Saturday, January 30, 2021

Blue-jeans

 People often speak of ‘Culture Shock’ and ‘Reverse Culture Shock,’ especially in missionary communities. When one first arrives in a new community oceans away from their native land, one is often gobsmacked by all the differences their new environs surround them with. The climate is different, the fashion is different, people of different races may look different, languages and accents are different, money is different, cars may zip by on the ‘wrong’ side of the street, the noises, the smells, the tastes, even the time zone may shift senses to the point of feeling perpetually off-balance emotionally. But the greatest difference is the ‘culture,’ a nebulous word that cannot be summed up adequately in the collective of previously cited attributes and notions. The ‘culture’ of a place is something greater than the sum of its parts. It’s a mentality. It’s a worldview. It’s an approach to life in humanity’s most basic terms.


But then spend a year in this new culture and return to America. Folks frequently claim the ‘Reverse Culture Shock’ can be just as brutalizing. The intemperate bustle of American life, the screens competing insatiably for our attention, the pressed masses uninterested in shaking hands (even pre-covid), but also the green spaces, the manicured lawns, the parks, the ability for people to queue properly in a line. It can be boggling and disorienting, yet at the same time distantly familiar, like returning to a familiar dreamland or having a vague but gnawing sensation of deja vu.


Danae and I feel we have done the transition often enough that we are rarely phased by it anymore. We split ourselves and we have two homes, two self-identities, nearly two beings. The Africa version of ourselves and the America version of ourselves, both so very authentically and genuinely ‘us,’ but also so dissimilar.


Mentally, my brain equates the change to a pair of blue jeans, a pair Danae bought for me years ago, before even going to Chad. Bizarrely, these pants represent America to me. I land, I head to our ‘home,’ wherever that may happen to be, I pull the jeans out of a box in storage and I put them on. I am now American me. I own no jeans in Chad. This is a uniquely American habit and a uniquely American version of myself. In Chad, it’s slacks and a short-sleeve button-up collared shirt seven days a week. In America, it’s jeans and never a short-sleeve button-up collared shirt.


We are now back in Chad, and everything feels like a distant, but familiar, life. We passed quarantine at TEAM, The Evangelical Alliance Mission, in one of the only duplexes. It was familiar and comfortable, a place we’ve stayed many times, with familiar and comfortable host missionaries on their compound, chatting to us from a safe distance. There was our familiar taxi driver, the familiar TEAM dogs, the familiar traffic, the familiar heat, the familiar 220V outlets, the familiar food, the familiar everything. I could sit on the porch and let the sensation wash over me that I am back home, back where I’m intended to be, despite almost a year away.


The morning we left N’Djamena for Bere magnified these sensations. Although we normally take the bus, we have driven it many times, and this time it was the only option, as public transit had been shut down. There was the familiarity of the driver showing up late, of loading all our bags on top of the truck, of filling the cab with the rest of the stuff we overvalued and then cramming ourselves in. There was the familiarity of AC never working and windows going down. The familiar gas station with all the guys selling baguettes like their lives depended on it, because they did. The familiarity of stopping at police checkpoints and insisting that, yes, our documents really are in order, you’re just reading them upside down, here’s a book for a bribe, thanks, let’s go. The familiarity of the camel herds south of N’Djamena, the only source of traffic jams in these parts. The familiar landscape, the gas sold from a glass bottle beside the road, the watermelons for sale at the toll booth, the woven grass mats of this village and the clay pots lining the side of the road in that village. The familiar jarring up my spine weaving on-road and off-road trying to find the path least damaging to the vehicle.


And then almost home. The hippo river. The last two villages on the way. The river where we baptize people. The Bere sign. The glint of the sun off the tin roofs of the hospital. The hospital gate. The people selling wares out front. Our gate. Our three guards all waiting for us to arrive to greet us home and carry in our suitcases. And our house. Our beds. Our mosquito nets. Our broken showers. Our droopy ceiling tiles. Our semi-feral cats. Our darkened light bulbs. Our leaking sinks. The mattress Danae and I have shared all 14+ years of marriage. Our 12x12 master bedroom. Our clothes.


And then the next morning, our jobs. Our work. Our calling.


I go to the hospital for worship, 7am, just like the last ten years. Songs are sung in Nangjere. A devotional is shared. Prayer is prayed. We no longer shake hands with everybody as we used to. I go to round with Andrew, not really being too helpful more than making sure meds are ordered. I go to a meeting, only to discover hospital administration and hospital finance is actually better than I left it.


What??? That can’t be right. The hospital made money during a pandemic, with lockdowns, with a poor harvest and economic turmoil, with a heavy rain that made roads impassable, with roads across the country beaten up so badly nobody wants to travel here? And the human resources aspect of the hospital is clean as a whistle? And they did all this without me? Maybe the hospital is better off without me!


