Saturday, May 24, 2014


Things we do for entertainment in Tchad…..

Lyol’s flip flops broke a while back.  I couldn’t believe that GAP shoes would break so easily!  He was quite sad about it.  So mommy and daddy had a contest.  Since both shoes broke, we each took one to repair (something weird doctor missionary parents would do).

Mommy, repaired one with 2-0 silk.  (opened, half-used suture that we hadn’t thrown away) It’s nonabsorbable and black.  Nice to look at.  Her skills paid off!

Daddy, chose something stronger but absorbable.  0 vicryl.  Purple and thicker.  He’s also got skills.  

We presented both shoes to Lyol and asked which one he liked better.  

He chose wisely and said he liked them both the best!  He was so happy to have flip flops again.  

Only time will tell now who’s shoe will break first.  Rainy season is coming and that absorbable suture won’t last forever!  

Only in Tchad will you entertain yourselves by pretending to be shoe repairmen.  I’m pretty sure we would have just ran to the store and bought a new pair in America.  But then again, we are pretty cheap sometimes!


The Things We Do for a Bok

Two quick chicken stories:

My ideas on tithe and offerings and faith and love have evolved somewhat since arriving here. I have become accustomed to seeing new things in church. Goats walking in the back door. Passing around the communal cup of water from an urn in the back when it’s too hot. Hearing three translations of a sermon (and being lucky to understand one of them). Bizarre theology. A list that could fill a blog by itself.

At offering time, it doesn’t surprise me at all anymore to see sacks of rice or bowls full of maize or millet or cucumbers or any other garden produce in the front of church as part of the offering. The head elder once embarrassed these poor genuine offering-givers and insulted them, asking if anybody in the church wanted it, because after all, what’s he going to do with that. Now we just take in to the market, sell it, and send the cash to the association.

Well, for the first time, I saw a chicken in the offering plate. It was awwweeesome. Unfortunately, I was on the platform that Sabbath. I’m afraid I didn’t bless the offering very well, because I was trying to clandestinely snap a photo on my phone during prayer.

After prayer, they took the chicken in the back. Well, the poor fowl didn’t like being part of the ceremony. He bok-bok-bukaaah-ed a bit too much. Eventually, an elder went into the back room and the noises ceased.

We don’t have Children’s Story at our church, but I’ve been thinking about starting it for quite some time. I thought maybe this would be a good first story.

‘There was once a chicken who made too much noise in church. The head elder broke its neck. Ok, kids. It’s now time to walk quietly back to your seats.’

Second story: I had a patient come in with difficulty breathing and fever. I’ve seen so many of these now they are getting routine. I brought him into the operating room (for ease of access to supplies) and cut into his chest wall, shoving a large tube into his chest cavity behind his lung. Liters of pus spewed out all over the floor, some of it actually falling into the trash can we had placed there to catch it.

Suturing the tube into place, I reflected a bit on how much suffering this guy had gone through in the last few months. There were scratches all over his abdomen, chest and flank. These are very common. This is the traditional ways of healing pain. Make a series of cuts on the skin overlying the pain. This heals the sickness. Duh. So obvious, it’s a wonder the medical community hasn’t caught on. I suppose I should blame Obamacare, since everybody else does.

Well, I got more curious than normal, so I asked him about it. He told me he had paid nearly $500 for these cuts. This is astronomical amounts of money in a country where 65% live on less than a dollar a day. He had been going to the witch doctor, who would sacrifice a goat and a chicken, then take the chicken foot and make these deep cuts on the poor young man.

If I weren’t so vehemently opposed to the whole witch doctor thing, I would love to go get a receipt for something like this and turn it into my insurance company.

olen and danae

Olen Tigo: +235 91 91 60 32
Danae Tigo: +235 90 19 30 38

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

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Saturday, May 10, 2014

Mom, Mom, Mom

Who are the people in your life who you owe eternal gratitude?  

Probably one of them is your Mother!  

She carried you for 9 miserable months.  She agonized with pain in childbirth.  She fed you.  She wiped your butt.  She fed you.  She wiped your butt.  She fed you.  She wiped your butt.  

She lost sleep every night while you were little….and then probably more after you became a teenager!

My mother is an important part of my life.  I love my Mom!

Your mother is an important part of your life.  You owe everything to her.  Without her, you wouldn’t have existed.  

There are mothers here who face HUGE risks just for the chance to have a child like you.  We live in Chad.  To be pregnant here is probably riskier than walking down a dark ally alone next to a crime scene on CSI.  Chances are that you will die 1 out of 50 pregnancies (depending on which statistics you use, if you even believe them here).  One out of every eleven Chadian women die in childbirth.  And all this is to give birth to children who have a 21% chance of dying before the age of five.

I’ve had 7 maternal mortalities this year alone.  It’s only May.  

And we are the good hospital.  

Seriously.  It’s sobering.  

Just last night I had a uterine rupture.  She had been in labor since the morning on her eighth baby.  She came from a bush health center.  They referred her to the district hospital, Lai (20 km from us).  Lai put a foley in her, shaved her, and referred her to us.  

Bumpy roads.  

She arrived with a BP of 60/40 with an arm presentation of a dead baby.  I was planning on turning the baby and delivering vaginally when I touched her belly and could tell that she had a ruptured uterus.  I called in the OR team and we saved her life.  She had 2 liters of blood in her belly.  She had been ruptured for several hours.  She should have died.    

