Arresting Development

So yesterday I did an ultrasound on a Muslim patient who hadn’t had a period for three years. She came from several hours away with her mother to figure out why she hadn’t had a period in three years.

I did the ultrasound and then turned to her and her mother. “Alhamdullilah! Praise Good God, you’re pregnant! Just past 27 weeks! I don’t know why you were having issues with your periods, but this baby has a solid heartbeat and is moving around. Everything looks perfect! Congratulations!”

Neither one of them seemed terribly excited, or even convinced. She did seem a little under the weather and had a fever and positive malaria test. She also reported a little burning when she peed. I decided to admit her overnight for some IV therapy.

Today on rounds, I repeated this was the miracle momma, being six months pregnant after no period for three years! Still no smile.

After rounds, the mother of the patient asked to see me in private. I joked with her, “Well, my wife wouldn’t like me going into a room alone with another woman.” (This woman was old. I figured this was an obvious joke.)

She assured me that my nurse could accompany us and asked repeatedly that I pardon her for the intrusion. I assured her right back that there was no intrusion at all and I’d be happy to talk to her. Didn’t really matter medically, but I was curious to find out why they weren’t happier about the pregnancy.

Once in a vacant delivery room, the mother started by asking me to pardon her over and over again. I told her I pardoned her, but I’d prefer to know what exactly I was pardoning her from. Explain.

She told me her daughter was beat up by her husband three years ago, when the periods stopped. The patient’s father then repaid the husband the dowry to buy his daughter’s freedom.

Could this be the ex-husband’s baby?

I told her, yes, it absolutely could be the ex-husband’s baby! But not from three years ago. She got pregnant sometime about six months ago.

The mother told me it was impossible for her daughter to have gotten pregnant six months ago, as she hadn’t had a period in three years.

I agreed with her that it was odd, but still possible she had that solitary ovulation and got pregnant. I wondered, “How do you know your daughter wasn’t having her periods?”

“Well, in our family, if you have your period, you need to eat by yourself. She eats with us every day.”

Oh, I see. Scientific-like.

The mother continued, “Also, she says she hasn’t been having sex with anybody. How is this possible?”

Well, both the Qur’an and the Bible are in agreement Mary was a virgin when Jesus was born. So there’s been at least one case study. Nobody here owns a toilet seat or a swimming pool, so you can’t use that excuse.

“It’s medically impossible.”

“In our family, we all marry within the family.”

“Well, maybe she’s back with the husband, or a family member that’s too close, or somebody outside the family, or maybe a Christian, or who knows. But it’s highly likely she has had sex with somebody in the last year. I can put the odds of that pretty high.”

“Pardon, pardon, pardon, doctor. I’ll pay any amount. We can’t go back to our village with her. If they find her pregnant without a husband…”

Oh, boy. I cut her short. “I’m sorry. Abortions are illegal in Tchad. And while they’re legal in America, we still don’t do them unless there’s a risk to the mother’s life.” After a very short reflection, I added, “Unless there’s a medical risk to the mother’s life.”

“No, no, doctor! I would never want an abortion! That’s sin! I just want you to give her a medicine that will stop the pregnancy for a short time. Then after we can marry her to somebody, then she can stop the medicine and the pregnancy can continue.”

“Um, even in America, that doesn’t exist.”

“Ok, what about a cream or something you can smear on her belly to make it look smaller.”

“I assure you, if I had such a cream, I’d go to America and be a billionaire.”

She was definitely non-plussed.

I went on. “I’m sorry, but I don’t know of any means to stop her from delivering a healthy baby in a few months’ time. Even if she delivered now, some babies at this age survive. If she’s going to be killed by her family in three months for having a baby, we can hide you here in the hospital for three months. We can call your family and say she has a medical condition that will take three months to treat. After delivery, I can find a couple looking to adopt. We have so many couples with infertility who are wonderful people and desperately want a baby. I could find a very nice couple, Muslim or Christian, whatever you want.”

The mother opposed. “No, our family will come. Everybody knows our family. Eventually somebody would see her with a large belly and would discover her.”

We sat in silence for a minute while I thought of what else I could offer her. I quoted her the Qur’an, 

13.8

God knows what every womb bears, by how much they fall short of their time or number or do exceed. Every single thing is before his sight, in due proportion.

He knows the Unseen and that which is open: He is the Great, the most High.

She nodded her head in agreement. I wasn’t really sure what that meant, because there wasn’t much counsel in it, just comfort, or at least I hoped comfort. Reminder that there was a greater plan.

The grandmother-to-be decided. “Can you discharge us? I’ve heard of a Marabout (witch doctor) past N’Djamena who will either be able to suspend the growth of the baby for a time until she finds a husband or who can smear a cream on her belly to shrink it.”

Sounds reasonable. “Ok, but if that doesn’t work, you always have an open invitation to come hide here and we can find an adopting couple.”

“No. If he can’t do it, I will travel the entire country until I find somebody who can.”

“Ok, but travel quickly. She’s gonna be mighty large in a few weeks’ time.”

We had a most amicable parting. Walking away, I just shook my head. Five years ago, this would have deeply shaken me. Now… Just another day at the office. Just another prayer who’s end result I’d never know.

ENEMIES

Enemies are scary. Kinda by definition. You’re supposed to shoot them. Or something. Who are your enemies? Who are ours? Who are mine? Stop and think. Start naming our enemies. Do you have enemies in mind? You need to get one before you continue!!! Think of one! Ok, now go on.

