Thursday, December 19, 2019

Wednesday, December 11, 2019

Moving a Cavewoman

‘Did cavemen ever had to deal with this?' I wonder to myself.

I’m currently packing the fifth suitcase, and I know there are many more yet to go. Tomorrow, we will drive all these suitcases up to Silver Spring and drop them off at Dad’s house for some of our very dearest friends, Blair and Brenda (or Brair and Blenda if the kids get mixed up), to bring to the airport in a month when we leave. We aren’t completely certain we will be able to fit all our dozen suitcases, dozen carryons and family of six into Dad’s minivan and tiny Audi, along with Dad and Donna.

‘This is totally a stereotypical situation,’ I think in my head. The man struggling to keep his wife happy, moving a half dozen suitcases and hat boxes comically into a hotel room for one night, tripping, stumbling, dropping things, but still madly in love. It all seems very much to warrant a black and white silent film à la Laurel and Hardy.

The reality is much less entertaining, the expansive master bedroom of our family lake house, cluttered to the brim, with me cramming one more T-shirt into a suitcase and then bouncing on top of it cartoonishly to compress things just enough to get the zipper shut, tangs holding on for dear life, scale registering 52 pounds, which we have scientifically determined to be the actual limit of the written 50-pound checked baggage limit.

If it conjures a black and white film in my mind, how hard is it for me to imagine this in Victorian England? Elizabethan England? Not too hard. What about Joseph rolling his eyes as he loads yet another bundle on Small Donkey? Yep, I get it, man. Or Abram asking Sarah, ‘Dear, do we really need another tent? Yes, Dear. Ok, whatever you need. Of course.’ Abraham, Brother, I feel your pain. I’ll bet you five bucks Noah’s wife was trying to sneak in a third elephant behind his back. I can even see Adam grimace as Eve hollers at him, ‘Make sure you pack my spare fig leaves, Honey!’

My mind’s eye enjoys the image of a man with a strong chin, leopard skin and unibrow looking entirely defeated as his wife convinces him they absolutely MUST pack a third club or else risk being eaten by a wooly mammoth should the first two clubs break. (And yes, I know wooly mammoths aren’t voracious human-eaters, but my mind’s eye tends to wander.)

Yet at the same time, I marvel that my beautiful wife was able to pack for the both of us for a week on a cruise in personal items. No, not carryons. Personal items. As in, the hand bag that fits under the seat in front of you. We are quite fortunate her bikinis are skimpy. Or there was that clothing-optional beach we got lost at on Saint Martin.

And then on our next trip, the van will be overflowing with camping gear (it’s not like we can carry it all on our backs, although she will try!). Or a long weekend in Tennessee with four full suitcases. It’s bafflingly unpredictable.

As it turns out, however, packing that fifth suitcase was just the beginning…

Every year when we return home, Danae tries to buy Amazon. Not a prime membership. Like, the entire warehouse. All the warehouses. I suspect a genetic compulsion. If you time the market with our vacations in America, I’m betting Amazon stock goes up while we’re stateside. She’s personally responsible for destroying square miles of forest merely in Amazon boxes. In addition, she got a lot of donations this vacation for her pet projects. So to all of you who gave so generously… I hate you. You make my life miserable.

Ok, so that might be a bit of an overstatement. And actually, she would have spent her own money to buy stuff anyway. So, I guess I love you. Thank you.

Danae bought THOUSANDS of baby T-shirts to give to newborns at our hospital. She bought hundreds of T-shirts for the staff of all the AHI-Tchad hospitals. (All these T-shirts were transported from Dallas/Oklahoma in our minivan, along with six people and their personal belongings, and nine boxes of medical equipment.) She bought MP3 players with solar panels so people can listen to the Bible in villages without electricity (which is all of them). She bought picture Bibles she had designed specifically for her, with versus she had copied from Bibles in a half dozen surrounding tribal languages. (Which we picked up in Tennessee and drove back in a full van.) She purchased her own invented ‘Grief Kit’ material for families who lose babies/children.

Do you know how many suitcases it takes to pack over a thousand T-shirts? I do! Too many. It takes too many suitcases to pack over a thousand T-shirts, if you want a scientifically precise answer. And all those picture Bibles? The over 200 pounds worth of picture Bibles? Oh, I haven’t even mentioned yet all the donated medical equipment from Mission Regan or all the scrubs people donated.

‘But, Urg. The third club is for us. Shouldn’t we pack another club to give to the people we’re going to visit? What would Jesus do?’ (I believe all cavemen were named ‘Urg’. And Urg had Jesus.) ‘But Noah, can’t I squeeze in twenty more sheep? You know, as sacrifices to God. Are you saying it isn’t a good cause? You don’t love Jesus?’ (They knew He was coming, right?) ‘Joseph, why don’t we just buy Big Donkey to help Small Donkey? Then we can take EVERYTHING! I mean, don’t you want the best for our Son. He’s God after all. Don’t you love Fetus Jesus?’

Yup, our wives have their noble reasons. Grrr.

So final tally:
12 suitcases travel with us.
12 carryons with us.
8 suitcases sent to my friend, Ricky, who’s arriving next week.
4 suitcases left with a friend, Bekka, who’s coming in January.
3 suitcases left with Dad, who’s coming with Donna in January.

27 suitcases. And 12 carryons. And over $12,000 spent on noble causes. (None of those noble causes were excess baggage, emotional or otherwise.)