I look around the hospital. I see a lot of deferred maintenance. We run out of water, I guess the float switch failed and wasn’t replaced and the other water tower pump seized up and wasn’t replaced. I see a generator is stripped into a million pieces and I remember I was told the radiator exploded and we’re still looking for a replacement. Cars look to be semi-functional, except the one that hasn’t run for years and another that needs a tire and starter, or something. I see the guesthouse still doesn’t have a new septic tank done yet. I see the wall that needs broken glass on it. I see the nursing school that delayed starting a new class of first year students. I see the ICU that hasn’t been set up. I see the recent container of supplies all piled into a building and not organized. I see the Apple TVs aren’t working. I see the security cameras need new LAN line or something. I see offline Wikipedia is down. I see a lot of broken laptops and tablets that need replacing or reconnection to iTunes. I see the employee handbook that needs updated. I see all the AHI finances that need attended to. I see the two ORs unfinished. I see the need for our solar farm. I see the need for a bigger OR complex even before the two ORs are done. I see the need to train doctors. I see the need to train another ultrasound guy. I see the need to line up a bunch of surgical coverage. I see a nutrition center, agriculture projects, animal husbandry projects, all vying for my attention. I see donors and their expectations. I see the kids needing homeschooling!!!


I see it all, just like I normally do when I get back. I see the enormity of it all. Another container arriving. Inventory. Thievery. The list just goes on and on.


A few years ago, I came home from my first day back at the hospital. Danae had spent the day at home unpacking. I got back overwhelmed and discouraged by all the work I saw needing to get done. And then Danae lit into me for something, I don’t even recall now what, which is true for the day after 99% of marital spats, it would seem. But it was enough to completely break me. I was done. I shut down. I just wanted to go to bed, curl up into a ball, rewind the clock, and start all over. Luckily for me, I have an understanding wife who figured out how my day had gone and that I needed something other than what she was giving me.


This time is different, however. I see the enormity of the work to be done, and I’m energized for the first time. I see that it can be accomplished. It’s a lot. It’s going to be hard. But I look around and it’s not just a few of us to do it. We have a team. A big and solid team. I’m no longer discouraged. I’m encouraged. I have an administrator, a charge nurse, an accountant, somebody in charge of our projects… I have a committed group of missionary doctors… I have Chadian doctors soon to finish school… I have volunteers… I have committed hospital employees… I have an AHI board both here and in America eager to do their part…


And I know we can do this.


I don’t know how. I’m not sure how to prioritize. I’m not sure which piece to bite off first. I know Danae also wants me in the OR doing anesthesia and cranking through patients. But we will delegate. We will chip in where we can. And we will get through this. This place perpetually improves, despite my best efforts.


And as an interesting aside and by nothing more than a fluke, Danae pulled out my jeans for me to travel back to Chad in this year. I wore them around N’Djamena and on the drive down and a couple days around the house. They feel comfortable, if a bit warm in this heat. But as it turns out, maybe that facade between our two versions of ourselves is starting to crumble, finally, after a decade. So long as we can keep Danae from wearing her African moo-moos in America.

Tuesday, January 19, 2021

Safety

 Safety


It’s human nature to want to feel safe. Of course, it seems to also be human nature to tiptoe the tightrope of self-preservation and self-sabotage. But once you have children, you probably scootch a bit closer to the children-preservation edge of the spectrum. That doesn’t mean you never have self-destructive tendencies. Our self-destructive tendency happens to be mission work.


I joke. We are here for two reasons. First, we felt called by God to tell people about Jesus, and to do so specifically in Chad. Second, we saw what a powerful effect good medical care could have in a place that didn’t have good medical care otherwise. It happened to be a lovely side effect that we are able to raise four children in a place detached from often negative American distractions that tend to not be soul-fostering, like television and video games and YouTube and hyper-sexuality and glorified violence and all the rest. Even on vacation, we find ourselves becoming lazy and putting Paw Patrol on TV or some other programming we consider to be somewhat benign. It does seem fairly reliable that after letting them ‘veg out’, we have some behavior issues to deal with for hours afterward. And even in Chad, the path of least resistance one evening might be to put on a Cosby Show for them to enjoy. And boy do they ever enjoy it.