Well, back in the Old Testament, the Children of Israel had enemies. A lot of them. But those closest to us can always hurt us the worst. I’ve had some fun lately digging into some Old Testament history.

About 1400 B.C., Joshua dies (unsurprisingly at the end of the book of Joshua). After that, Gideon lays the smack down on some Midianites (in Judges, it’s such a sweet story, too bad it’s really unrelated to this one) and then Eli, the high priest, leaves Moses’ desert tabernacle on Mount Gerizim and builds a second one under his rule among the hills of Shiloh (1 Samuel), somewhere around 1100 B.C. The folks still back on Mount Gerizim feel this creates an illegitimate priesthood and a bogus tabernacle. And the folks at Shiloh harbor some ill will toward the old farts back on Gerizim.

Now do you remember the time in the Old Testament when Israel split into the northern and southern kingdoms in 931 B.C.? Well, this was pretty much the cause of it. Saul and David and Solomon did an admirable job trying to keep the kingdom together. But still, the guys in the north really didn’t like the temple in Jerusalem. It couldn’t be held together any more. The north was quite adamant God was high atop Mount Gerizim. So there. Okay, fine then. The south said the north was full of heretics, practicing idolatry up there in them thar hills far away from Jerusalem. Civil war ensued. The TEN tribes in the north kept the name ‘Israel’. The TWO tribes in the south took on the name ‘Judah’.

Then the feud got exceptionally nasty around 722 B.C., when Sargon II from Assyria conquered the northern kingdom. Skipping ahead to 2 Kings 17, Sargon II decides to take a pass on going after Judah in the south, and contents himself in bringing all his POWs from Israel back to Assyria. But they didn’t stay in Assyria. This Sargon cat was wicked smart. And mean. He split all the Israelites up and dissipated them out to the farthest-flung provinces of his empire, essentially shattering any chance they had at maintaining a sense of culture and heritage. These became lamented as the Ten Lost Tribes, one of history’s most affective, thorough, mysterious and amazing disappearing acts.

Shortly thereafter, those in the southern kingdom (Judah) essentially suffered the same, if somewhat delayed, fate. The north had prophets warning them (Amos and Hosea) as did the south (Joel, Isaiah, Micah, Zephaniah, Jeremiah who recorded the north’s demise and predicted the south’s, Habakkuk and whichever lugubrious soul wrote Lamentations, probably also Jeremiah), before the south got nailed about 136 years after the north in 586 B.C.

A couple hundred years after the north was taken and just a bit after the south was taken, Ezra, and then Nehemiah, return home to Israel/Judah, only to realize it appears Sargon the Deuce and his successors did the same thing to others, taking non-Jewish POWs from his other wars and scattering them all over the place too, including old Israel/Judah. Now in Israel/Judah those returning from exile find their ancient lands occupied by these apparent squatters. The returning exiles were appalled such a ragtag group of imposters would dare call themselves Jews! And the squatters were downright livid the exiles didn’t recognize their inherent Jewish-ness.

The posers claimed to be the remnant, the group Sargon II missed when he carried off the POWs, descended a couple hundred years. They claimed to be the ethnically intact and pure Jewry. And argued the returning exiles had been defiled, lost their pure blood and pure religion to their slavery and mixed-breeding. Wait, no! The ragtags that were sent to occupy Israel by Sargon II were the mixed-breeds!!! Oh, boy.

Well, the Talmud, the renowned historian Josephus and 2 Kings all seem to support the claim that Sargon II did indeed send a diverse and piecemeal bunch of pagans to repopulate Israel. In fact, 2 Kings goes into some detail, explaining how the pagans begged Sargon II to send back a Jewish priest to teach them the religion of the land when lions started snacking on them. And wouldn’t stop. 2 Kings even goes into the details of where these squatters were sent from, and it’s a long list of various towns.

But as you would expect, they just mixed Yahweh in with their own gods to form a witches’ brew of half-baked heretical beliefs and erected altars and statues to such in the temples of this abandoned Israel. 2 Kings even goes into specifics such as child sacrifices and other unpleasantries. If you read the end of the chapter, you can even sense the ill will Jeremiah had toward them, that their children and children’s children kept up these ugly practices, ‘even to this day’.

So when Ezra and Nehemiah get back and want to rebuild the temple, these half-bred heretics come and welcome them home like long-lost brothers and offer to help them rebuild. Well, they don’t even look like they’re the same ethnicity, let alone speak the same language. Ezra tells them thanks, but no thanks. Except he’s not that nice. In his own book (Ezra 4), he describes the squatters as the adversaries of Judah, even though they’ve been the stewards of the land for the last 200 years, feeling like they’ve been practicing good Jewiness and probably using words like ‘Jewiness’ on accident, and offering to help rebuild the temple. Ezra says, ‘You may do NOTHING with us!’ Well that’s not very neighborly.

So the squatters got pissed. They started writing letters to the new king, Cyrus at that time, then Darius later, just trying to give the returned exiles trouble. The squatters developed a sense of freedom fighters against a much larger group of occupiers who sought to disband them.

Despite the opposition, the returned exiles eventually rebuilt the temple in Jerusalem. The two groups, both claiming to be the true Jews and accusing the others of being fake and corrupted Jews, settle into this enduring enmity. The squatter Jews who are accused of not being true ethnic Jews and mixing religion, retreat up to the northern kingdom of Israel and Mount Gerizim, the site of the original and true temple. The returning exiles, accused of being corrupted and outbred while in exile without organized religion and study and worship and community, settle toward the south and Jerusalem, Judah. Whoa.

