Sunday, December 28, 2014

Got milk?

Got Milk?

It’s me, Addison, the baby of this great Netteburg family.

I’m so thankful for my mommy. She loves me. She also gives me milk. It’s one of my favorite things in the whole world. And it’s good for me too!

Do you like milk?

Mommy says breast milk is the best. I’m so thankful that my mommy could give me what I needed to get big and strong. Now I’ve graduated to special powdered cow’s milk. Yum! It’s so good.

Sometimes families here need help with milk for their babies. Mommies die here, leaving a grandma or an aunt to become the new mommy. The new mommies don’t have breast milk or enough money to buy powdered baby milk.

We have a program to help the new mommies. We have anywhere from 12 to 24 babies at a time in our baby milk program. They find out about us from word of mouth. We do an investigation via tribal drum languages to surrounding villages to make sure they are legit. Then one person comes once a week to get milk and work a little. The babies come with their new mommies every few weeks.

Our friend Tammy used to run this program, but she moved back to America, so now we have been helping out the orphan babies since this past summer.

Mommy says that true religion is to care for the orphans. I guess these babies just don’t got milk and need it. It’s as simple as that.

My friends in the pictures are not orphans, but their mommy had THREE babies at a time in June. I think she was getting another chance at having lots of babies because she has had 6 children die. Now she has 4 children! The triplets breastfeed, but mommy helps them out with 1 can of baby milk per week. They are 5 months old and looking so cute!

An orphaned baby usually gets 1 can of formula per week up to 1 year of age. Each can costs $6. So for the 12 babies currently enrolled, it costs $288 per month (that’s a lot of math for my 1 year old brain). This past summer we had up to 25 babies in the program, but many of them graduated.

I love helping my mommy with this baby milk program. I know you will too!

If you want to help with this program, you should still give via AHI. Just tag it Bere Baby Milk.

Merry Christmas! Love Addison Noel  

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
Volunteers Welcome!!!

Wednesday, December 10, 2014


It’s nice to have short-term volunteers to remind us of how unique our careers are.

We just got a group of two anesthesia students and one anesthesia professor. All of them have worked years in ICUs before going into anesthesia. And all of them got to see a case they’ve never seen before.

I was in the OR chatting with these fine people when Sabine came and got me from pediatrics. She told me a kid swallowed of bottle of chemicals used for growing cotton.

I’d seen this before and knew what to expect. I called to the anesthesia students and asked if they wanted a shot at saving a life. They eagerly responded in the affirmative, so off we went to pediatrics.

In pediatrics I found a classic organophosphate poisoning. A boy about ten years old. And he was wet. Just imagine every possible way to lose fluids, he was doing exactly that. The most dangerous part was the froth coming out of his mouth.

These kids die when the fluid in their lungs overwhelms them. This kid had lots of fluid in his lungs. I could hear it from ten feet away as I walked up.

I sent somebody off to get atropine and explained to the anesthesia students that the treatment was essentially atropine until the lungs are no longer wet.

Atropine is a ‘code’ drug, meaning, it’s a drug that’s given in a code, or when a patient’s heart stops. In fact, when a patient’s heart stops, atropine may be the first medicine you give in your attempts to restart the heart. So it’s considered pretty potent. We give 1mg IV for a newly-stopped heart. Or maybe 0.5mg IV for a heart that’s fixin’ to stop and is very slow, but hasn’t stopped yet.

Well, we gave this kid 5mg IV bolus to start. This is a higher-than-recommended dose, but he was quite clearly on his way out, so we went for broke. His lungs started drying ever so slightly, but he was still quite wet. So we repeated it. I didn’t measure his heart rate, but judging by the amount of atropine he got, it was probably well over 200 beats/minute.

Next we gave him glycopyrrolate to dry him out. The anesthetists had just brought a bunch over with them, so they gave a couple doses.

He was actually drying out nicely, so I left for a meeting and left them in charge, essentially to give a couple milligrams of atropine whenever his lungs got wet.

I returned about four hours later to some bad news.

The boy had been sent home to die.

Organophosphate poisonings usually happen inhaling stuff or getting stuff on your skin. This kid had swallowed a whole bunch of it for reasons unknown. By the shear volume in his body and calculating roughly how long we’d need to treat him… It was decided his odds of survival were very low anyway and we would risk using the entire hospital supply of atropine to treat him. As it was, he received 21mg of atropine. That’s 21 pushes of medicine usually reserved for restarting a stopped heart. Or preventing a heart from stopping. Or preventing a child from having too many airway secretions during surgery under ketamine anesthesia.