For the most part, our kids build things out of sticks and mud. They make forts. They turn on the hose and make muddy natural swimming pools. We built a treehouse, which provided months of fun until termites felled the tree the treehouse was built around. There are zip lines. There are pets from monkeys to camels to donkeys to tortoises to rabbits to semi-feral but exceeding fertile cats to dogs to hedgehogs by the dozens. There are trees to climb, but they know not to climb the mango trees, whose branches break without warning. There’s a slack line to balance on, although none of us are very good at it. There’s a chicken coop we built, which no chicken ever spent more than a minute in, but we were so good about cutting out holes for the eggs to drop into. There are chores of setting out the laundry and burning the trash and watering the garden. They sweep the floor and do the dishes and put away the laundry. There are moments to go out and kick a soccer ball, throw a baseball, catch a football.


They speak French and a smattering of Chadian Arabic and few words of local languages. They understand what poverty is and what hunger and disease and suffering are. They know what it’s like when nobody has your own skin color and they have grown up in a house that would be condemned in America, frequently without running water or electricity, with sketchy wiring ever since Jamie and Tammy left years ago, and a leaky tin roof, screens and bars over the windows, half of which can’t close, the entire house covered daily anew in a fresh layer of dust. They sleep all four in a tiny bedroom, because that’s how they like it and because that’s the only room with a weak air-conditioner capable of getting the temperature down into the high-80’s. Even when we are back in America, they prefer to all sleep in the same room, no matter how many empty beds are in the house.


My kids are odd. They have both nature and nurture stacked against them, being the offspring of yours truly and growing up in a culture not their own. They are of the ‘Third Culture Kid’ variety, not fitting in with American peers, nor being considered ‘normal’ by Chadian standards. This really hit home for us when they met a few other TCKs this year in America before the pandemic precluded social gatherings. They immediately bonded just as the missionary family help books would have led us to expect.


However, we don’t often think about our kids’ safety. Sure, we do more than if we were in America. We frequently worry about them getting sick. They were bitten by a rabid cat. They come down with malaria several times a year. We have been swimming in a river moments before seeing a hippopotamus plod by. (Hippos kill more people than any other mammal in Africa.) There are dangers. Of course, we see other dangers in America. Having grown up in a place with so few cars, my children are decidedly not street smart, oblivious to the notion of checking for cars before sprinting into a road.


But in general, we let our friends and family worry about our safety for us. They seem to do a fine job of it without our help.


Ironically, there have been some twists in the last year to what is normally an imminently-predictable storyline.


You see, I’m currently in the capital of the country, N’Djamena. Normally, I should be typing this, or something similar, back in our home in Béré.


We finished a long unpaid leave in November. We’ve been serving in Chad since 2010 and are nearing the end of our term. (Actually, our term ended in 2016.) There isn’t a whole lot left in the tank and there are many miles on these tires. We wanted to last another year or two, and we had a little money in the bank to survive, and we had a great team of physicians in Béré to carry on just fine without us, so we asked for an unpaid leave of absence and the church granted it to us. We hiked the Appalachian Trail in all our free time, but that’s another story.


Passports took forever to return due to the pandemic. With some help from the state department, they were finally expedited, something that hadn’t been an option when we initially sent them in. Chad required us to have a negative COVID test within six days of arrival, so we were tested on Christmas Eve, and then told it would be 7-10 days for results. But if it takes seven days, there’s no way for us to use the test to get back! A physician friend from church pulled some strings to get us our results just in the nick of time. The next business day after the passports arrived, I was in the Chadian embassy getting our visas processed in one day. And the day after that, we were on an airplane, eager to come home.


It’s always strange, to have this sense of home. Even after ten years of back and forth, it’s odd to contemplate what is home for me. It’s even stranger to contemplate home for my children. I think we all have different sentiments of home. My kids have grown up in a home in Chad, but we take increasingly long vacations in America each year. So maybe my oldest will have a different feeling than my youngest. Home is where nobody looks like me, nobody shares my culture, a world I had never known while developing my idea of self for my first 31 years. And America is where I go to visit when I am not at home. To be so familiar, and yet so foreign. To feel so comfortable, and yet unfitting. To understand, yet never be understood. To recognize the dangers, and yet feel safe.


We landed. We came home. We saw familiar police working in the airport. We heard people address us as ‘doctor,’ apparently still aware of who we are. We brought our 28 checked bags and seven carry-ons out to our good friend and taxi driver, who immediately whisked us to our quarantine. 


Chad requires quarantine for seven days for all arriving passengers, followed by a negative COVID test. So we obliged.


And just to make things interesting, the day we arrived, Chad instituted a lockdown of the capital. Nobody in. Nobody out. You have four days to fly out if you want to, and then the airport is closed.


Well isn’t that special. The reasoning was there had been 200 cases in the capital over the month of December. Not 200 cases per day. In a month. So because of 200 cases in a city of millions over the course of a month, everything shut down. Only essential stores open. No public transit. Fines for being caught without a mask, which has been the norm for months now. No school, church, mosque. No gatherings of ten or more. Lockdown.