That’s not the end, though. The apogee came in 167 B.C. after Alexander the Great swept through with Hellenistic culture. The Seleucid king Antiochus Epiphanes ruled over the Jews. The dude proclaimed himself to be the incarnation of Zeus and condemned to death anybody refusing to worship him. That’s just harsh.

Well, the savvy mixed-breeds in the north decided they could accommodate. They would allow Antiochus to dedicate their temple up on Mount Gerizim to Zeus, and get this, somehow the north allowed Antiochus to erect an altar to Zeus in Jerusalem, in the south. Antiochus sacrificed a pig there, pretty much biggest heresy somebody could do. This became known as the ‘abomination of desolation’, which sounds impressive and important. Antiochus’ successor even leveled the temple on Mount Gerizim in 128 B.C.

But under the Romans, the temple was rebuilt and the group became a large and established community occupying a sizable chunk of land between Judea and Galilee. 

Do you know who these people were?

These were none other than the Samaritans. They even got the name clear back in 1 Kings 21.

Yup, that’s right. These bastard displaced persons during the exile who dared to ask if they could help rebuild the temple and finally withdrew to Mount Gerizim, the site of the original Jewish temple to Yahweh, these are the Samaritans.

So there you had it. Jesus came along at a time when the mainstream Jews were in Judea to the south and Galilee in the north. Samaritans were sandwiched between the two groups. And they were hated. I mean hated. They were openly cursed in synagogues. They weren’t allowed to be witnesses in courts! Imagine, somebody could lodge a claim against you and you couldn’t even call a witness! In fact, get this, Samaritans were not even allowed to convert to Judaism!!! How’s that for evangelism! The official Jewish position was that no Samaritan could ever achieve any sort of afterlife.

Jews typically would cross the Jordan when traveling between the lands of Judea and Galilee just to avoid Samaria. After all, it could defile your holiness! You wanna start a fight, call a Jew a Samaritan and just see what happens! They were a spiritual brand of lepers, avoided at all costs, vocally condemned, and preferably struck with rocks should you unfortunately cross paths with one at an intersection. Idolaters worthy of death.

They were openly counted as enemies. Archenemies if ever there were. Centuries of bad, bad blood.

Let’s jump to Luke 10:25. ‘And behold, a certain lawyer stood up and tested Him, saying, “Teacher, what shall I do to inherit eternal life?”

‘He said to him, “What is written in the law? What is your reading of it?”

‘So he answered and said, “‘You shall love the Lord your God with all your heart, with all your soul, with all your strength, and with all your mind,’ and ‘your neighbor as yourself.’”

‘And He said to him, “You have answered rightly; do this and you will live.”’

Okay, cool. Love God. Love neighbors. I’m down with that. Hang on…

‘But he, wanting to justify himself, said to Jesus, “And who is my neighbor?”’

Then Jesus told the story of the Good Samaritan.

In the Good Samaritan, the Jew gets beat up and the holy priest and Levite pass him up, while the Samaritan helps him out. So Jesus says the Good Samaritan is the neighbor.

Yeah, I get that.

Wait. No. You mean…

So what you’re saying is…

Essentially…

We just said, ‘Love your neighbor as yourself.’

Then we said, ‘The Samaritan was the Jew’s neighbor in the story.’

I studied math. If A = B, and B = C, then that means A = C.

So, that means I’m supposed to love the Samaritan as myself?

I’m supposed to love my ARCHENEMY as I love myself?!?!?!?

Surely you don’t mean that. Dude, this is complicated. There’s a loophole, right? It’s a parable, right? There’s wiggle room here, right? No?

Jesus traveled frequently through Samaria, refusing to traverse the Jordan River to avoid them. On one of those trips, he met the woman at the well. He asked her for water and she responded what the what? You know, right, I’m a Samaritan? You’re in Samaria. You know that, right? And you are aware you’re Jewish? You’re not even supposed to be stooping to speak to me. You want to drink water I give you?

And then Jesus does some craziness. He tells her she can have eternal life. That’s so a no-no for a Jew to think a Samaritan can get in on that! Not cool, Jesus!

It goes on. The woman tells him, Jesus, you know, right, that our fathers worshiped on this Mount Gerizim and you Jews say that people should worship in Jerusalem.

Are you kidding me??? This woman is rehashing the 1100-year-old debate?!?!??! Really?!??! She still knows 1100 years later what causing this divide! How messed up is that? Which mountain we can worship our omnipotent, omniscient and OMNIPRESENT God on?

But check it out, she’s ahead of the Jews. She goes on to recognize, ‘I know that Messiah is coming. When He comes, He will tell us all things.’ He’ll sort this big mess out between us. No worries.

Jesus responds, ‘Yup. You got it. That’s me. Guilty as charged.’

Wait, you’re the one to sort out the divide between us?

At this point, the disciples return from town and start straight trippin’ seeing Jesus chatting up a Samaritan woman. The woman walks into town and brings out a bunch of men, saying, ‘Come see this dude! Could this guy be the Christ?’

Then the Samaritans invited Jesus to stay and teach them. And Jesus stayed days with them. Amazing.

Even after the resurrection, Jesus still has his mind on the Samaritans. In Acts 1:8, the very verse before His ascension to Heaven, Jesus’ last words were, ‘You shall be witnesses to Me in Jerusalem, and in all Judea and Samaria, and to the end of the earth.’ Dude specifically mentions Samaria. This guy for sure practices what He preaches.

