Monday, November 10, 2014


This is the stuff that you think about when you think of missionary doctors…

But in reality it doesn’t happen all that often. But it did happen today.

It was a normal Sunday. I did rounds on maternity. I have about 12 patients, so it wasn’t that big of a deal. My preeclamptic patient is still pretty sick with BP’s at 170’s/120’s while on atenolol pills. I gave her a touch of lasix today.

I have a premature baby that is 1.8 kg that is doing well and 2 weeks old. She didn’t want to go home yet though because she’s afraid her family will give her baby water. I said she could stay at the hospital as long as she wants. We are giving her free rice so she’ll have something to eat.

My postpartum intestinal perforation is looking better. She is now 12 days postop. Today I brought her to the OR to open her incision that was leaking some pus, not surprisingly. The pus was coming from her abdominal cavity, so thankfully there was an opening through the fascia to let it drain. I extended it. She’ll get better, but it will be a long time packing her incision. Just glad to get the pus out again, now she can get better. Glad to not see stool either! Her intestines were pretty fragile and inflamed.

One of my patients has placenta previa and came in at 33 weeks with bleeding that stopped. She is now almost 35 weeks and I have planned to do a c-section at 36 weeks. Today I repeated the ultrasound and it looked like the placenta may be only covering the cervix part way, and not fully. So I told her that we’d just wait and see if she bleeds. If she does, we’d do a c-section.

Her mother has been whining to me all week about going home. She’s tired of being at the hospital. It’s dirty here. She’s arabic and doesn’t like to be dirty. I’ve explained over and over that she’s here because she has a high risk of dying from bleeding. This morning it was the same thing on rounds. Finally, I said, “Ok, you can bring her home if you promise to come back in a week. No sex. No work.”

They are actually from NDJ, but had family here in Bere and promised to stay in Bere.

She packed up to go home. Then she broke her water. “Now she has to stay again. Let me know if she starts bleeding,” I told Sabine, the nurse.

I go home around 2pm and eat yummy burritos that my mom made today. Literally, she made hand-made tortillas! Yum! I love mexican food! I enjoy a little time playing with Lyol, Zane, and Addison.

About an hour later, Sabine calls me from the hospital phone, “She’s bleeding a lot!”

I call Mason on the phone and tell him to get to the OR as I’m walking quickly to the hospital. Dad is informed too to come help with surgery.

At the patient’s bedside, I lift up her dress and see about a liter of bright red blood between her legs. She’s got no IV. Her Hbg had been 13, so we’d probably be okay. Still, she’s bleeding. The placenta must have just been too close to the cervix.

We had known she would probably bleed, just was trying to get the baby more mature.

She was in the private room on maternity, thus there was no way to get the stretcher in the room. Plus, I would have to run all the way back to the OR to get it. There was simply no time! I wanted to get her into the operating room as fast as I could.

So I picked her up in my arms and carried her to the operating room. I felt like some hero on a movie set. Maybe just less makeup on me, and a little more fully clothed than today’s woman hero in the movies. Though blue scrubs are so sexy.

However, it wasn’t fake blood on a movie set. It was real blood. And we needed to stop it quickly.

Everyone gawked as I carried this hemorrhaging pregnant woman all the way to the OR. All the while blood is running down from her and saturating my scrub pants. There was no time! We had to get her into the operating room. Plus she only weighed about 90 lbs, so really was NOT heavy.

We all worked quickly. Ndilbe put a plastic drape down on the OR table. I yanked her pretty arabic dress and flowing drapes off that were now soaked with blood. Sabine got an IV and we poured IV fluid into her.

I listened for a heartbeat with the doppler, but couldn’t hear one and was convinced the machine just wasn’t working right. But I wasn’t sure if the baby was living. It didn’t matter either way. We had to stop the bleeding to save this mom’s life.

Mason quickly got her spinal and we prepped her abdomen. Dad and I scrubbed, and we did a quick entry. Cut to fascia. Rip fascia apart with fingers, rip muscles apart, tear into peritoneum. Bladder flap down, Cut into uterus. Rip uterus apart. Delivery of Baby….

Baby girl screams.


Close mom up.

Survey the scene.


This afternoon was one of those times. I told Mason in the OR that I had arrived. This is one of those times when you thank God that He has prepared you for this kind of life in the mission field. It’s exciting. It’s rewarding. I had the blessing of carrying a hemorrhaging patient into the operating room, cut out a screaming baby, stop mom’s bleeding, and be thankful to save two lives in the process. Our OR team is awesome. Life is good. God is good.

Back home to play with our kids. Aahhh…..After showering off the nasty blood of course.

As a friendly reminder, we accept tax-deductible donations through Adventist Health International at Or there’s a donate link on our website that will take you there. You can pay by PayPal and shoot AHI an email to notify them you sent in a donation for us. Or you can send a check to “AHI - Bere, 11060 Anderson Street, Loma Linda, CA 92350” or call 909-558-4540 or fax 909-558-0242 or You can even set up recurring donations. So many easy ways to give! AHI has a new standard of 100% of your donation will arrive here in Bere. They find all their overhead operating costs from other sources. Anyway, we’re very humbled by how God has chosen to use us and if you would like to be a part of it, please help with your prayers, finances if possible and volunteerism if you’re feeling called!

