Independence & Storms

Some big storms can knock down some big branches. So I encourage my children to gain independence... And go at it with an ax. But don't worry, there was supervision. Brya, who was also chopping. Don't judge me for allowing a woman to chop up my tree. I'm just trying to keep the local workforce employed. 

Olen Netteburg

Missionarydoctors.blogspot.com

Danae.netteburg@gmail.com

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

Olen et Danae Netteburg
Hôpital Adventiste de Bere
Boîte Postale 52
Kelo, Tchad
Afrique

Volunteers Welcome!!!

LIONS AND TIGERS AND... Hippopotami?

So what do you do if you're telling the story of David killing bears? In a place with no bears? In a language with no word for bear? Where nobody's ever heard of or seen a picture of a bear?

Yup, that's right! Our David killed a hippopotamus to protect his flock!!!

Go Eric for thinking on your feet!!!

Inappropriate

I get tired of paying people’s medical bills. Particularly children. Well, that’s not entirely true. I get tired of parents refusing to pay their kid’s bill. The kid is innocent. But I’m still much more hard-hearted than Danae. I may be vomiting my guts out from malaria, but I still would rather round myself on pediatrics than let her do it. I can’t afford otherwise. Danae’s too soft. She always agrees to pay for every child’s medical bills. She’s already paying too many medical bills on the maternity ward, despite most of the treatment there being free. It would be cheaper for her to stay home and not get paid than for her to work and pay everybody’s bills.

In the last four+ years, I’ve tried multiple methods of coercing parents to pay their bills. At first, I tried the optimist/pragmatic approach. “You know if you buy these medicines, your kid will get better, right? And if you don’t, he’ll die, right?” It didn’t work.

So I switched tactics. I tried the guilt tactic. “What kind of father won’t pay for his kid’s medical bills?” That didn’t work either.

I tried the financial approach too. “You realize it’s a lot cheaper to pay for these medicines now than it is to pay for the kid’s funeral.” That never convinced anybody, even though it’s true. And they’d find the money for the funeral.

I tried shaming. “Dude, you have a super nice watch. You have a cell phone! Go leave it at the pharmacy as collateral. Once you pay off your bill, you can come pick it up. Or your bicycle. Or your cooking pot. Anything! Seriously? Your cooking pot is more valuable to you than your child’s life!” Even this didn’t work, boggling as it may be.

I tried threatening. ‘You know, kids are expensive. They don’t come out of the vagina holding money in their hands. You need to feed them, pay for their medicines, pay for their school. They are expensive. If you can’t afford to pay for the child’s medicines, we give birth control away for free here! Male condoms, female condoms, pills, shots, intrauterine devices, implants, vasectomy, you name it! Free! I’ll even pay tie your tubes! If you can’t afford this child’s medicines, he will die. Then you’re just going to have another one! And guess what?!?!?! I can promise you that next child will be sick eventually too. And you won’t buy the medicines for the next child either?!?!?!?! And they will die too!!! And some day, you will need to answer to God how you decided to have a bunch of kids that you refused to take care of, chose your cell phone and cooking pot over, and allowed to die, all because you couldn’t pay $2.10 for intravenous quinine!!!’ I was always screaming by this point. Hence the exclamation marks. Remarkably, this had been my most effective technique.

But the other day I was rounding on pediatrics again. Once again, a very well-educated and well-dressed couple inform me they won’t be able to pay for their baby’s medicines. $2.10. I remind them we gave them free medications the day before and we told them they would need to spend the day looking for money to buy today’s medicines. I also remind them they are from Bere, so surely have plenty of friends, family and neighbors who will loan them $2.10 to pay for their kid’s treatment. The father starts a not-unfamiliar tirade about how I am an American and can’t understand because Americans only have two or three children each, maybe four. It’s easy to pay for only four children. I agree with him. Why do you keep having so many expensive children? Why not just stop at four and take good care of the four you have? He thinks about it for a while. Then decides he had better just stick to the party line. We don’t have any money.

I know this tactic well. This is when parents enter the game of chicken. They lock you into a stare down. If the kid is just a little sick, this game can go on for days. If the kid is a lot sick, and they don’t realize it, the kid can die. Or if the kid is a lot sick, and they do realize it, the parents figure it’s futile and a waste of money and no way will I cough up the money as the father, but if you want to pay for my kid as the visiting missionary I suppose I could be sufficiently gracious to allow you to do that. Usually, the parents will finally produce the money. Occasionally, rarely, I lose the game of chicken and I agree to pay. But I’m not ok with the innocent child losing in this game. This is so frustrating. Taxing, even.