And you can go on to read Acts 8, 9, 15, etc, where the disciples go ahead and witness to the Samaritans! Philip, Peter and John came and laid hands on them and they received the Holy Spirit. Saul, Paul and Barnabas all pay visits to Samaria too.

You know, when you really boil down Jesus’ life, you could make a reasonable argument that Jesus died for preaching the message ‘Love Your Enemy’. Very unpopular in Jesus’ time. Hmm… you know what? It’s actually a very unpopular message today. You say it’s easy? We all buy into it? We say we do. What would our lives actually look like if we genuinely bought into this principal. It’s powerful.

Martin Luther King, Jr. Gandhi. They pretty much both died for this message.

It’s a scary message. It could change the world.

What would be different if you could just Love Your Enemy?

Imagine. Imagine specifically. What was the enemy you thought about in the first paragraph? Do you think God gives you an out so you don’t really need to love that enemy as you love yourself? How would you behave differently, what would be different, if you loved that enemy as you love yourself?

Love Your Enemy. No exceptions. Imagine. Jesus felt it was worth dying for. Do you?

Reality/Daily Mission Life

My nurse on maternity just came to my door.  It’s 1:30 in the morning.  Sabbath morning.  She’s got lots of experience so I trust her.  She just came to tell me that one of our patients had delivered and was quite anemic (hemoglobin 4).  The baby died soon after delivery.  I gave her the keys to the operating room where we keep the blood bank so she could get another bag of blood to transfuse because the family still wouldn’t give blood.  Sad.  One of my realities.  

The same patient had come in the night before very pale with anemia symptoms and a hemoglobin of 3 and no bleeding.  (For reference, any hemoglobin under 7 is typically considered life-threatening and gets transfused in America.)  We gave her two bags of blood, about half what she would have received in America.  The family wouldn’t give.  Our blood bank is limited.  Mom said baby was moving less.  She had no due date (unsure of her last period, which is typical here) and I have no ultrasound for the moment.  I explained that the baby needed the mom’s blood to survive.  Still the family wouldn’t give.  They fear they may not have the strength to work in their rice fields if they give their blood.  They play a dangerous game of chicken to see if we will give from our blood bank.  And it’s a game we always lose, drawing blood before every elective surgery, drawing blood from our volunteers, drawing blood from our staff…  

Once last year I went without an ultrasound machine for two days.  It was a very long two days because I depend on it so heavily.  Now I’m at five days and counting with two busted machines.  It is a very terrible situation.  But what do you do?  

Three days ago I opened a young lady with a small Phannensteil incision for possible ectopic pregnancy.  Positive pregnancy test.  No ultrasound to confirm, but pain.  Not too terrible though.  Not anemic to speak of.  I just couldn’t send her home without knowing.  And…..there’s nowhere near that has an ultrasound.  Everyone usually comes to us for referrals.  Lai, Kelo… even further.  

Well, it’s a good thing we opened her, because she had a growing and life-threatening ectopic pregnancy in her right tube and she was actually ruptured with a small amount of blood in her pelvis (500cc).  

Oh, and just prior to her case I was told we didn’t have any 10, 12, 14, 16, 18 size foleys  (tube to empty urine from bladder).  I found a bunch of straight catheters, so taped one of those in place during the case.  Again, one of my realities.  It’s never a surprise anymore.  Just do the best for the patient with what you have.  

Today I opened a “three month” pregnant lady with a huge flank/pelvic mass that I shouldn’t have had to.  An ultrasound would have clearly told me that I didn’t have to open her.  She had such pain and the patient said through translation that it had only been there since the pregnancy started.  Differential diagnosis: ectopic (hey, I’ve had a seven-month ectopic pregnancy), torsion with large ovary, huge liver abscess, other abscess, cystic kidney, intestinal tumor (less likely) given no vomiting.  

No ultrasound.  What to do?  Positive pregnancy test.  I opened her.  

It turned out to be a large retroperitoneal mass (more than 15cm) extending down into pelvis with a normal (or at least intrauterine) pregnancy.  So my most likely diagnosis now is a large cystic kidney.  Of which an ultrasound would have easily shown.  At least it was a small incision.  And don’t judge me for opening a normal pregnancy.  

I closed her up, not messing with a kidney while pregnant.  We’ll bring her back after she delivers to deal with her mass if still necessary at that point.  I re-questioned the family when explaining the diagnosis.  They said, oh ya, she’s had that mass since she was married (a few years).  Awesome… that’s not what you said BEFORE the case!  

Invasive testing (a surgery!) when otherwise wouldn’t be necessary.  Part of my reality right now.  

Back to the repair of our ultrasound machines…  We swapped ultrasounds with our sister hospital in Moundou, since their machine was better and we do more ultrasounds.  Then Moundou’s ultrasound broke while in our possession.  We sent it back to America for repair, which took three months.  We then took back our ultrasound machine from Moundou while their machine was getting fixed.  We finally got back the good ultrasound machine from America.  But then it just broke.  And then the old machine broke right away after that!!!  I don’t know what we can do with the old machine, but we will send both machines back for repairs with the next volunteer returning to America in a couple weeks.  But it will likely not return until January.  So odds are good we will be without an ultrasound for the next 4-5 months!!!  That’s really going to hurt us financially and with the care we give also.  (Ultrasound is about 6-7% of our income and 1% of our cost.  That’s good business!!!)  We’re hoping to find either a donated machine or the funds to buy a new one.  SonoSite sells Adventist Health International a sweet portable machine for $7500 plus $2500 for each probe.  We really should have a spare.  