And so our visitors had another first. First time they sent a ten-year-old home to die, when there was still the possibility of fighting longer and continuing to give atropine in a likely futile attempt to save his life, but possibly at a huge expense of resource which could be spent on other patients.

That’s a really tough first. I know, because I still remember those firsts quite vividly. I remember all the newborns we gave up on, knowing neither the family nor the hospital could afford the resources to really go all out 100% saving lives, particularly when we are already quite certain of the outcome. It’s rare the Tchadian father willing to spend every last dime to fight for the life of his child if it’s unlikely the child will survive. It’s difficult to allocate limited hospital resources to likely futile cases.

But we are taught to provide the highest level of care at all times. We are taught death is the worst possible outcome. So our urge is to always fight.

Tchadians have us beat in some ways. Although they may often accept death too easily, when I’d rather see them fight to save life, they always accept death gracefully. There aren’t many things I would describe as graceful in this culture, but they know life, spirit, soul, what have you… They know there are some things which transcend mere breath.

And that realization, for most of us, even if we say it intellectually… To not just say it but believe it and live as though we believed it… It’s another first.

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

Tuesday, December 9, 2014

Overly Sweet

It’s 3AM. Danae and I are both awake and have been all day. One or the other of us have been in the hospital all day. She just had two C-sections. And I’ve been bouncing to the hospital and back repeatedly to check on a patient. Our kids are likely to wake up in less than three hours. So why not write something?

This morning at our morning report, I learned a diabetic came in comatose around midnight with a blood sugar near 600. The nurses knew he required aggressive fluid resuscitation, so they gave him a whole liter of fluids (sarcasm, one liter is not much, but nobody ever gets more than a half liter every six hours, so he was ahead of the curve) by 7AM. We’ve been over this before: Diabetics in comas needs lots of fluids. Oh, and they also crushed up a metformin and stuck it in his mouth. Awesome.

So I went to see the patient and I ordered fluids. Lots of IV fluids. And I kept cycling back throughout the day to keep hanging fresh bottles of IV fluids to replace the empty ones.

Now you may think my job is hard and HHNK (Hyperosmolar Hyperglycemic NonKetotic Acidosis, used to be HONK, which was an exceedingly cooler acronym) is difficult to treat. But Bere Adventist Hospital makes it simple. You see, my only blood test is a blood sugar. And I can only get that about every twelve hours.

Typically, DKA and HHNK patients have normal-appearing potassium levels, even though they’re quite potassium-depleted. They’re just so viciously volume-depleted that it looks more normal than it is. So as you start replacing their volume with IV fluids, the potassium level goes down. It’s fun to treat elevated blood sugars with insulin, but the thing is, insulin drives potassium into the cells and out of the blood stream. Then the heart starts receiving lots of blood without potassium. Then the heart stops. And I learned in residency that cessation of cardiac activity is rarely a desired outcome.

And being unable to check a potassium level, I was left to guess. I gave my patient lots of Lactated Ringer’s, which is an IV fluid with a little bit of potassium. So I figured (prayed) the patient had enough potassium to support a whiff of insulin without his heart stopping. Normally, I’d give this guy 7 units of insulin per hour, but I had no way of knowing his potassium level and I had no IV pump. I’m just running in half liter bottles as fast as I can. So I don’t really get excited about the prospect of giving him a 7 unit IV push blind.

So I wimp out and give him 10 subcutaneously, which may not help, but is unlikely to hurt, which I think is an oath I took at med school graduation. Maybe. Then I give 20 units. Then I give 20 more. Every few hours. Blind.

Oh, and his blood pressure has been 60/40.

And there’s the pesky question of why he got so out of control in the first place. He apparently stopped his meds a few weeks ago. He felt lousy the last couple days and started treating himself with unknown IV fluids at home, because he thought he had malaria.

So now I have him on ceftriaxone (for ?typhoid, ?UTI, ?pneumonia, ?meningitis, who knows!?!!? Don’t judge me, I have no xray, no… well, let’s just say I have very little) and quinine IM, which I’ve never given before. Quinine decreases the blood sugar and is the world’s greatest anti-malarial, and can be given IM, although it frequently causes painful muscle necrosis. I could give it IV, but I want to give fluids quickly. And I don’t want to bolus quinine, or else I’ll stretch out the patient’s QT interval and push him into torsades de points (which also ceases cardiac activity, see above under ‘undesirable result’).

I would ask for intense nursing care, but his current nurse has over 20 hospitalized patients, all receiving cardioactive IV drips and is also in charge of consulting all new patients coming in overnight. And busy season is picking up, so we usually consult at least 60 new patients each day, many at night as well.