Saturday, November 8, 2014


There are those who say abortion is illegal no matter what. There are those that say abortion is LEGAL no matter what. There are those that say abortion is illegal unless the mother’s life is at risk.

Please define that. Do I want a non-medical somebody defining that?

Do I want the government defining what is safe for a mother’s life and what is not?

The medical field does have some black and white lines. In fact, it has many. But it also has lots of grey ones.

What is abortion? It’s terminating a pregnancy.

I live and practice in a country where abortion is illegal. I also live in a country where NOTHING is illegal. Corruption is rampant. Are rules really rules?

Trust me. I have my religious convictions. But I also think that God created us to USE OUR BRAINS! The Devil has created sicknesses, diseases, and terrible parts of pregnancies that cause death to a mother. This is even more rampant in the developing world here.

I have seen my share of death. Believe me. Where over 15 moms die a year at my hospital, I have seen my share of death! Multitudes of developing fetuses die. Multitudes of newborns die (prematurity, vertical transmission of malaria, neonatal tetanus, sepsis from home deliveries, prolonged labor causing hypoxemia, etc). I’m not exaggerating. Multitudes.

I am NOT in favor of killing. The fetus or the mother. But whose life is more important? Can a dead mother support her developing fetus anyways?

I used to think… Wow! That’s a hard decision to make. I would let the family decide.

Well, guess what? Families don’t decide here. Women are used to having no rights. Really, NO rights! And the men never come to the hospital because they have no backbones and are afraid they will have to pay something if they show up. Or maybe they might have to give blood to save their hemorrhaging wife. Meanwhile they have 2 other wives at home.

So I decide.

I decide to let mom live. I FIGHT for mom to live. I SCREAM for mom to live. I GET ANGRY for mom to live. I PRAY for mom to live.

One of my moms on maternity right now came in a few days ago with generalized edema. She was probably only 16 or 17 years old and on her first pregnancy. She measured 33+5 weeks on the ultrasound. The baby measured just over 2 kg’s. She had severe preeclampsia with very elevated BP’s. Severe preeclampsia is very dangerous here. The treatment and road to recovery is delivery of the baby. (The only helpful lab work here for this are blood type, hemoglobin, and a urine dip stick…….No platelets, liver, or renal labs).

I explained to her 2 sisters and her that her pregnancy was making her very sick and could kill her if we didn’t deliver her baby sooner rather than later. I also explained that at over 2 kg, the baby had a high chance of living but was still premature. On the ultrasound the baby looked quite active, so didn’t appear unhealthy.

I gave her steroids for fetal lung maturity and induced her. It was her first baby, but still she delivered quite quickly with cytotec. She delivered in the night with one of my best nurses.

The baby died soon after the delivery. The nurse said she had a hard time pushing the head out, so maybe not enough oxygen during labor along with prematurity could be the cause of death.

Mom’s diastolics are still in the 130’s the day of her delivery. She’s still quite sick and at risk for death here in the bush of Africa. Preeclamptics die of pulmonary edema here. I’ve seen it many times when they come in late in the game and seizing. There’s no back up when mom’s lungs go south. There’s no ICU to send her off to. It’s best to prevent pulmonary edema by knowing the risks for developing it. If you get pulmonary edema with severe preeclampsia here, there’s lasix, but…then you either live or die. It’s not easy here.

So did I take one life to gain another?


I don’t believe God is EVER happy with losing life. He CREATED life. He made us to love and hope for the best in things.

It’s easy to look at things in the rearview mirror and judge. Lets say if I would have waited another week to induce mom. Would baby have had a higher chance of living?


Would mom have had a higher chance of dying?


It’s never black and white in these difficult cases.

Next patient comes in and breaks her water at 12 weeks. The fetus is still living. She’s hemorrhaging. But her cervix is closed. Can I help the mother live? Or should I just sit by and watch her die? Can I do a life-saving surgery on her? It’s an abortion.

Or maybe she’s not hemorrhaging. Maybe she’ll just develop sepsis in a couple of weeks and die from that overwhelming infection. I’ve seen it all here because people come with extremely delayed care here. Should I wait and see? I make my choices to help mom live.

I know why people are against abortion religiously. The Bible says do not kill. If you allow a government to carry out killing, then you are guilty of killing too. If you have the chance to vote against killing, and don’t, then God will hold you accountable.

But please use your brains. If the government can say that abortion is illegal no matter what, it then favors the killing of a mother when her own life is at risk.

I for one would prefer to make my OWN choices as an OB/GYN. I don’t want some non-medical professional telling me how to treat my patients.

My patient is my number one priority. And I deserve to have a choice. I just try to have God guide me to make the right decisions. It’s all in His hands.

Just something to think about the next time you want to judge abortions.