This week I got to remember what it’s like to be a single parent to three kids temporarily.  Olen’s been in the Ivory Coast for a week and a half for global healthcare conference.  Mom usually watches the kids during the day.  But… she got malaria this week.  Thankfully our new student missionaries have jumped in and helped out so much taking care of the kids when I’m at work.  

It’s just me and my dad taking care of things at the hospital.  Then Dad also got malaria!  So one of those days it was just me.  He was in bed for a day, though I did make him come in for five minutes to start a thoracentesis. I just didn’t feel like puncturing a lung since it wasn’t urgent.  

Dad’s getting better (he’s 72-years-old) after three days of Malarone and Fansidar.  Mom’s (also 72) treatment is finished, but she’s still sick.  So continue to pray for her recovery.  She may need quinine, but we’ll see how she does overnight.  I told my dad that I am stuck with the old (them) and the young this week!  He’s not really old, my parents have a strange youth to them!  Malaria can knock any young whipper-snapper down on their butt.  

On a positive note, I somehow managed to treat a few cases out of my comfort zone while Olen and Mason were away and while Dad was under the weather.  A 20-year-old boy with diabetic acidosis (complete with Kussmaul respirations and not quite with it in the head).  Fluids, fluids, fluids.  Lots of checking to see if nurses were actually giving it.  Checking to see if family were paying for the fluids that I prescribed.  Night one at 11pm,  found nurse sleeping.  Didn’t yell (go me!) and instructed to please get a second line like I said to the previous nurse, and pound the fluids (10 more bottles before morning!).  Next morning, no more Kussmauls.  Yay!  Some improvement. 

More fluids.  

Next day.  Patient actually able to communicate and actually with it.  Thank you Jesus.  I thought for sure I was going to kill him.  (Not me, but the sickness of diabetes).  

(Editor’s Note: Danae treated this extremely-non-obstetric patient who would have otherwise died as perfectly as any physician could in our circumstances, saving his life. I discharged him the day I got back.)

Next to him was a CHF exacerbation that I somehow managed not to harm, and actually to treat.  No ultrasound.  And we’ve never had a working x-ray here.  Another reality.  Just go on exam and symptoms.  Labs… what are those?  I’m serious.  Hope he’s not hypokalemic with the Lasix I’m giving him.  If he were, we don’t have any potassium supplementation.  Eat lots of green foods!!

(Another Editor’s Note: Danae treated this dying patient perfectly as well. I discharged him too the day I got back on atenolol and minimum-dose furosemide.)

Another 20-year-old kid on surgery that had a couple of leg abscesses walked for the first time in a year and a half with the help of a walker.  He is such a bright, happy, smiley kid.  He is so happy to be up on his feet.  

He thought he was paralyzed.  But his legs actually have sensation and can move some.  He can’t bend at his hips at ALL.  I have no idea what he has!  I’m an OB doctor.  But because of his sensation and slight movement, I said, why don’t we see if the walker can help him!  Up till now his family has been carrying him around everywhere, or he just stays in place.  

Today I got to see his smile while he was using the walker for the second day.  He was so, so happy.  He said he hadn’t been upright like this for a year and a half!  Pray for his continued practice with the walker.  Hopefully we can give him a little independence with practice!  

We were just in America for a month to celebrate my parent’s 50th wedding anniversary!  Congrats mom and dad!  

It’s not really a shock to go back and forth anymore (between America and Tchad).  

However, this time I attended a board review course for my obstetrics/gynecology oral boards.  The shock now is in studying!  Ha ha, really it is in studying what labs and tests I’m supposed to be ordering on my patients.  It makes me chuckle and laugh, and a little sad.  These patients don’t even have 1/10th of the care they are supposed to be getting!  We don’t have much to offer them.  (And now we don’t even have an ultrasound!!!)  It’s sad.  It’s the reality here.  You get used to it.  You get used to not having supplies.  Accepting less than quality care because to enforce more would literally take up your last amount of energy and you’d never make it long-term.  You get used to death.  Of cute little babies dying.  Of moms, struggling to have a family, dying in childbirth.  Of old people who have lived a happy life dying.  Fifty is old here, well past the average lifespan.  If you live to fifty, you have made it.  

I’m so happy that Olen has returned from his galavanting!  Mason and Olen returned last night.  The conference was wonderful and now they will fix our hospital!  Ha, not likely, but hopefully gathered a few more tools to keep us from going insane earlier than expected.  (The cultural challenges as they pertain to work, school, church and home are still by far the greatest stressors. Perhaps that will change over the course of generations as the world becomes smaller and globalization advances each year.)

Please continue to keep us in your prayers.  It’s easy to get back to America and forget that the daily struggles continue here.  And it’s impossible to describe fully the struggles we share with the Tchadians.  But, I assure you, they are very real every day here.  But so is God, and He keeps us sustained.  

CAMEROON TRIP

Since it is slower season now at the hospital, we finally have time to catch up. Even though our surgeon and our babysitter (also known as my in-laws) are gone, we still have more free time in rainy season. The drop off is sudden. We’re extremely overworked half the year and extremely overstaffed half the year. The respite is welcome. It also gives us time to catch you up with our news.

Way back in March, I had to chance to take a second trip to Cameroon. My first trip in January was very brief, and I only had the opportunity to visit Batouri, in southeast Cameroon. This time, I was able to see so much more and visit so many more people!