I was just in the hospital and the patient has been here over 24 hours. And he JUST now peed. And he has received 13 liters of fluids. That’s 26 half-liter bottles of IV fluids. Thirteen liters. That’s three and a half gallons of IV fluids. That’s twice somebody’s normal blood volume. And 11 of those liters were given in about 17 hours. Three and a half gallons and he just now peed. Try this for fun: Drink three and half gallons of any liquid. Then don’t pee for a day.

Anyway, his tongue is not quite as dry as it was and he’s starting to move around a bit and open his eyes and make some noises and localize pain (which is medico-speak for ‘pinch him and see if he tries to push your hand away’). His blood pressure is up to 110/60, although he’s still not talking or filling out the Sudoku I left at his bedside. I probably should have started with an easier puzzle.

Anyway, just praying he survives, as HHNK carries up to a 25% mortality rate, even in the states.

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

Volunteers Welcome!!!

Monday, December 8, 2014

Part III The Futuroscope

Seeing so much good change through the retroscope (not to be confused with the rectoscope), we now look to the future of Bere Adventist Hospital here in Podunk, Tchad.

We do not do handouts. We do not create dependence. We do not replace local employment with foreign employment if the expertise exists or can be created locally. We do not diminish people, take away their pride or claim to be superior. We do not help where one can be expected to help themselves.

So what do we do? We create temporary projects which empower and generate independence and lead to self-sufficiency and pride. And we witness. With this in mind, we set bold plans for the future. With our volunteers and philanthropic partners (that’s YOU!!!) and through God’s grace, we will accomplish great things next year! Below are our top priorities and ways you can join us in making these most critical needs a reality for the people of Bere and throughout Tchad.

We have virtually all the supplies necessary to finish construction. What we’re missing now is the expertise. In this entire district, there is no plumbing or electricity. So you can’t very well expect our local laborers to know what they’re doing along those lines. We are fervently praying for God to send us a volunteer, be it short-term or even long-term, who can help us complete the construction and perform the hospital maintenance Jamie so faithfully did.

But we’re open to all comers, including administration, accounting, pharmacy, evangelism, agriculture, medical, etc. We’re convinced everybody has something to give here. French is obviously a desirable skill (or Arabic), but is no prerequisite. The most important service one can render here is leading a life of Christian example.

We will continue to support the 17 students we have already taken on in medical and nursing school.

We are deciding to move forward in faith on our nursing school. The pieces are slowly falling into place. We have the shells of the buildings. The government provides a curriculum for private schools, which we will obviously improve upon. We have three Tchadian nurses with advanced degrees, plus a fourth finishing next year, plus Mason McDowell, our anesthetist with a doctor in nurse anesthesia. This school would save us the $24,000+ we paid this year sending other students to school. It will also allow us to create a better culture of quality nursing and spiritual care for our patients and to eventually send nurses out into the countryside. Another need is somebody to be the leader at our new nursing school. The ideal person would be a francophone nurse practitioner or physician's assistant. I don't know if they even exist in the French medical system. Or somebody with a masters. Or a physician, if he or she is interested in teaching nurses.

We are also deciding to move forward in faith building health centers. We have received dozens of requests to open health centers and hospitals. We will start with one and see how it goes. Typically, health centers are self-sustaining. And now we will have quality nurses to staff it and provide a good witness. While there is purpose in having a large training facility like Bere, where we can train, nurses, midwives, anesthetists and surgeons, the real work and witness is in rural health centers.

We will also be starting mobile clinics. We will load a Land Cruiser with supplies and head out to rural underserved villages and put on week-long public health programs. While teaching general public health, we will also be bringing members of our nutrition center to screen kids for malnutrition. We will also bring evangelists to preach the Gospel. We will also be sending out nurses and doctors to consult patients.

There are a few things which have possessed us to move forward now. Mostly, it’s a great guy named Mason McDowell and his wife Kim. Mason has taken over my anesthesia and pediatric responsibilities and Kim has taken over the school. I now finally have the time and energy to attend to the administrative and expansion responsibilities as well as my medical responsibilities. And there are other volunteers ready to either take on some of my responsibilities or help in these new projects.

So besides even more volunteers, what are we lacking?