At this point, after seeing this child suffering and talking to these resourced parents, and after taking part in this ludicrous dance each day of the last four years, my soul sighs. Somewhere deep within, I feel my heart inhale deeply and then fall, letting it all out. I give up. I am no longer angry. I am barely even sad. I am simply tired, at the end of my rope and letting go.

So I turn to the mother.

‘Did I have sex with you?’

The mother’s jaw drops. Her eyes get wide. The husband takes a step back (which, I note, is better than a step forward). Even my nurse turns and looks at me.

The mother is quite certain she doesn’t understand the French this crazy guy is speaking. ‘Huh?’

‘Did we sleep together?’ The neighboring kids’ parents are overhearing this and are getting curious. Boy, imagine that! We may have quite the story to tell in the market about what the white missionary is doing in town!

‘No.’

‘You’re sure?’ I’m wading pretty far outside of what was taught at the three-week missionary training course we took. Although, admittedly, I did skip a lecture and the asking-the-national-if-you’ve-ever-had-sex-with-her topic may have been discussed in my absence. And Danae is a lousy note-taker.

‘We never slept together.’

‘You are absolutely certain you and I have never had sex with each other? I mean, I’m a heavy sleeper and I’ve been known to sleepwalk. And every time I have malaria there’s about three days I’m completely out of it and don’t remember a thing. Maybe we had sex and I’m just forgetting it.’

‘No. You never had sex with me.’

I turn to the husband. ‘Did I ever sleep with your wife?’

‘No.’

‘There’s no doubt in your mind?’

‘You never slept with my wife.’

‘Ok. Then that baby isn’t mine.’

The lights come on. The relief is evident. The husband smiles. The wife starts cracking up. All the eavesdropper in the room, and even in the next ward over, start laughing out loud.

‘So I never had the pleasure (presumably) of sleeping with your wife. This child will never work in my fields. And this child will never take care of me when I am old.’

And then the coolest thing happens.

With a smile, the father of the baby shakes my hand, nods his head recognizing I just out-maneuvered him in his own game of chess, pulls a large bill from his pocket, and walks off to the pharmacy.

I feel my heart inhale again. I feel a smile on the corner of my lips. Respite for the soul can come in the strangest of circumstances.

(I’ve used this same method now repeatedly. And astoundingly, it works every time. Everybody smiles and laughs and the father digs out some money to pay his bill.)

Restore a Child has given many significant donations via Adventist Health International to pay for bills on pediatrics. It’s been a huge blessing. So now Danae can round on pediatrics again without emptying out our safe! But it’s always a challenge trying to determine who is truly needy and won’t be able to pay their bill and who is playing the deadly game of chicken.

Olen Netteburg

Missionarydoctors.blogspot.com

Danae.netteburg@gmail.com

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

Olen et Danae Netteburg
Hôpital Adventiste de Bere
Boîte Postale 52
Kelo, Tchad
Afrique

Volunteers Welcome!!!

Hemotoxic

I hate snakes.  I hate snakes.  I hate snakes.  

I hate them even more after this story.  

We have some neurotoxic snakes.  Their venom attacks the nervous system.  There are other types of snakes here that are hemotoxic.  Meaning once you get bit, the venom binds to your blood’s clot-making system, causing it to quit working properly and your blood can no longer coagulate and make clots and stop bleeding.  In our worst cases, our patients slowly ooze from their IV sites, from their ears, from their nose, from their gums, even from their eyes.  They cough up blood, they vomit blood, they poop blood and they almost always pee blood.  Slowly.  No big gushing fountains of blood.  Just mere oozes.  Oozes that never stop oozing.  And despite the slowness of the oozing, you eventually outstrip your body’s ability to make new blood.  Your marrow can’t keep up with the slow oozing.  And you eventually hemorrhage to death, or “bleed out”.  

Scary, right?  Remember the Ebola epidemic?  Caused you to bleed out.  Same thing.  Only if you get bit by a snake you aren’t contagious like with Ebola.  

I once had a pregnant patient come in with a nose bleed after getting bit.  It stopped eventually and she did fine.  I’ve had another pregnant patient come in after getting bit, lost her baby, delivered, stayed in a coma for a day or so, but eventually recovered. 

I’ve had some real disasters this month.  This was one of them.  But somehow I had a bit of hope for the patient who came in last week.

