Tuesday, July 7, 2015

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

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

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.

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