Well, I’m proud to say we’re broke. AHI-Bere is officially broke. Zero money. AHI-Bere used to have loads of money. Historically, Bere has been the most financially-blessed AHI institution. However, we have spent all of it to get to where we are. I’m proud to say we’re broke, because we have spent all your donations on extremely important and productive projects and not just buried our talent in the ground. You can see all we’ve accomplished above. Much of it has gone to projects which further our goal of a financially-independent hospital. Your donation dollars have never gone to routine costs like nursing salaries. In fact, our hospital has made money, repaid debts, put money in the bank and made further investments this year. Oh how I wish you could come visit to see how much has changed! We have really done a TON with your contributions.

So there you have it, you who ask how you can help. You can come be a part of what we’re doing by the labor of your own hands. You can share this link on your Facebook page with a note that you would trust us to be good stewards of your tax-deductible donation dollars. Or be a part of what we do by making it financially possible.

AHI can take donations in many ways. You can pay by PayPal, check, phone, credit card, etc. Just mark it as Bere or send them an email indicating you made a donation and wish it to go to Bere. Another option is to shop through and list your preferred charity as Adventist Health International. Then 0.5% of your purchase price is donated to AHI. I don’t think there’s any specific way to make it go to Bere as opposed to the Global Fund at AHI, but we really love AHI and their Global Fund needs to be fed too.

Visit for information on donating or click the PayPal link on our blog. And it’s tax-deductible, if you’re into that sort of thing in December.

You choose:
909-558-4540 or
Adventist Health International
11060 Anderson Street
Loma Linda, CA 92350

Thank you once again for keeping us going long after we thought possible, be it via prayers, kind words or donations. We appreciate how you help shoulder the burden when we are taxed and hurt. We hope you feel proud sharing in our triumphs and trials. And we pray you share our hope for the future. Thank you immensely for spending your free time reading our blog. And thank you for partnering with us and trusting us with your hard-earned donations. We daily strive to please our Heavenly Father and be worthy of the faith both He and you have put in us.

And as always, we can be reached at

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

Volunteers Welcome!!!

Sunday, December 7, 2014

Part II The Retroscope

Every once in a great while, we need to take off our myopic glasses and step back and take in the grand picture. And maybe even allow ourselves to be just the slightest bit proud.

We can get so focused on our short-term troubles we forget the blessings we’ve been fortunate enough to know.

Since our arrival four years ago, we have built…

3 large houses for expat staff.
5 small houses for expat staff.
4 hotel rooms for volunteers.
A waiting room in front of Urgence.
A lab/pharmacy/cashier complex.
A private ward in front of pediatrics.
A nursing office in front of pediatrics.
Sidewalks throughout the entire campus.
A new water tower.
A wall around the compound.
A new labor and delivery complex with four labor beds and private and public consultation areas.
A 14-bed maternity ward.
New toilets throughout.
A 16-bed private ward.
A four-building nursing school compound.
A chaplain's office.
A guard room.
A storage building.
A two-theater operating building.
A dental building.
An outpatient surgical office.
A public health building.
A post-op/ICU building.
A restaurant.
A kitchen.
Family sleeping quarters.

We have also recruited a full-time anesthetist from America.
We have also recruited three Masters in Public Health who are running great projects.
And we now have a third physician. Actually, even a fourth! Our first Adventist Tchadian physician in the country just finished school and started at Bere this week. (AHI paid for his medical school!)
We currently are supporting 17 Tchadians in nursing and medical school.
We have a program to deworm the entire region of a million people with albendazole.
We have a Burkitts tumor treatment program free of charge.
We have acquired more land for the hospital.
We manage a nutrition center.
In January we will install computerized medical record and physician order entry, the first of its kind in Tchad, which will also generate stock orders. We have already built the wireless network.
We are also starting TV public health and evangelistic programs we will be showing on TVs at our hospital.
We will start drilling wells and expanding the public health project next year.
We have planted a garden and hundreds of fruit trees for the patients.
We have started raising goats and chickens for patients.
We have a dozen church plants we are helping with.
We are helping with a lay evangelism school.
We have received two new 30kva generators.
We have received containers of equipment including oxygen concentrators and various other medical equipment.

Yes, we are tired, in case you were wondering. No, we are not yet burned out.

The reality, however, is many of these projects are just half-finished. We have the outside shells of the buildings, but they are empty inside. The last two Januarys, we had AMAZING teams come and construct all these buildings. The goal was Jamie Parker, our full-time maintenance man, would be able to finish these projects.

Jamie and Tammy left in March and Jamie had back surgery in July. Between health issues, family issues, and the fact they had spent five years on the battlefield, they made the decision to return in November, pack up shop and go home. It’s truly the end of an era. They had accomplished so much in their five years, it’s hard to believe they are only human and there are only two of them. We have been so blessed to have them. We’re grateful to all our volunteers, but there were never harder-working or more productive volunteers than the Parkers. (Incidentally, if anybody has $7000 burning a hole in their pocket, we need some money to buy Jamie’s tools and motorcycle and other items from him.)