The Ministry of Health values our work and gave us a letter, authorizing us to leave the capital to travel to the hospital and resume our work. Without public transit available, Jonathan has graciously agreed to send up his Land Cruiser and driver to take us down in a private vehicle. But he also needs a paper authorizing him to travel, and the authorities in Béré don’t want to give him that letter until they see our letter. We get our authorization, only to discover the dates are written for us to travel down on the 13th. Well, that shouldn’t be a huge inconvenience. Most military at checkpoints won’t be able to read anyway. They will see official-looking paper and stamps and wave us through. But then we also notice it’s for December. And 2020. Well this simply won’t do. So delay another day to get the right dates. Then it’s today, Sabbath. So we are waiting until tomorrow to finally make it down to Béré after twelve incredibly unproductive days in the capital, unable even to hold a committee meeting long overdue. We are feeling the drastic inconveniences of a pandemic.


We had just come from America, world capital of coronavirus. 


I know half our friends fall onto one side of the political spectrum and half fall onto the other. And that’s fine, we love them both. Both my best friend and my wife’s best friend both fall on the opposite side of the spectrum Danae and I might, but we’re all still best friends, always eager to help and support each other. And probably half the people reading this will fall one way and half the other, when it comes to politics. And America has taught us recently that politics must dictate the way we view absolutely EVERYTHING in the world. Never mind there’s no human being, including my wife, I agree with 100% on every topic. But yet I must follow my political subgroup 100% to the end of the earth. I just can’t understand this blind following of man’s creation.


We see folks on both sides of the pandemic fight being unrealistic. Wearing a mask is unchristian, a sign of a lack of faith in God’s protection. Anybody staying home is ‘living in fear,’ the way no Christian should. Allowing lockdowns is infringing on rights. ‘Masks don’t work.’ ‘Vaccines are literally the mark of the beast.’ 


And then others insisting you are an immoral person if you set foot outside of your house and being calloused to the economic and emotional hardships of others. Nobody can find a middle ground because nobody even wants to look anymore. Either you’re Team Doomsday or Team Overblown. Everybody thinks they’re in the middle, but none of us are. No matter what you do or say, half the population will hate you for it, both sides pointing fingers and screaming that the other side is intolerant.


Regardless your take on the matter, statistically, we seem safer from the pandemic here In Chad, although all statistics have outliers. Here in Chad, there have been 104 deaths attributed to coronavirus. Not in one day. Since its inception. And 200 cases in a month closed the capital. It’s incredibly inconvenient. 


But now I can point out to my worriers back in America, I’m safer from the virus than you are! Required negative test less than a week before entry, testing required a week after entry, and the entire capital isolated and locked down for 200 cases in a month!


We had the same ironic and darkly-twisted joy during the Ebola pandemic when everybody worried for us… ‘You have more Ebola in America than we have in Chad!’ We are fortunate Ebola never came here, as it would have doubtlessly decimated the country as it has others to the west of us. And we are lucky there aren’t more coronavirus cases in Chad, as there isn’t the capacity to put people on ventilators or afford fancy treatments. If COVID will kill you without intervention, it will kill you in Chad. There is no intervention available.


This ironic reversal of fortunes of safety sadly continued this week, as we watched in horror as self-styled patriots illegally entered the seat of government with the purpose of terrorizing lawmakers and a country, and to interfere with a constitutionally-mandated democratic process, one that has served us for over 200 years in a building considered sacrosanct by the entire democracy-supporting world. The hypocrisy of stopping democracy in order to save democracy hurt our hearts. There was no anger, just sadness.


Politicians have peddled conspiracies vociferously to whoever will listen. And we devour what the stentorian voices rage on until we consider it gospel.


As Americans, we have enjoyed setting ourselves apart as the beacon of freedom and democracy the world over. A righteous and justified elite, we could parade our country as an example of what is possible. 


And now my Chadian friends welcome me home, concerned for my well-being, and glad I am in a place safe, such as Chad. It wasn’t always this way. Corners of the country still reek of civil war from less than a generation ago. The constitution here is constantly in flux to allow a despot president to remain in power. But they have seen our hypocrisy.


Chad has elections in April, but this date could be moved. The president may win 120% of the vote. The pandemic and crumbling infrastructure and sinking economy and poor harvest and… it’s a tinder box in search of a match. I can’t say civil war isn’t possible here again. But I can say that nobody in Chad is storming their legislature at the moment.


We have always said we feel safest when we are where God wants us. It’s drastically cliché and many oppose the notion. It depends on your definition of safety, I suppose, but we choose to think of safety beyond this life. We do place value on this earthly life, and our safety therein, and the safety of our children above our own. We have no desire whatsoever to be martyrs. It’s not really our thing. But we see the relativity of our earthly definition of safety and we regard it as a moving target, and as such, something not to invest too much effort attaining. 


