Monday, May 27, 2013


A lot has happened in the last month since we’ve last written.  

For one thing, there are hardly any volunteers still here.  Everyone’s on vacation.  Melody and Jonathan left with threatened preterm labor.  Tammy and Jamie left in April.  My dad and mom left the end of April.  The 3 student missionaries left a couple weeks ago.  Athens just left last week.  

So we are down to the Roberts, Bronwyn, and us.  

With few people brings more responsibility.  For me that has come in the form of expanding my comfort zones in the operating room.  

Now, I don’t claim to be a general surgeon.  I don’t even like inguinal hernias or hydroceles.  I went into OB so that I wouldn’t have to deal with men.  (not really, actually I just liked it.)  

But the last week of April came, my dad left, and Samedi was on vacation still.  Samedi is one of our nurses that learned how to do surgery over the years.  He is quite capable  and has a lot of experience.  I put on my man pants and decided that I could handle it one week without him.  Just as long as the hernias held off a week….

Well, wouldn’t you know it but I had several inguinal hernias.  My first was actually a repeat hernia.  Ugghh, I thought.  If someone else failed doing it, why would I succeed?  But, I do believe it actually went quite well.  The next hernia was a HUGE one.  So I thought after my first 2 difficult ones, all of the rest would be easy.  

Then the next morning I had another one.  He had been strangulated the day before, but someone had reduced it.  I cut through the fascia, dissected out the cord with the hernia sac, and cut into the sac.  I thought I had better look at his intestines since he had been strangulated (the intestines were stuck in the hernia for a while).  I stuck my fingers through the small opening where the sac came from to reach for his intestines.  I pulled out some intestines, and they looked normal.  Then I pulled out some more.  
Who knew I could be so happy
about a dead intestine -
outside the body!

Uh-oh.  There was about a foot of small intestines that was quite clearly dead.  How do you know when an intestine dies?  Well, it turns purple and black.  The blood supply had been cut off for long enough that the tissue died.  

The rest of his intestines looked fine.  So….this was my UNcomfortable time!  I started to sweat a little more.  (had already been sweating.)  Was I nauseated?  Oh, wait...there’s no one else!  Not nauseated.  Not sick.  Not a general surgeon!

I’ve got to take out his dead bowel.  I say more silent prayers and try to remember exactly how I’m going to put his bowel back together.  I’ve done it a couple of times with my dad.  And with Samedi, but not for a long time.  We had actually just done a small bowel to colon reanastamosis a few weeks before with my dad, but I had gotten nauseated during it and had to scrub out.  I really don’t like poop in the abdomen…..and I can always blame it on the pregnancy.

I have someone call Olen to bring a general surgery book so I can review just in case I can’t remember what to do.  

As he’s coming, I decide that I’m going to do an end to end re-anastamosis after I cut out his dead bowel.  Olen reads me the gist of things from the surgery book.  It’s a little helpful in that it reassures me that we’re doing the right thing.  (oh, and ya….we don’t have those fancy staple guns here that they have in the states).

We only have 2 bowel clamps in the laparotomy kit so I clamp off dead bowel, clamp and tie it off from the mesentery, and then get it off of the field.  It was starting to stink.  If you leave dead bowel in someone for too long, they will get septic (body wide infection) and die.  

I start the tedious job of reconnecting the 2 parts of good bowel together.  I move the bowel clamps back a little so that I can get to the tissue edges.  Then I put the clamps side by side and start on the underneath-back side with 3-0 silk.  All interrupted suturing.  Next I put together the inside part of the bowel on the back side.  Now for the top.  I suture the rest of the inside of the bowel together that is towards me on top.  Then put the second layer over the top.  Wow!  Thanks God!  I almost freaked out, but You helped me stay calm and do the right thing.  

I remember Dr. Scott (general surgeon) saying that it’s the corners that leak if it’s going to leak.  I reinforce the corners and then check for leaking.  He had a nice patent (open) new small intestine that did not leak.  

Greatful to be done with the HARD part.  I shove (gently) his intestines back through his small hernial opening.  

Now on for the easy stuff…..the hernia.  I NEVER thought I would say that!  