I say ‘we’ have done this in the greater sense. Obviously, without God nothing is possible and even if it were, it would all be for naught. Danae and I have very little to do with these things except for providing vision and guidance, recruiting the volunteers to do the job and being blessed with financial and management partners. These things have been accomplished with Maranatha, ASI, One-Day Project, A Better World-Canada, Restore a Child, Gospel Outreach and many individuals who have chosen to be a part of what we do, either by volunteering personally or by participating financially.

To each and every one of you who have used your hands to lift a hammer, sign a check, or fold in prayer for our hospital… A most sincere thank you!!!

And stay tuned for yet another blog very soon to follow!

Saturday, December 6, 2014

The Coda and the Hook

We are at the four-year mark here in Tchad, and with the exception of fleeting fantasies, we have no real desire to leave just as of yet. Despite all the challenges, be they political, cultural, language, social, climate or sickness, we still feel blessed every day, knowing God is entrusting to us the care of some of His most precious children, because He loves us, not because He needs us. We are very grateful and humbled to be of use.

Our jobs are never boring. In fact, this is the most rewarding and interesting job I can imagine. It is never JUST a job. We don’t envy anybody anything (unless you’re reading this while eating at Taco Bell). However, in spite of the variety of tasks and people and pathologies we encounter each new day, we fear our blogs become just different verses to the same song, with a never-ending coda and a really annoying hook.

How many times can I write my frustration running out of supplies? Last week it was gauze and HIV tests. This week it’s gloves and syringes. It’s been forever since I’ve had an antihypertensive besides atenolol or a diabetic med besides metformin. We ran out of steroids yesterday. I could go on and on. Nobody can keep a decent stockroom stocked before things run out. Part of the problem is they can’t keep an electronic record. Part of it is the government won’t allow us to import our own medications. Part of it is the fact our regional pharmacy supplier is always bare. Part of it is the fact the national pharmacy, where we’re required to buy our supplies, has cupboards like Mother Hubbard’s. And part of it is the apparent inability to plan in this part of the world. The entire country ran out of Tylenol in July. Awesome.

How many times can I write about tumors the size of grapefruit, if not larger? Or women dying in labor, essentially dead already when they’re dumped on our doorstep? Or babies dead in the uterus prior to arrival? Or kids dying from malaria? Or my own kids being sick with malaria. I know there are tragedies all over the world. I know death is an ultimate common denominator. But there’s a reason Chad has the lowest life expectancy, and is always tops or near tops for maternal mortality, under-5 mortality, neonatal mortality, worst place in the world to be a woman, worst place in the world to be a sick child, most corrupt country in the world, worst country in the world to be a tourist, etc.

And yet on the positive side, how many times can I write about the lives saved, the diagnoses made, the diseases cured, the surgeries done, the free care given, the amazing staff found, the administrative successes, the protocols implemented or the fact we are still growing at a rate our hospital’s infrastructure can’t support, despite our location way out in the bush?

So there is this dissonance which is hard to define and even harder to explain in blog. We love our jobs. Our patients are so interesting. We’re filling a need. We know God wants us here. We have a supportive community of foreigners. We have supportive families in the states. We have friends faithfully praying for us. We work hard. We spend time with our family. We have no time for anything else. There is no free time. There is no leisure time. There are no hobbies. But that’s ok. We are full. We have time for our family and time for service. Life is beautiful.

And then the frustrations.

Every job. Every house. Every situation. There are always pros and cons.

But the cons here are just so… con-ish. So very very con-ish. Way out on the extreme of con. Like you drive out a mile or so to get to the normal con. Then you take a left, go around a hill and past a lake and a guy with a piece of straw between his lips, then continue driving another 2539 miles. Then you arrive at these cons.

But the pros are just so pro-y. And they far outweigh the cons.

How to explain this love-hate relationship with this mission field? I don’t know. Perhaps that’s why we have this deep-rooted desire to recruit help out here. Misery loves company. But it’s also no fun to celebrate your successes alone. And in the end, there is simply no way to explain Tchad to somebody who hasn’t spent time in Tchad. My friends who come visit from other countries in Africa are… impressed, often unaware there are still countries like this one on the same continent. Forgotten. Left behind. Like Kirk Cameron after the rapture. That’s Tchad. Yup. Tchad is Kirk Cameron. Print it.

Stay tuned for more blogs coming very soon.