She came in 2 ½ weeks postpartum. She must have come in Friday afternoon because by the time I saw her on Sunday, she already had an abdominal ultrasound that showed “ascites and her uterus was empty.”

I wasn’t overwhelmingly impressed with her state. She was neither fantastic, nor sick. She was a young Arabic girl who had delivered her first baby. Her baby was skinny as they had been giving him water, but nothing unusual. I gave them the spiel to not give water.

Something just didn’t quite feel right about her abdomen. I couldn’t really feel a small fundus, like I should. Her abdomen wasn’t really distended, but wasn’t really as soft as it should be either. She had no pain and was eating some. Apparently she had had pain the day before, but was getting better on oral antibiotics.

Something was just off, and I couldn’t tell what it was.

I told her not to eat the next morning, so that I would have the option of doing surgery if I wanted to. I hadn’t decided if I was going to do a D&C for possible retained membranes or a laparotomy for possible abscess.

She really had nothing special clinically to go by. It just wasn’t quite right. (Can I write that on my preoperative diagnosis?……not quite right?) Doctors call this a ‘gestalt,’ a gut feeling resulting from a combination of tiny parts of a patient’s being that seem fairly innocuous but add up to an ominous future.

The next morning, she didn’t look better, but no worse either. I repeated an ultrasound and found her uterus to be completely empty, but she had a 3cm cystic mass in her right lower quadrant.

We obviously don’t have a CT scan, although that would have made things much easier. Something just told me to open her.

So I did. And it’s a good thing.

Upon entry of the abdomen, liquidy pus came out, followed by liquidy poop.

Awesome. My favorite. I hate the smell of poop. I had just gotten over the pregnancy hormones and was actually feeling back to normal. I was actually feeling great. After the miscarriage, I got malaria for a couple of days, but then was feeling awesome! But I still hate the smell of rotting poop in an abdomen.

She was a mess inside. She must have been perforated several days. I don’t know how she looked so good clinically. The ascites seen on the ultrasound by Doudje several days before must have been diarrhea in the abdomen, or pus. Now, her intestines were all stuck together. While trying to gently separate some of the intestines we kept finding pockets of pus.

We managed to find 2 sites of intestinal perforations and repaired them. Even though they were less than a cm each, it’s never easy to repair inflamed tissue. Somehow we got a couple of layers of suture over the holes. We irrigated a ton, and put a couple of drains in. Then we began to close up her infected abdomen.

Upon suturing one of the drains, a used suture accidentally flung up into my unprotected eye.

Yuck. I closed up the fascia, put in interrupted sutures in her skin, then unscrubbed and washed my eye.

Let’s get an HIV test, just to be sure.

HIV test came back.



Did the suture really go in my eye? Or did it just touch the outside of my eye as I closed my eye. I wasn’t really sure. It was just dirty suture on my eye. It’s not like I got poked. It probably didn’t even touch the inside of my eyelid. Did it? I’m not sure.

Well, I know the HIV prophylaxis medicine is really nasty to take. I remember an attending in residency on those meds for a month and he looked awful by the end. It gives really bad diarrhea and just overall ickiness. I remember Ndilbe last year taking the meds here for a month. By week 3 ½ he looked terrible too.

But would I be mad at myself 10 years from now if I could have prevented HIV?

Yes, I should have been wearing protection!

Eye protection, that is! But it’s so HOT here that I can’t see with goggles on because they fog up instantly. I make a mental note to get some really nice, anti fog clear glasses or goggles next time I’m home.

But now, I didn’t really have a choice. I had to take HIV meds for a month. Olen would want me to. I will do it for Olen. Olen had been in America for 10 days and was now getting ready to go to the airport to come home.

I texted him and told him, and we both agreed for me to take the nasty meds.

So now I’ve been on nasty meds for 1 ½ weeks. I’m back to being nauseated again. It’s not quite as bad as pregnancy nausea and doesn’t come with the same fatigue. But it’s not fun. I now understand why people spit during hyperememsis gravidarum. They spit because even their spit tastes bad.

My spit tastes bad. Water tastes bad. Food tastes bad. I feel icky all of the time. But praise God that I have medicines that I can take. And it’s only 2 ½ more weeks to go!

Oh for 2 ½ weeks to pass quickly! Morning and night nasty effects of pills. I’ve got it easy though compared to the sick people here.

My patient is slow to recover. But she is recovering. Please pray for her continued recovery.

As a friendly reminder, we accept tax-deductible donations through Adventist Health International at Or there’s a donate link on our website that will take you there. You can pay by PayPal and shoot AHI an email to notify them you sent in a donation for us. Or you can send a check to “AHI - Bere, 11060 Anderson Street, Loma Linda, CA 92350” or call 909-558-4540 or fax 909-558-0242 or email You can even set up recurring donations. So many easy ways to give! AHI has a new standard of 100% of your donation will arrive here in Bere. They find all their overhead operating costs from other sources. Anyway, we’re very humbled by how God has chosen to use us and if you would like to be a part of it, please help with your prayers, finances if possible and volunteerism if you’re feeling called!