I left Bere on March 9 and caught a motorcycle taxi from out front of the hospital to Kelo, a little over an hour away. Through my sunglasses, I surveyed the familiar terrain of Tchad. Bone dry. Brown. Flat. I saw the Tchadians turn and yell, ‘Nasara!’ as they watched me go by, a bit surprised to see a white guy on the back of a motorcycle taxi. I saw mud hut after mud hut and thatched roof after thatched roof pass at 25 miles per hour. I felt strangely at home, exactly where I supposed to be. And I felt good. I felt like I was setting out on an adventure, fulfilling my calling and my destiny. And despite leaving my family at home, I felt happy and at peace. And I felt a bit of a sunburn starting on my forehead as well. I felt a lot of things. But after an hour and a half on a motorcycle by the time I gently dismounted, one thing I could no longer feel was my butt. I paid the driver and sat on some mud bricks drying in the sun while I awaited my next chariot. Normally, this would have been uncomfortable for me, but since my tushy was already numb, it was tolerable. 

From Kelo, I hopped in a bush taxi (aka, a Corolla with seven adult men) to Moundou, also a little over an hour away. If you’ve never sat with three other large men in the back of a Corolla, you really should try it. It builds character, which is a cute way of saying, it’s survivable, but miserable, kind of like spending four days on a life raft in the middle of the ocean being surrounded by sharks and choosing which one of your dearest friends you throw overboard. 

In this Corolla, you can’t sit flat, you sort of need to tilt your pelvis in order to make enough room for four sets of hips lined up in series. The shoulders are also an impossibility, so every other man will need to lean forward. The unwritten etiquette, which not all passengers will have read, perhaps due to its being unwritten, is that you do this in such a manner as to appear natural and comfortable, as if you would have chosen this semi-fetal position even if you had the entire back seat to yourself. 

The great trick to master is shifting positions. Obviously, you cannot sit forever in this position or you could actually have an entire butt cheek fall off. I’ve seen this happen to fellow passengers and it’s not pretty. But you don’t want your seatmate/s to feel they are causing you discomfort when you’re shifting, particularly if they’re sleeping and drooling on your shoulder. So with the same extreme of care you would use to put down a colicky infant at 2am after spending the last 90 minutes rocking her to sleep, you slowly transfer the leg which has the knee in your chest, the same leg you are no longer certain is attached to you due to complete loss of sensation, down behind the foot you have resting on the floorboard, which is probably piping hot because the exhaust pipe has a hole in it. Then the lynchpin maneuver is transferring weight onto the numb foot while tilting your pelvis the other way. The whole process, from conception to completion is actually quite drawn out and takes about 15 minutes of deliberation and planning to decide yes in fact, I must change positions or else I will scream in delirium, and another 15 minutes to execute slowly without disturbing other passengers. Approximately 20 seconds after successful completion of this procedure, it is guaranteed that my seatmate will stir, snort, blow his nose into my shirt, and jam his hipbone into my kidney hard enough to make me pee blood for the next two days while flopping his head onto the passenger opposite me. I always get the one who didn’t read the unwritten etiquette. Every. Time.

Now, I know what you’re thinking. You’re thinking, Olen, what are you complaining about? That sounds absolutely delightful! Well, please recall it was about 110 degrees the entire time and there is no air-conditioning in any of these public transits.

Getting out of the Corolla in the midst of the hustle and bustle of big-city Moundou, I couldn’t feel the right half of body or either leg from thigh down. I bravely opened the door and grabbed my leg, picking it up and swinging it outside the car. Steadying myself on the doorframe, I hoisted myself into a standing position, leaning ever so slightly and ever so casually on the car. I spent the next few minutes gazing about and taking in the scenery, looking natural. Unfortunately, the car was parked between two empty busses blocking anything else from sight. But no worries, I just made those busses the most interesting-appearing busses in Africa, staring with such wonder that others came to see what was so fascinating. Once the pins and needles left my feet, I hopped onto another motorcycle taxi across town to the car park for Cameroon. (Actually, I didn’t hop. I eased my heiny onto the seat. If you’ve ever ridden 100 miles on a bicycle after not riding for years… Then get on the bicycle again the very next day… Then you know what it felt like.)

In Moundou, I picked up Vadym, a Ukrainian surgeon I was fortunate enough to have along as a travel buddy. Waiting for Vadym, I passed the time watching a ragamuffin of probably ten or twelves years of age selling tea. He would fan a charcoal burner, pour a glass of hot water into a cup with a tea bag and give it to a customer. When the customer finished, he would take the ten cent fee, deposit the tea bag into the next glass and rinse out the used one in a pan of muddy water he had used to rinse out the last 100 glasses of tea. I wondered what his life would be like. Would he sell tea for $0.10/glass for the rest of his life? Would he move up in the food chain and start selling sandals or other things? It was the middle of a weekday, so he clearly wasn’t banking on an education getting him far. It made me sad, but why? He seemed perfectly content going mindlessly about his tea-service rituals in his torn and filthy rags. And his customers seemed all too content to have a minion to chide about his lack of tea-serving skills. Vadym showed up and stirred me from my stupor.

From Moundou was another couple hours to the Cameroonian border, through the border, and a little bit more to the next bus stop. Again, it was a Corolla. But this time, Vadym and I got the front passenger seat. Well, technically, Vadym got the passenger seat and I got the shaft. No, really. The shaft on the stick shift. That was my seat. I positioned myself as any self-respecting macho man would, leaning over on my side with my chest on Vadym’s shoulder, my nose in his neck and my leg up on his lap. We really could have made a very cute, if not uncomfortable, couple. It wasn’t too bad, except for fourth gear. It didn’t help that the driver was always very aggressive going into fourth. Fortunately, we only used reverse four times for a total of 78 seconds. I remember each of those 78 seconds extremely well. I wish I didn’t.