She was a young village girl coming in with vaginal hemorrhaging at six months pregnant.  I mean, she was really pouring out blood, not oozing.  Vaginal bleeding, we know how to treat.  The only thing is she had been bitten by a snake four days prior with no antivenin (“anti-snake-venom”) given.  And… our hospital was out of antivenin.  Sigh.  

With uncooperative blood like this, it’s never a good idea to do a c-section.  I’d rather get her delivered vaginally.  However, she was bleeding too much.  And we weren’t certain that her blood wouldn’t coagulate, just speculating since we have no labs to test that here, except for cutting the patient and sitting around and watching to see how long it will take the blood to create an effective clot, if ever.    

So c-section here we come.  

Mom was completely alert and talking as we wheeled her into the OR.  I don’t like to scare people, nor do I ask everyone if they know God before surgery, but this one just was a setup for disaster.  You see it over and over here.  You can see death has a higher possibility of occurring in this patient, but not in that one.  You think about it later and wonder if it would have changed their eternal outcome if you would have said something and told them it was easy, just accept grace, unmerited favor.  No point in wondering anymore. 

Like most of my patients, she didn’t speak French.  I asked her through an OR nurse if she knew God.  She said she did, but seemed shy and not real clear with her response.  I told her it was never too late to decide you wanted to be on God’s side.  The thief on the cross decided right before his death. We prayed and started the c-section.

Cut through skin, fascia & uterus.  Got tiny little baby out.  Only about 1 pound.  Looked dead already, but had a heart beat.  Lived only a couple minutes.  

Closed uterus.  Uterus wouldn’t contract well.  Put stitches around uterus to help it stay contracted.  Seemed to work.  

One problem.  Her muscle.  Her abdominal muscle would NOT stop bleeding.  And her uterus then started to bleed from the suture points.  A few more sutures put in.  Sutured up the muscle as best as I could.  Next her subcutaneous tissue (her fat) kept bleeding.  I kept suturing, closing off all of the tiny vessels that wanted to bleed out.  They were begging for a way to let her blood drain.  Skin sutured.  Done.  She wasn’t hemorrhaging vaginally.  Her conjunctiva looked pink.  Sigh of relief.  

Five units of blood were given during her surgery.  She was blood type O positive and we only had six more units in the fridge of O+.  I put a very pressurized dressing on her lower abdomen and prayed for the best.  Sometimes that’s about all you can do here.  

Two hours later Ndilbe told me she did not look well and looked really anemic again.  

Oh boy.  This wasn’t going to end well.  I knew it.  Mason knew it.

But as a doctor, it’s hard to sit by and watch someone slowly ooze to death without trying everything you can do.  So we try.  We try despite our knowledge this is unlikely to work.  But you think there’s a chance.  You give the patient that slim chance.  And then you leave the rest to God.  

We urgently brought her back to the operating room.  She was not the same young girl, alert and talking.  She was in a bad state.  Anemic and out of it.  

I reopened her and found a belly full of blood.  The abdominal wall muscles simply would NOT stop bleeding.  Now bleeding seemed to come from everywhere.  I wanted to try to block off all of the big vessels that might be causing her hemorrhage.  I did an emergent hysterectomy.  There was no more pelvic bleeding.  I ligated her bleeding abdominal muscles again.  I closed her again.  

We tried.  Mason poured more blood into her.  Yet five more units for a total of ten bags of blood.  When I finished the surgery, he held up his last unit of O+ blood, and we agreed reluctantly, hesitantly, somberly, that we couldn’t give it to her.  We needed to leave something for the inevitable pediatric patient with a hemoglobin of 1 or 2 or maybe 3 who would certainly come in that night, like they do most nights this time of year.   We did everything, except give an eleventh bag of blood.  

She lived another eight hours.  And then she died.  She died of a snake bite.  One that we don’t have the antivenin for.  And one that the family refused to go to Lai (18 km away) to get the available antivenin.  It costs 38 dollars there.  And we hadn’t charged her anything for the care we gave her.  Honestly, it probably wouldn’t have made a whole lot of difference.  It was already so late in the game.  

We won’t know the real outcome, her eternal destiny, until Heaven.  Only God knows.  Until then, we keep trying.  

Chadian Ambulance

Congratulations. You are now a Chadian villager. You are happy
living a simple, rural life. You live in a small mud hut and provide
for your family with the simple crops that your field produces. You
sometimes sell chickens or goats in the market. You don’t have much
money. But you don’t need much money either.