Simeon and I then repaired his hernia and were happy to be done with him. 

In that same day came a ruptured appendix.  

God is teaching me to depend on Him and do my best.  

The next week Samedi came back and I was very grateful to have him help and do the hernias.  No more stressing over hernias!  

But that too was not to last, as Samedi needed to go to help in Moundou for 2 weeks while James is away.  So… I’m once again… stuck being the only surgeon here.  But it’s not as scary anymore.  Hernias and hydroceles are my friend now.  I think I’ve already experienced the worst of them now.  They are much faster than hysterectomies and less risky for bleeding too!

I guess I was getting to comfortable in the 100 degree heat!  It was time for a change.  

Friday, May 24, 2013

The Heat

This is what hot cooks
look like in Tchad.

by Lyol

Mom and Dad keep running out of time to write these blogs, so I’ll just give you the lowdown on my little brother.  

The last thing they told you, well over a month ago, Zane was still having fevers.  Bla, bla, bla… same thing as last year… bla, bla bla… Zane’s sick and getting more medicine.  

More attention for little brother.  Less attention for me.  This was simply unacceptable.  There was even talk about Zane going back to America again WITHOUT me!

So… I pulled some strings with the other Nasaras, and we borrowed an air conditioner.  Yes, they do have such a thing in Tchad.  

Now I haven’t gone to medical school like my parents, but it seems simple enough to me if your kid is hot, you should make him cooler.  This may be easier said than done when it’s over 100 degrees in your bedroom at night.  And in the morning you wake up and it’s still 95 degrees.  I’ve only heard my parents throwing around these numbers… all I know is: It’s HOT!  

Mommy and Daddy had clearly failed after two weeks of overdose cipro and two weeks of maximum dose ceftriaxone and a failed course of overdose quinine and overdose fansidar, so now I got my chance to run the show.  

Daddy plugged in the air conditioner.  Zane’s room is the easiest room in the house to put it in because you can close the windows.  Plus there’s a little kitty door in one wall to stick the AC vent out and block off the rest with a towel.  

Two weeks.  Voila… no more fevers!  I’m a genius!  Plus, I get to sleep on the floor in Zane’s bedroom and enjoy it myself too.  Mom and dad said it got down to only 85 even with the AC, but still this seemed to help.  

What a "fried" electrical adaptor looks like.
Then … attack on us … Mommy woke up to a burning plastic smell and noticed smoke coming from the electrical adapter.  It was burnt to a crisp!  

They gave the AC a rest after that scare.  But then a few days later, Zane had fevers again!!!  I"m telling you, my diagnosis is the right one.

Mommy and Daddy eventually replaced the electrical adapter with another one.  Maybe the first one was faulty.  Cheap imported stuff.  Not real Tchadian quality.  Anyway, the fevers went away the first night Zane was back in the the cool air conditioning that took the bedroom temperature way down to 85.

Then it happened again.  The second adapter fried too!  And then another rest from scary burning electrical stuff.  And then Zane’s fevers came back again.  So we gave Zane a week of quinine.  Yucky stuff.  

The wild animals in Tchad keep us entertained.
Next, Gary re-wired a new electrical plug to the AC machine.  That way there was no need for an adapter.  But this too was too much for our house’s fragile electrical system, I guess.  

So I begged Gary to try one more thing.  He wired the AC directly to the house’s breaker system.  This has been working for a couple of weeks.  Mommy and Daddy say it’s cheaper to pay for the fuel for the generator to run the AC than to go back to the states early.

Zane’s fevers have seemed to be directly related to the amount of time he spends in heat.  So he gets AC to sleep at night and for his nap.  

Thank you for coming back, Miriam.

Now he can’t complain anymore.  I'm so tired of listening to my parents worry about Zane’s fevers.  Mom and Dad say it doesn’t make any medical sense to them, but… most kids in the states don’t have to be put to heat tests like we do here, so they still think we are normal.  

That’s good I guess.  

Gamma says that Daddy didn’t tolerate the heat well when he was a little boy, so Mommy says it’s his fault.  I guess we are supposed to live in Iceland, but Mommy doesn’t like the cold either.  Where’s a missionary hospital that’s about 80 degrees year-round?