Just last night, we had another small safety incident, one we have experienced many times in Chad, but never in America. We nearly died in an electrical fire.


Ok, that’s a massive exaggeration. I walked into the bedroom and smelled plastic burning. Danae said it was just dust and I almost believed her, but out of habit, I began walking around to sniff all the outlets. If wires aren’t snuggly connected, things get hot and melt, and outlets in Chad seem to be awfully cheaply made and rarely snug. I was about to give up, but decided to step up on a chair, then up onto a desk, in order to peak above the closet, where I saw wires headed. We’re still in the guesthouse of the capital, in a room unfamiliar to us. I removed a piece of cloth lying loosely there and discovered a half-melted plastic electrical connection. It was smoking and hot. Had it gone on, I’ve no doubt the fabric would have caught aflame and we would have had an electrical fire on our hands, along with a flaming fabric up near wooden ceiling tiles and trusses.


God provides. He has thus provided us safety and health. It’s possible the day will come when He judges otherwise. Until then, and especially then, we choose to follow. 











Thursday, February 13, 2020

Bunny Man



Bunny Man

I had counseled my patient before his surgery; he may need an amputation of his right foot. He accepted the risk.  A few cuts into my diabetic foot debridement, it was clear. His foot needed to come off.  His infection was bad, life-threatening.  The gangrene was worse than I expected.  Slicing into the necrotic skin over his foot, the air in the tissue escaped and seemed to be happy to be free and dancing its tentacles of stench through my surgical mask and deep into my nostrils.  The nasty juice under the skin spilled onto the floor.  I palpated up into his lower leg and could tell the infection traveled a significant distance.

I wasn’t sterile yet, so I took off my gloves and grabbed some yummy-smelling hand sanitizer a previous volunteer had left.  I break it out on special occasions such as this.  I squirted a tiny bit of it in each of our masks to cover up the putrid smell of dead flesh (but not enough to get drunk!).  Now we were good to go!  

Mark was providing anesthesia care, and the patient had significant hypotension following his spinal.  Mark was treating it perfectly.  The patient was still lucid.  

I hadn’t talked to the family about the amputation (I had only talked to the patient on rounds), so I decided to bring his wife in to show her how badly he needed an amputation.  Yes, into the operating room.  He was my last case of the day, and it was Friday afternoon.  

The wife looked at his wound and started to panic.  I escorted her out and talked to the men.  They started to get upset. I would do an amputation?!?!?!  So I brought two men in to show them the wound too.  They did not want an amputation.  

I wasn’t sure at what point the patient himself decided he also did not want an amputation, but he then started saying he did not want an amputation.  

Wait, what?  No, you already told me you were okay if you needed an amputation.  We had discussed that I would try to save your foot, but if the infection was too bad, I would have to take it off.  You had agreed.  

“I would rather die, than have my foot cut off!”  

Oh boy.  

Okay, bring a proper translator, get the family on my side, etc, etc.  

“Ok, well sir, you are actually dying, and I need to take off your infected foot.”

His blood pressure was dipping into the 50’s systolic.  Maybe I can claim he doesn’t know what he’s talking about.  

Mark had repeated a few doses of epinephrine, and we were pouring fluids into him.  We also started a blood transfusion.  

I had some questions translated into Arabic.  “What year is it?” 

“2019, no it’s 2020”.  

Okay, well he still knew what he was talking about.  Sort of.  

I exchanged family members.  I explained the gravity of the situation to the new family members, and finally they all agreed with me.  Two of them came in and tried to talk some sense into my patient, who was laying on the table, ready to have his leg amputated or ready to die.  One of which was going to happen that same day.  

My patient still absolutely refused amputation.  

I was using his early-20’s grandson as a translator, at this point in tears, unable to get it into his grandpa’s head; this needs to happen!  

No way.  “I’ve been injured several times in the military.  I was always fine.  God took care of me.  He will this time too.  If it’s my time to go, then I accept.”  He went on to explain his past injuries.

At this point, Mark, Philippe, Andrew and I were just standing back in the OR while different family members came in to plead with the patient to accept.  They told me to just cut it off and don’t listen to him.  

I explained to them I had to respect his wishes.  I would not simply lop off the leg of an unwilling patient.  He had to tell me to. 

Mean while it had been about 30 minutes of begging and pleading with this man, who would clearly die without an amputation, and maybe would die with an amputation.  

It was sad.  I tried my best to explain things to him.  I was worried he would get too hypotensive and not be able to talk to us anymore.  

God gives us choices to make.  We should respect those choices in others too.  Even if they are making the wrong one.  