As soon as we hit the Cameroonian border, literally, that very mile, the terrain starts to vary. There are hills! And after that, mountains! It was a very neat experience to share with Vadym, who was excited about the scenery after being in Tchad for a bit. And nope, I still can’t feel my tuckus.

The next minibus took us to Ngaoundere. This minibus had the potential to be alright; however, Vadym and I unwisely accepted the front row, right behind the driver. There is a ledge about 12 inches high right in front of the seat. So your feet are tucked nicely in under your bum. It’s actually not too bad for the first hour or two. But eventually, you will be forced to abandon your bottom forever or adopt a new position. Essentially, all other available positions resemble an in-utero contortionist. We mercifully arrived in Ngaoundere around 10pm. 

Debarking in Ngaoundere, everybody told us to spend the night in Ngaoundere and take the train the next evening to Yaounde and on to Douala. Forget that! We got places to go! You can’t slow down and drive the speed limit when you’re on about the Lord’s business!

Shorty after midnight, our big bus (our one exception with air conditioning!!!) left for Yaounde. Vadym and I were so excited to have rows to ourselves to stretch out! This section was absolutely delightful. It rained a bit, something I hadn’t seen since October. And in addition to the variation in terrain, there were other changes from Tchad. As we drove along, more and more thatched roofs were replaced with tin roofs. More and more mud huts were stuccoed and even built from wood. There was greenery, vegetation, jungle!!! Vadym was so excited to see the jungle and everything else, and I was very contented to be sharing the experience with him.

In Yaounde by early afternoon, we switched to another cramped minibus for a slow ride to Douala. Once again, I drew the short stick. I had the window seat, but also the seat over the wheel well. So once again, knees in chin. Arriving in Douala, I was ready to amputate my own gluteus maximus and minimus. I was 65% certain I had peed in my pants, but I couldn’t be sure. I simply couldn’t feel a thing anywhere near that particular zone of my anatomy anymore, besides the extreme burning sensation as the pressure came off my blood supply and I could feel the circulation start flowing through my nether-regions. And I really didn’t care by that point anyway. 

From Douala, we took a taxi to Buea, arriving 2am March 11. Well, scheduled to arrive earlier. But at one of the frequent checkpoints, a police officer (it was a one-man checkpoint) asked for my yellow fever vaccination. He lectured me about terrorists, since apparently they also don’t care their yellow fever vaccination cards. He also warned me that I might be bringing scary American viruses into Cameroon, which is equivalent to espionage. Lastly, he berated me that I may be harboring EBOLA, but I had no proof since I didn’t have my YELLOW FEVER vaccination card. He asked for a bribe to pass. I told him if I was really so dangerous, he should either imprison me or vaccinate me. He didn’t feel either of those were as beneficial as a bribe. By then we had been on public transit or waiting at a bus station for 41 hours straight. I regretted not having taken that train from Ngaoundere to Douala. My smile had worn off. Somehow Vadym still had his. Miraculously, we still had two butt cheeks each. And zero blood clots in our legs. Or lungs.

Despite our 2am arrival, Dr and Mrs Bellosillo greeted us warmly at their front door. Mrs Bellosillo had even prepared a meal for us!!! A real meal! Thus far, we had been sustained on soda and crackers. Now we had real food! Unfortunately, I was having trouble being sufficiently coordinated to lift the spoon to my mouth to eat it, I was so tired.

We spent the next five days at the Adventist medical center in Buea, Cameroon, a town in the tiny Anglophone part of Cameroon. It was delightful! In addition to the delights that Mrs Bellosillo fed us nonstop and Dr Bellosillo lack of interest in us seeing patients (reports of my clinical acumen precede me), Buea is in a perfect climate situated on the side of Mount Cameroon, the highest mountain in Central Africa. It’s elevation and proximity to the ocean kept it comfortable. We slept under a sheet and without a fan. It was perfect. In fact, all throughout Cameroon, we discovered fast and cheap internet and amazing (and amazingly cheap!) food. And the roads… oh my. I mean, the vehicles may leave something to be desired, but the pavement… after Tchad… it felt smooth enough to race an Indy car. Well, except the frequent speed bumps.

Dr and Mrs Bellosillo are real missionaries. I’m just a pretend missionary. These guys have been at it for over two decades on a couple different continents and in several different countries. They are the real deal. And with all that experience, they know what’s what. Vadym and I were enthralled listening to their stories from Zambia, Botswana, Nepal, Philippines, etc. We were impressed watching them navigate the administrative challenges like it was nothing. And we were humbled by the long hours they put in without complaint. I will never be Bellosillo-cool. I’m just not that hardcore. 

Vadym and I spoiled ourselves rotten (and Mrs Bellosillo spoiled us too!) and went to the beach a couple days. Both of us, however, missed our honeys. Just not as romantic with a Ukrainian dude as with Danae. All in all, Buea was simply awesome. But we certainly saw both the need and the potential at Buea Adventist Medical Center. Dr Trixy Franke and her husband Bill really brought the center from death to life and it is quite busy (from three patient visits per day to now 20 patients/day in addition to the hospitalized patients, which are several). Now the Bellosillos are keeping that momentum going and the center will soon be upgraded to a full-blown hospital from a health center. And administrative measures are being advanced as well. And they even have real, sit-down toilets!!!