It’s sobering to be part of this fight for mothers.  

That’s why we are trying to improve things here.  Each time a mother comes to her prenatal visits here it improves her chances of survival.  Each time a mother delivers at our hospital, it improves her chances of survival.  Not because we are that good, but because care elsewhere is so bad, or simply not there.  

How do we get them to come?

Through day to day teaching in the village with our Project 21.  Zach and Charis are two Public Health organizers who are heading up this important project this year.  Loma Linda University’s Global Health Institute is helping them continue to stay here by paying a small stipend and part of their school loans.

Every delivery is free.  Every c-section is free.  

We give bribes for delivering at our hospital.  Every woman who delivers here gets baby clothes and a water bottle, if we have them.  It might seem like nothing, but it may be the only present she gets for her baby.  They don’t throw baby showers here! And I’ve never seen a diaper.  (Don’t believe that lie that all you need is boob and diapers.  Really, all you need is boob.)

So it’s time to finish what’s started!  We had some generous donors give money for a new maternity ward and delivery suite.  The shell is up and beautiful!  The inside walls are actually finished and painted inside.  

But I still can’t move in!  There’s still plumbing and electric to finish.  

While we wait for our plumber and electrician to return from his annual leave, we can finish the details.  He’s only one person, and we’ve kept him too busy with everything going on!

We need some tables, desks, shelving, curtains to separate the delivery beds, and benches.

It’s almost finished!!!  

For now we continue to do deliveries in a room the size of a master bathroom.  Often we have 2 or 3 mothers laboring in this tiny, sweaty enclosure, sometimes multiple mothers laboring on the floor.  But out this armpit, we help bring life.  We help save mothers’ lives.  We help save babies’ lives.  

Tell your mom you love her.  (Warning: Gratuitous plea for financial help coming…) Send a check to AHI.  Note the sidebar to our blog for donations to AHI, please mark "Bere Adventist Hospital."


Imagine the wet feeling of urine always running down your leg as you get up to welcome your visitors into your home.  Imagine the stench that plagues your clothes and anywhere that you spend more than a few seconds.  You wrestle daily with the desire to not drink water so you don’t leak as much volume… but then your pee is more concentrated and smells more.  Your family may have money, but they refuse to spend it on you because you are worthless.  You are nothing.  You just stink. 


That’s what it’s been like for Hawa for 8 years!  

Last year she was almost a success story after having had several surgeries here.  She was dry for a month.  I was so happy.  And then she leaked again.  

How do you measure success?  When do you just give up?  Why do some surgeries work and others don’t?  

I don’t know.  

I don’t know a lot.    

I don’t know why some surgeries work, and others don’t.  But I know I am persistent.  Sometimes that pays off too.  

And a lot of you are persistent.  

I posted on Facebook that I needed a little money to provide food for a fistula lady, and people wrote!  Money came in!  And I am so thankful for your prayers, encouragement, and every dollar that you sent.  

In the month of February we did 4 vesico-vaginal fistulas (google it).  Three were successes.  But not Hawa.   

Hawa came in originally with her bladder inside out.  The whole part that connects the bladder to the vagina under the pubic bone was gone.  Her left ureter was also gone.  She had a recto-vaginal fistula as well (an unnatural connecting tube between the rectum and the vagina, causing stool to leak into the vagina, which we have repaired).  

There were issues with all of her post-operative courses to say the least.  The first repair was a good one.  The tubing got kinked that goes from the foley to the bag.  Not good for fragile bladder/vaginal tissues.  The bladder fills with urine and the pressure on the surgical repair site causes breakdown of the surgical closure and leakage.  Still a lot of it took.  After this, her expired ureteral stent broke off in her one remaining ureter.  (We have since obtained some new ones from a generous company.)

The second surgery was another repair of her ever-present peri-urethral VVF openings.  We have done away with tubing by the way because of the kinking issue and lack of nursing.  Drip, drip, drip into a pan is the way to go.

Third and fourth more of the same.  Malaria with a post-operative course is no fun.  One of those times she developed a terrible cough, so that pretty much did us in.  Pressure (coughing) on fragile tissues is no good.  After her cough got better I repaired her 10 days post-operative (a no no because tissue is no good) to make number 5 because I was so annoyed the repair had broken.

Sixth surgery in February?  Went well.  Should have worked.  

She was dry for a week and a half.  But now she’s still got one tiny little hole to the right of her urethra.  It’s way better than it was, true.  But not dry yet!   

How do we measure success?  Do we say, “Well, she is way better than she was!” ?

When do we give up?  

I don’t want to give up because I know it will work the next time.

So… we will do it again.  But this time more severe.  I will open her up abdominally, do a supra-cervical hysterectomy (to take away her menstrual cycle), repair her fistula vaginally, and close her vagina to take away tension on the urethral area (have done lots of vaginal flaps that have helped her but not good enough).  

Unless someone else has any bright ideas!  : )  Or unless one of my Uro-gyn friends wants to come visit and help!  

I’m making her wait two months for the next surgery.  Book your tickets now!

In the mean time, she’s “my daughter.”  You who have sent money support her.  Every Sunday I give her $10 for the week to feed herself and her little boy.  For now she just hangs out at the hospital on her mat.  The hospital supports her because every VVF surgery we do is for free.

So thank you all for supporting Hawa.  She’s your daughter too.  Thank you for being part of her success story.  

It’s just not finished yet! 

Stay tuned in June and July.