There was one moment from this night I will never forget.  I was allowing different family members to come in, trying to talk some sense into this man.  

I saw two scenes unfold before me.  Andrew, turning calmly, quietly, non-intrusively away from the action, hands folded in prayer.  And the grandson explaining to me, the patient accepts.  They come simultaneously.  A life saved.  

I couldn’t believe my ears!  It actually brought tears to my eyes (which doesn’t happen very often anymore).  What a struggle.  What a relief. We can now help this man.  What an answer to my prayer, Andrew is the right surgeon for Bere.  He may not feel completely ready to do the gamut of cases that exist here, but he is ready to be used by God.  And God is clearly using him.  

We invited the other 6-7 men into the room.  Yes, into the operating room!  The head of the family lifted his face toward the sky and led them in prayer, all with palms facing up, better positioned to receive Allah’s blessings from heaven.  It certainly was a sight to see, especially if you are not used to family members in an operating room! 

They soon left.  We continued our case.  We cut off his leg and I sliced up the sides of his leg and removed all of the dead tissue I could.  We packed his wounds open.  

Two days later, I had to cut his leg off even higher.  He made no remarks about not wanting it.  He said, do whatever I felt best.  

After a few days of redressing his wound from his infected amputation, he told me through translation that he had a present for me.  

What!?  A present?  

The next day on rounds, I heard something moving in a box under his bed.  I suspected it might be an animal because all of the nurses know I love animals.  He told me, open the box.  I opened it and there were two teenage bunnies inside!  My patient raises bunnies for a living and wanted to give me something special.  


I love our new bunnies.  The kids are already playing with them daily.  


The Test

The Test

This is only a test. Do not panic. This is only a test.

Do not mind the darkness. Do not mind the lack of running water. Do not mind the dead batteries in your phone, in your flashlight, in your… everything. This is only a test.

If this were a real emergency, it would seem… well, just about exactly like this. Except I wouldn’t be telling you, ‘This is only a test.’

Dad did it. Dad got remarried. So now we have Donna in the family.

She’s alright. You know, as far as wicked stepmothers go. (Kidding, kidding.)

Donna has traveled the world, including the third world and including Africa.

However, her stories from the third world seem to involve scenes witnessed from a luxury cruise ship or panoramas absorbed from the veranda of a luxury safari lodges or… well, you get the picture.

One problem: Our family is NOT the luxury type. 

Sure, just like anybody else, we can enjoy the finer things in life. We can go all out and order sour cream on our Taco Bell burrito every once in a while (but we prefer carrying in our own store brand tub of the white, creamy goodness and dolloping it on ourselves). We can drink Perrier (so long as it’s sat out a few days and gone flat and we didn’t actually pay for it and somebody holds our nose for us). We can stay in a hotel that’s rated with stars (plural!). We can buy non-pre-owned clothes occasionally!!! (There’s another name for that, but I can’t remember what it is off the top of my head… oh right!… ‘new’.) We fancy. Boogie. Wait, no. That’s a dance. Bougie. Poverty chic.

Donna’s just plain chic, which until recently, we merely presumed to be alternative spelling for soy chicken.

So when Donna assumed herself to be tough enough to hack it in Chad, we chortled. But vows were taking, visas were attained, flights were booked and paid for, and, seeing as how they were non-refundable (the tickets, not the vows), and seeing as how we aren’t the family to even let a lukewarm month-old strangely-bubbling piece of quiche (see, we’re fancy) go to waste if it’s free, we figured she might as well come.

We gave her a day here before we pulled the plug. We decided enough was enough and we shut off the generator.

‘It’s broken,’ we lied. It was freaking hi-lar-i-ous. As if all three generators could ever possibly die at the exact same time. But she bought it.

So for a week, Donna was here with only rare electricity and running water. Shower in the drips when they run. Rush to plug in everything when the lights go on. Then groan when the lights go off the moment you plug something in. Sleep without a fan. No blow dryer or curling iron for you, sister!

How do you like Chad, now!

What? You like it here? What’s wrong with you, woman?!

Hmmm… we may need to turn up the pressure…

Oh, dear! You don’t have water to drink, Donna? I’m so sorry. Well, when in Chad…

What? You already stocked some water?

What? You’re ok without your phone?

But… Hmmm… 

Huh? You cleaned out that stank fridge? Hmmm…

You’re just fine with eating in candlelight? Hmmm…

You don’t need the fan at night? Hmmm…

Well, I give up. I’m out of ideas.

Night before Dad and Donna head home, the ‘mechanic’ comes to fix the generator. (Read: the actor we hired to pretend to be a mechanic.) Within a few hours, the generator is magically purring away, allowing Donna to charge her phone for the loooooooong journey home.

