then, just as I thought I was getting better, I vomited severely.  Olen was sick last week with some fatigue sickness.  Everything was quite vague, but he looked awful.  

If my garden would grow.  It’s just so hot and dry here.  I pay Bria 2 dollars a day 5 days a week to water and make the garden grow.  But it still looks pretty desolate.  I don’t think it’s her fault. 

If the neonates would stop dying here!  I still have the picture from Sunday night of two perfectly-healthy-looking but dead baby boys lying on the table next to each other.  The first was there when I arrived just as it delivered; the second was a shoulder dystocia that had been stuck for over 5 minutes.  It may have been dead before I arrived, and it took me only a minute to deliver him.  Try as I might, CPR would not revive him.  Those two beautiful boys are forever etched in my mind.  Is what I’m doing even making a difference?  It seems like they just KEEP dying!

If we could teach to prepare for emergencies.  Another night this past week, I couldn’t find any DeLees (suction devices for neonates) to suction out the newborn’s lungs that were filled with meconium (poop stained amniotic fluid).  The ambu-bag that was there was broken.  The newborn wasn’t breathing well.  So I wiped the mouth off with alcohol and did resuscitative breathing.  Praise God she’s still living and went home after 3 days of IV antibiotics for her fever.  It seems sometimes like NOTHING has changed in the year and a half we’ve been here!  I had this problem when I first got here (no materials to use for emergencies) and it STILL exists!  

If the poor were not so poor.  Well, it’s really poor here.  Louise, the lady that does my laundry actually does quite well for here.  But she’s still very poor.  She makes 25 dollars a month.  Her husband is blind, and can’t work.  Louise and her large family have ONE mud hut, and a second one being built right now.  




I could go on and on.

If...then, maybe I could have some peace of mind.

So this blog is getting quite negative.  

I pause.  

I walk outside to my garden.  Yes, my dry and quite desolate garden.  My wonderful dad has watered the small watermelon patch, the 4 surviving grape vines, the squash plants that aren’t producing, the Oze’ (kind of like spinach), the 2 foot tall avocado tree with all of the leaves eaten off, and the 4 new trees that my sister gave me.   I take a closer look to see what’s still growing.  

I’m holding Zane who currently doesn’t have a fever.  I’m looking at 4 small mango trees that my mom has grown from seed.  They are now 6 inches tall.  I’m about to leave when I notice something else.  

It’s a pineapple plant!  

I planted 3 small pineapple tops several months ago and thought they’d all died.  They continued to get water because they were next to the mangos and watermelons.  There is a new bright green shoot coming out of one of them!  

If any of you are gardeners, you know of the joy you get when things grow that are not supposed to.  

I’m reminded of the Pineapple Story, the missionary who grew pineapples.  He finally gave all of his problems to God.  Yes, missionaries have problems too.  They don’t even deal with them the right way most of the time, but God is still forgiving and takes us back time after time again.  

I’ve never before grown a pineapple plant, but maybe God wants me to give it to Him and watch Him take control of that...and everything else in my life as well.   

Thursday, May 3, 2012


I was rounding on surgery one day shortly after arriving in Tchad. During rounds, I sent a post-op hernia patient home. He asked me what his diet should and shouldn't include when he went home. Then he asked specifically, 'Can I eat some poop?' I asked him, 'Why would you want to eat poop?' 'Because it tastes good. Just a little bit to flavor food.' 'Do you use your own poop or where do you get it?' 'Well, we usually get it in the market.' I was completely baffled. They hadn't covered this in Institute of World Missions. I asked him to describe what exactly this poop looked like. 'Well, it's a white powder, naturally.' I finally realized that he had asked, 'Est-ce que je peux manger du sel.' I had heard, 'Est-ce que je peux manger des selles.' 'Sel' and 'selles' are pronounced the same. The only difference was 'des' (pronounced like 'day') and 'du' (pronounced like 'do'), both of which mean 'some'. 'Sel' is salt and 'selles' is poop, always in plural. Another time, I greeted one of our local government medical officers and asked him, 'How was it in the countryside?' He looked at me very strangely and asked what I was referring to. I explained, 'Well, I've heard that you really love the countryside.' Now he was shifting from defensive to frankly offended. 'Who told you that?' 'Everybody you work with. I thought it was well known. You mean you don't like the countryside? All the small villages out there in the countryside. Don't you find it relaxing and peaceful and tranquil out there?' He threw his head back and started laughing. It didn't really seem funny to me, but at least he wasn't aggressive anymore. So I laughed along. Then he explained to me the difference between the words 'bourse' and 'brousse'. I had actually asked him how it was in the scrotum.

love 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 Afrique
 Volunteers Welcome!!! 

Tuesday, May 1, 2012

Zane with fever again

Zane and Danae returned to Tchad Tuesday. Zane now has a fever of 102. Autonomic dysregulation? Prayers, as always, are coveted and appreciated.

love olen and danae