‘cuz… well… my wife loves people. And Jesus. I know, totally annoying, right?

(I didn’t even tell you about landing at 3am in N’Djamena and loading 12 suitcases and 12 carryons into/onto a Corolla, then onto a bus, then onto/into a LandCruiser, stopping to pick up the suitcases that fell off and into the mud, and finally get them into our living room, where the suitcases vomited their contents all across our house.)

(In case you’re reading this, Dear, I love you 😘.)


And now PUSH!

Celestine had come to our hospital in labor.  Her twin babies were both breech, but this wasn’t her first baby.  With a little patience (always for breeches), she delivered vaginally with the help of some lifesaving maneuvers to deliver the nuchal arms they both ended up having.  The first baby had to be resuscitated for about ten minutes, but finally let out a good cry.  Both babies are doing well now and are already one week old.  

Every day we provide obstetrical care for the surrounding villages.  We receive many referrals from the neighboring cities of Lai and Kelo for prolonged labor.  Often times from Pala as well (a four hour drive in dry season).  I’ve had ruptured uteri travel the bumpy roads all the way from Pala.  I have about 20 ruptured uteri every year, almost always unscarred uteri, and always from prolonged labor.  

The country of Chad was named the worst country to be a woman in 2019.  In 2018 it had the world’s worst maternal mortality rate.  I know we are making a difference here, but hopefully not worsening these rates.  Just kidding.  I know we are making a positive difference in individual lives.  But sometimes it feels like a drop of water in an ocean.

Our hospital delivers about 1200 babies a year.  We have one obstetrician and two family practice physicians, each with a year of obstetrical fellowship.  We have one local midwife with her masters, and five or six nurses who function as midwives.  Our nurses do all of the normal deliveries, and call the doctors when there is a problem.  

Every Tuesday and Thursday are our prenatal care visit days.  Usually once a month women walk from all around (yes WALK) just to get checked out while they are pregnant.  Prevention goes a LONG ways.  They also know that when they deliver at our hospital, they will get a free baby Bere Adventist Hospital T-shirt and random other baby clothes or blanket/hats.  This has been going on for years, and they will ask for it!  These are women who do not get a fancy baby shower, so it might be the only new thing they will get for their baby.  It’s so fun to give to them!

There are three main causes of maternal deaths here in Chad.  Hemorrhage/Anemia.  Preeclampsia/Eclampsia.  Malaria.  With good prenatal care, the risks of these causes of deaths can be assessed and often death can be prevented.  

Most deliveries in Chad are home deliveries.  The problem is that many of these home deliveries have never had a good prenatal visit, let alone ever had an ultrasound.  Malpresentation goes undiagnosed.  Multiples go undiagnosed.  Often at the expense of the baby, and sometimes the mom as well.  And many of these home deliveries are grand multiparous patients.  So their uterus does not want to contract, and they bleed.  Sometimes to death.  

So many times surrounding places that provide ‘prenatal care’ have never done a blood pressure on a patient.  Thus, the patient arrives completely comatose after their eclamptic seizures at 8 or 9 months of pregnancy.   

Malaria affects everyone here, but it hits hardest on the pregnant mothers and babies.  Malaria also causes anemia, further compounding the hemorrhaging problem of delivering at home.  

All of our nursing students rotate through labor and delivery, but it’s time to graduate some midwives!  We’re going to make it official and open up our midwifery training program.  

To all of my midwife friends who would love to teach a course….come on over.  It will likely be a 4th year to our three-year nursing program that we already have going.  But we need to develop our own curriculum and make things official.  French friends with curriculums already in place would be very welcome! 

So come on people.  Help us PUSH some babies out!  And push some midwives into training.    

Push, don’t PUSH!

Push, Don’t push

Okay, I’m a gynecologist.  I’m supposed to get people to push, right?  Well, that works in the obstetrical land.  Push the baby out.  Push yourself down here on the bed so I can examine you.  Lots of pushing in the OB world.  

But in the surgical world pushing is bad.  For an abdominal surgery, we want a nice soft abdomen.  No pushing involved.  Pushing makes it hard to see.  Pushing makes it hard to poke your needle into tissue and then tie off a vessel to stop the bleeding.  Pushing makes the bowel get in the way.  

Why do I have so much pushing in my abdominal surgeries?  All of my cases are done with spinal anesthesia by my nurse.  He learned how to do anesthesia from others, but was not formally trained.  He does not know how to intubate.  Spinal anesthesia works great when it works.  But sometimes the medicine doesn’t work here, even with a perfect stick.  Sometimes then you have to give ketamine, AKA God’s gift to the developing world.  

Needless to say, I often times don’t have a soft abdomen to operate on.  But you know what?  I do the case anyways.  Because that’s what we do here, we push on even when it’s hard.  Visiting doctors don’t like it.  I don’t like it either, but I’m just used to it.  If a case gets too difficult with the patient pushing, I make the nurses call Olen just in case the ketamine gets a little too deep, so he can secure an airway.  So I try not to complain to much during surgery about pushing, because then I just have to worry about the patient’s airway (as Olen is often home with the kids lately).  

We recently had a visiting CRNA for our Smile Train.  She mentioned that we need a training program here and I absolutely agree!  I think we should start one RIGHT NOW!  All I need is a dozen or so CRNAs or Anesthesiologists to come for one month (or less) per year.  You’ll help us set up our curriculum, and voilà….We’ll be on the right track!  

We certainly have the surgical volume!