Now that Donna’s gone, we can finally leave on our generator and bask in our constant running water.

Now what’s the stereotype?… Was it wicked stepmother or wicked stepson?

(Only kidding, we actually did have genuine generator issues the ENTIRE time they were visiting, more so than we’ve had in all 9+ years here. We were so spoiled with Jamie and then Rollin to keep things humming. The generators seem to be on the mend now, although we still had to shut down for a few hours this morning. And when the generators are out, out water goes out too.)


(As a second aside to the story, the mechanic came in at night and worked until 11pm fixing two generators, or at least patching them to workable for the moment, although we still needed two solenoids, now installed, and two more pieces, which are arriving from America next week. He also diagnosed a third generator and is working on it at home and bringing it back next weekend. At 11pm, he decided to work on the Prado, which he had diagnosed by midnight and decided he would need to take that one home too. At 6am, he got Rollin’s car running for the first time in almost a year. Then pulled the starter from the pickup to take home and work on. Then he had our old beastie running again for the first time in years, although not adequately. It will also need to go to Moundou if it’s ever to run again. He worked fast and we kept him busy with seven engines! When a previous mechanic had heard this guy was coming, the old mechanic told the new mechanic he was also a witch doctor and had previously paralyzed two mechanics to cross his turf and he’d kill him. Apparently, our mechanic wasn’t impressed, because he came anyway. Never boring here…)

The Toilet Seat

The TOILET SEAT

‘What is WRONG with these people?!?!?!’

Who doesn’t have a toilet seat? Why would somebody not take the very simple measure to install a toilet seat, so they can enjoy a creature comfort?

So we ask Jessica, our first volunteer to really ‘belong’ to us and not our predecessor, to bring us a toilet seat from America, since they weren’t able to be acquired in-country.

A week or so later, we have a toilet seat!

As we luxuriate in our frivolity, we recall the toilet in the back of our house, the guest quarters, also lacks a toilet seat. So why not ask my aunt and uncle to bring another one with them, so they can also appreciate tushy-delight? They oblige.

This is just one example of the myriad scenarios that left us shaking our heads, wondering, ‘What were James and Sarah thinking???’

James and Sarah were here for seven years before our arrival. Before we came, even from America, I would hear stories of how they had changed Bere from a run-down chicken coop into a fully-functioning and nationally-renowned hospital. But all I saw was the busted stuff!

At one point, I stepped back and looked at old pictures and listened to the local stories about what Bere Adventist Hospital actually was ‘back in the day.’

It’s impressive.

New wards were built, people were trained, reputations were elevated, etc. But they clearly had been here too long. They were willing to accept toilets without seats!!!

Well, well, well. The times they were a-changin’. We installed toilet seats. We improved this place drastically. No more toleration for frozen fannies.

Never mind nurses didn’t show up for work, or work when they did show up for that matter. Never mind we ran a tiny freezer chest on a timer to keep it forty degrees. Never mind we had chicken wire poking up through our counter top. Never mind there was no tub or hot water. Never mind our water ran out and our generator was off frequently.

We had plush seats for our keisters. 

Fast forward nine years.

We have fresh meat. Six new people with which to share our blessings and challenges. Diana, Sarah, Gabriel, Staci, Megan, Andrew… we can even toss in Elijah and Adelaide. Gone are the days of the family business, with Rollin and Dolores. Even down at the airport, we’ve had a bit of a changing of the guard. Gary and Wendy are long gone. Keith and Tammy and team have arrived. Only Jonathan and Melody are of our vintage.

To us, of course, the old days don’t seem so long ago.

But I think this new team has identified some ‘toilet seats’ of their own.

I can see James and Sarah now, faces cradled in their palms and eyes rolling, as they marvel at our inability to function without a 2-inch wide resting place for our bums instead of the standard single inch.

It would seem our new team has some hangups. They are so needy and high-maintenance. They insist on things like ‘electricity’ and ‘water’ in order to provide adequate care to patients. They get all whiny every time they need to repair a perforated gastric ulcer by dying headlamp, or deliver a baby by candlelight, or go eight days without water for a shower, or don’t have water to drink in the African heat, or can’t bathe their baby and keep them mosquito free and comfortable, or can’t perform an ultrasound on a pelvic mass, or can’t get laboratory testing, or can’t order medications, or… you see where I’m going? This new generation is just plain soft.

They also seem genuinely befuddled on why I insist on push-starting our car every time. Having a busted starter is a fantastic anti-theft device! Or why another couple cars haven’t worked in months to years. Or motorcycles. Or…

We simply take public transit if we must. Or we set up the tent and hammock in the back yard and sleep out there. Or light candles. Why fix stuff? We remember the old days when we didn’t have a toilet seat!