You are a woman. You are a mother. You have cared for many children.
Each one is special to you. Your daughter gets married and is now
expecting. Her family will soon be expanding.

You get word that your daughter has been having seizures at home. You
don’t live in the same village as her, but you must get to her. The
roads are bad because the heavy rains have already started, but none
of that matters to you. You must get to her.

You find your daughter at her home in a coma. Her husband has not
taken her to the hospital even though she has been seizing for many
hours already. You know better. You know she needs help.

You don’t have transportation. You ask people around if they know
anyone who can get her to help. One young man knows someone else who
has a motorcycle.

The motorcycle arrives. Your daughter is not waking up. Her body is
floppy and difficult to position on the motorcycle. It doesn’t
matter. She must get to help. You position her behind the driver and
sit behind her so she doesn’t fall back. Her legs flop down on the
sides of the motorcycle. You prop her head up between you and the
driver. This must work. You must get help.

You arrive to the nearest health center. You carry your limp daughter
to the door only to find out they are sending you to the nearest
hospital.

Back on the motorcycle. Just as you are taking off she starts seizing
uncontrollably. It’s really scary. You think she is dying. Finally,
after what seems like an eternity, she stops seizing and goes limp
again.

Off again over the bumpy, mud-slicked roads. You hold tighter onto
the driver in front of you so your daughter will not slip from between
you. Her breathing is rough now.

You get to the hospital.

Only to find out they are referring you to the mission hospital 20 km
away still.

More bumps, more puddles. More seizing. Whatever it takes.

Finally you arrive at the mission hospital. It has been over 12 hours
your daughter has been seizing and not speaking. The people there
explain that your daughter is suffering from toxemia of pregnancy
(eclampsia) and that she needs a surgery to deliver her baby to make
the sickness go away.

You wait outside of the place where she is having surgery. You are so
tired, but you refuse to sleep. You have to stay awake to see your
daughter come out of the surgery place.

After a long time the doctor comes out and explains that your daughter
is very sick. The surgery went well, but unfortunately the baby was
too sick and has died.

Your daughter stays in a coma for the next 2 days. The staff tries to
reassure you that sometimes this happens and people can still survive.
You do what the staff ask, repositioning her, massaging her legs. You
keep a little hope left. You are so tired still. You have barely
slept in the past few days. You would do anything for your daughter.

The morning of the third day your daughter opens her eyes. Your
daughter, who you fought for, opens her eyes and talks. She asks for
water. Words cannot express the joy you feel. It was almost
hopeless, and then she recovered. And you are so thankful. You have
your daughter back.

This is a true story. In the past week, we had six seizing pregnant
patients come in. There’s not much going on in the hospital, as far
as elective cases, but the emergencies are keeping us busy somehow.
It’s hard to tell sometimes which sickness they have when they have
signs and symptoms of both eclampsia and cerebral malaria, so we treat
them both. You can’t really base your decisions solely on blood
pressure or fever or other tests.

So far none of the six have died. One walked home today. The patient
in this story has fully recovered. Two of our patients are still
seizing postoperatively. Our hospital has run out of magnesium, a
medicine to prevent seizures in this sickness. Luckily I found some
expired magnesium hidden in our office, but it is from 2013. It’s
probably less potent now. It’s also illegal to give expired
medications here now.

Many, many times I see this burn on a comatose patient’s leg. It’s called a Tchadian tattoo to those who have visited here. Even if you are not comatose, it’s easy to get burned. But when you are unconscious, your legs flop so easily on the sides of the motorcycle, it’s impossible to not get burned. The burn is the easy part to heal. Sometimes it’s not so easy to fix the underlying problem.

People use all types of ways to get their loved ones to the hospital. The least common method is by car. Other ways are moto (motorcycle), ox cart, donkey, pousse-pousse (a hand pushed cart with large wheels), and by foot.

Tchad bombings

More bombings in Ndj this morning. I'm not saying this to scare you all, bc we are far from the capital but doesn't make me want to leave the country either bc I have to go trough NDJ.

Here's what another missionary wrote/discovered about the situation, "the story is that the Tchadien police discovered a BH safehouse and raided it this morning. Those in the house blew themselves up which also killed 5 police officers. So it was not another attack except that the police attacked them. Still terrible but makes us feel better about it. "

Prayers appreciated!

This just after the bombings 2 wks ago. Hopefully things calm down before we are to go back to America in 3 wks (leaving via Ndj). Another reason why I don't like cities!