But there are so many needs still. They don’t even have a working microscope. They lack most lab supplies. They don’t have an x-ray. They don’t have an incinerator. Their generator is broken. They need paint. But what’s exciting is how they’re improving all the time and have such great potential to computerize and could someday become some sort of surgical subspecialty center. They have two operating rooms way nicer than anything in Bere!

From Buea, we left in a car to Douala, then fancy bus back to Yaounde. And I mean fancy. Stewardess pushing a trolley of croissants and pain au chocolat along with tea and soda. Oh my. And a toilet! From Yaounde to Nanga, the home of Cosendai University. All tolled, we awoke at 4am to leave Buea and arrived in Nanga around 8pm, well after dark. Then we sat at Cosendai guest houses for an hour or so while they searched for the guy who was supposed to have our rooms ready, but didn’t. Oh well, we went and got a hotel in town, which had a generator until we got there and ran out of water in the tank. That’s ok, though, there was a nice foam mattress.

The next morning at 7am, we met with the president and administrators of Cosendai University who were gracious enough to postpone their trip to Yaounde a couple hours so they could meet with us. Their dedication is impressive. I spent the rest of the day with Abemyil Marie, the head of the nursing school at Cosendai University. She’s something else. Just amazing. She has started the first four-year nursing degree in the country in conjunction with Loma Linda University. Her students love her and so do I. But the poor students need to go far away to Yaounde for decent clinical experience. Locally, the only options are a run-down government hospital or a teensy little dispensary at the university.

But there’s hope! Cosendai University has 554 hectares given by the village. That’s 1400 acres. That’s two square miles!!! And the government is ⅓ done building a new paved road from Yaounde to Bertoua which will be the main access for all parts north and east in Cameroon. Nanga is halfway between the two big cities of Yaounde and Bertoua. The potential is huge. And they already have a building ready to be turned into a 30-bed hospital. Just needs a little elbow grease! (And man-power and supplies, like a big-ol’ generator.) It would immediately be the hospital of choice for an hour in each direction. And as for the nursing school, with some teacher exchange programs and simulation labs and possibly distance-education lectures, this place could be world-class.

Later that same day, it was back on a bus for another six hours back to Yaounde, arriving after dark and settling into a hotel room bed. One hotel room bed. Vadym. And me. One bed. He was a complete gentleman the whole night, I’m happy to report.

The next morning we met with the Cameroon Union Conference officers and heard their vision for the future of the church’s health work in Cameroon. They have some big plans! We also went and saw a health center in Yaounde, which is doing well on the same campus as the big church and the big school and the federation headquarters. Run-down, but busy and passionately staffed and run by a great guy named Timothé.

Later that same day again, it was onto another bus to Bertoua! Once in Bertoua, we got on a motorcycle taxi (me, Vadym, a motorcycle driver and our luggage!) and headed off to find a car going toward Batouri. On the motorcycle, Vadym got his camera and iPhone stolen when a second motorcycle drove by and the passenger on the back slashed the camera bag strap and sped off. That was a serious bummer. After lots of head-scratching, we kept looking for a car headed to Batouri. We were told they were all gone and it was too late at night. But finally, we found a vintage 1870s-era pickup truck lorry headed in exactly that direction with two only moderately-devious-appearing guys in the cab. They offered us two seats for a frighteningly-low price and we set off, past the police checkpoint that had given me grief on the way in. The truck intermittently broke down. We came to various rain gates, which were bolted shut and honked and honked until we woke up the entire village and found people to unlock the gates. I kept the GPS on my phone and tracked us so I’d know how far we were from Batouri just in case the other two guys in the truck got creepy and Vadym and I had to bolt into the thick jungle. Always prepared I am. We finally arrived to Batouri Adventist Hospital at 2am, were graciously given beds (two, in fact) and sacked out into a stupor.

I had been to Batouri just two months prior and still loved it. On top of a hill in partial jungle. This is a place with character, attitude and spirit. Dr Andre Ndaa had the hospital thriving, then it went through a tough few years before Dr Bellosillo arrived. Now the place is thriving once again under the leadership of the administrator Philemon and the physician Dr Roger. These guys are amazing, as are all the staff, who worked faithfully for a long time without being paid, although they are now being repaid all that overdue salary as the hospital is once again making money and paying off debts. The jungle which had taken over the hospital has now been hacked back and buildings which were swallowed whole in bush have been repopulated with patients instead of spiders and snakes. There are a faithful number of patients as Batouri Adventist Hospital has become the hospital of choice for the region, both inpatient and outpatient and surgical and ultrasound… You name it, Dr Roger does it! The patients and staff absolutely love this guy. A missionary from DRC to Cameroon via Chad.

The hospital still has some massive needs, however, including a new generator and garage and a water tower, as they’re completely at the mercy of city utilities, which are sketchy to none. They also need simple things like an incinerator, etc. But man I love this place! I do fear for what will happen once Philemon retires. He’s such a cool guy.

Anyway, the trip back involved a private car to Bertoua, a bus Ngaoundere, arriving very late. Staying in the pastor’s house. Very early bus to the border. Corolla to Moundou. Lengthy discussion with the police as I refused to pay the $4 bribe. They threatened to put me in jail. I pretended to call the US embassy. They let me pass. Near heat stroke. Then finally arrived to find my beautiful wife and kids and spend a weekend at a fancy hotel after a couple weeks apart and roughly 90 hours on public transit. And hear my wife tell me she’s pregnant with number four. And it’s mine!

I love my life.