We just went through a week and half with essentially no electricity. It was frankly dangerous for the patients, not to mention lost income and lost reputation for the hospital.

And it was the right thing to do for the newbies to get frustrated, even angry. It was an unfortunate series of events and oversights that led to all three generators breaking down at the same time, something that should never happen. But it did. And our newbies were capable of both rolling with the punches and surviving, but also getting downright righteously indignant that the scenario would come to pass, and resolute it would never happen again.

We have such a great team now, a team able to see all our missing toilet seats, amenities normal to any remotely-modern hospital, but lacking here, and things we have grown accustomed to living without. This is the team to take the hospital to the next level. This is the team that will put lovely seats on all the barren rims.


And from where I type, although I can assure you my literal bum is quite well supported at the moment and my legs are not numb at all… it’s my figurative bum getting all worked up over the figurative seats this team will put on all our figurative toilets. It will be awesome. 

Candlelight

Candlelight

When I think of candlelight, I think of a nice dinner with my husband.  No children.  A pretty white tablecloth.  A table with a view, overlooking water or city lights.  A wonderful aromatic hot dinner set before us.  Quiet.  Romantic.  

Or…

A very calming evening after a stressful day.  Tranquil classical music.  A hot bath drawn and soft warmth lighting the bathroom.  Relaxing.  

Candlelight.  That’s what I think of.  

But not this…

This is far from usual.  Surgery, albeit basic, by candlelight.  Not something I often think about, or quite frankly, ever want to think about again!  This is insane!  

If you’ve been reading our blog, you know that we’ve been having generator problems for a week and a half already.  This has been getting serious.  Our batteries are dying on our headlamps.  My cell phone is dead.  It gets charged up every now and then when we send it down to Bendele, but for the moment it has been dead.  

Staci and I joked that we would eventually be doing surgery by candlelight.  And now that time had come!  

A lady came in bleeding heavily with a term pregnancy.  She had stopped bleeding somewhat, but I went to help Staci in case we decided to do a c-section.  Staci is perfectly competent to do a c-section, but I am happy to help in the dark if need be.  Everything is harder in the dark!  We have already done several emergency abdominal cases this past week with just a headlamp in the operating room!  Everything is harder, trust me!  

I held the candle up to the woman’s clothes to see how much blood had leaked onto her clothes.  

Staci examined the woman, who was 4cm and not bleeding heavily anymore.  No heartbeat on doppler, but we needed to confirm it with an ultrasound.  

Hmm….how are we going to do this as the machine doesn’t hold a charge?  And the only small working generator is being used to try to repair the other big generators.  Finally a mechanic has come!  

Well, we’ll have to make do!  I quickly blew out the candle so that we could approach the generators and fuel source.  We made the rest of the way by moonlight.  

We brought the patient outside and had her lay on a piece of plastic, near where all of the men were working on the generators.  We carried the ultrasound cart out to be plugged into the working small generator.  OUTSIDE!  In the DARK!  

It fired up once being plugged in to the small generator.  

Sadly the baby had already died.  I always try to get these cases delivered vaginally.  The key is augmentation and early transfusions.  As the woman’s mother spoke French, but the patient didn’t, I regretfully had to use her own mother to inform the patient of the terrible news.

With a plan underway for this woman, we then stopped by urgence as a nurse had informed Staci that there was a trauma for her to see.  

We entered the room in urgence, dimly lit by a few people’s cell phones.  A young 20’s male was lying on the bed with no sheet, no shirt, blood covering his entire head.  It ran down his chest and saturated the bed. A student nurse was holding three compresses over the wound, but it clearly was still bleeding.

I held up my candle to see a little better. 

Staci went to the operating room to grab a razor, a couple sutures, and a staple gun.  Andrew soon arrived as he had been helping the men with the generators.  

There was no water, as there was no electricity, so Andrew ran to his house to get some more water so to irrigate the 5cm scalp laceration.  I got some more of the story while waiting and holding pressure on the bleeding wound.  I explained to the student nurse to fold your fingers up so they can put more direct pressure on the wound and not with a flat hand as the pressure was not directly over the wound.  We chatted about what had happened.  Someone had hit the patient’s head with a machete.  Who knows why. 

Staci and Andrew quickly made it back and we irrigated his wound.  We found a significant arterial bleeder and sutured both sides of it.  Irrigation again, and then Andrew stapled the skin shut.  Pressure dressing.  Done.  

The candle was still burning.  Thank goodness as it took quite a bit of scrubbing to get this man clean again!  

And then back home.  To candlelight.  And quietness.  It is actually quite nice to not have all of the stimulation of the cellphones and computer.   We even have the kids sleeping. 


And since I am writing this, we have electricity again.  But that’s for another story.