#21 Pee

I had a blog called poop, so I figured I needed one called “pee” too.  Plus, that’s all I smelled yesterday.  

Lyol’s finally getting the hang of things I think.  I don’t know what kind of treats Nana Bland is giving him during the day, but this morning he woke up at 6:15 and said, “Pee.”

“Okay, Let’s go to the Toilet!”

“Toy” (Lyol’s name for toilet)

We run to the toilet and Lyol ACTUALLY pees on his little plastic toilet that Wendy loaned us.  Amazing!  His cloth diaper is DRY from last night!  (Trust me, it’s more motivating when you’re in cloth diapers).

-------

She came with her Dad on Sunday this week.  Tall, shy, Arabic girl in her early 20’s.  I’m sure she’s been embarrassed for some time now.  She would barely look you in the eye, letting her orange and white scarf hang over her head and face, mostly looking at the floor.  

I tried starting with a history.  Though it was unnecessary because the room smelled like old urine the moment she came into the office.  

She didn’t speak any French, any Arabic (neither did I), or any other local language from around here.  Apparently she only spoke another language similar to Arabic.  So with the help of a nurse, my French was translated into Arabic, and her father translated everything to her.  And back again.  Needless to say, the history was not helpful.  Her only child was living and 2 years old, and she had only had this problem for 3 months.  No history of trauma either.  So I threw away the history.  

I started with a vaginal exam after the men left the room.  Okay, there’s the diagnosis.  Vesico-vaginal fistula (A tract from the bladder to the vagina).  She had a 2 cm hole behind where the urethra should be.  A GAPING hole allowing the stench of urine to escape all over her beautiful arabic clothing.  

VVF’s are a huge problem in Africa.  They have huge hospitals in other parts of Africa, one specifically well known in Ethiopia, with many specialized surgeons.  I don’t know of one in Tchad yet, but I’m sure many women have this problem here.  

Many women also die in childbirth here in the villages.  When there is a problem, it is often several days of labor before they seek help.  If the baby’s head is stuck in the vagina, it can cause the tissue between the vagina and the bladder to die.  Several days after, this tissue falls off and eventually causes a hole (or fistula) to remain between the bladder and the vagina.  It’s often old and scarred down tissue too, so not always easy to repair.  We RARELY have this problem in first world countries due to excellent prenatal and obstetric care.  Here, you can become an outcast with the awful odor of urine.  

We weren’t able to do her surgery until yesterday.  I promised that she would be the first surgery of the day, but I had an emergent bleeding 6 month molar pregnancy to do first.  This week has been extremely busy for some reason (trauma ortho cases and amazing other cases that will have to wait for another blog).  Really you never know what’s going to come in the door.

My dad and I scrub in to start the case (very glad he’s here).  The huge gaping hole in her bladder is staring at us.  There is ACTUALLY no urethra (the hole that you pee out of).  It had been scarred off, or closed up on it’s own.  We are both sure this problem happened during childbirth.  Okay....this is way out of my league!  I’ve only seen ONE fistula before in the states and it was more like a pinhole near the cervix.  Luckily my dad has done many fistulas before when he used to live in nigeria MANY EONS ago (before I was born).  Of course, it was much more difficult in the days before opposable thumbs, what with the pterodactyles swooping by (that was Olen’s sentence of course).  

Dad said he’s made urethras before, so we find an area that looks like it may have some healthy tissue and maybe some muscle for the urethra.  I poke a small curved clamped through this area and into the bladder.  Okay, never done that before!  Just made a makeshift urethra.  We thread our suture that we’re going to use later through the same hole as a guide for the foley.  In goes the foley.  The foley needs to stay in for a while I think, maybe 10 days?  I don’t know, I guess I’ll have to read on that, and if any urogynecologist has any suggestions, please feel free to e-mail me.  I certainly don’t want her new urethra closing off too early.  

Next we move on to the “easier” part.  After cutting off some of the scar tissue, the healthy bladder mucosa and vaginal tissue bleeds.  Yes!  Bleeding tissue means healthy tissue.  We were able to close the mucosa, then an extra layer on top of the bladder mucosa, and then finally closed off the vaginal epithelium.  

I asked Samedi (the janitor, turned nurse, but in reality surgeon here) how long he would leave the foley.  He said 7 days.....and he’s made several urethras before due to fistulas in his many years here.  This was nothing new to him!  He says they were able to pee afterwards too, so we will see.  Please pray for the recovery of this young woman.  

------

Two weeks ago a young woman came in with the same smell.  She had delivered a dead baby at home 12 days before and now was leaking urine continuously.  An extensive exam revealed necrosing vaginal and bladder tissue hanging into her vagina.  There was not only the stench of urine, but also the smell of rotting dead tissue.  My dad and I debrided (scraped away) what we could, and then cleaned it with diluted bleach water.  Her fistula repair (about 3cm hole) will be difficult I think because it is deep in the vagina and harder to get to.  At least she has an urethra (the normal hole you pee with).    I put a foley cather in her for one night to see if it would help collect some of the urine.  It didn’t help, so I took it out the next morning.  She will come back in 2 months for her fistula repair.  

You will notice on our blog, missionarydoctors.blogspot.com, that we have a link for donations. This is through Adventist Health International’s website. Please keep in mind that AHI takes 10% of the donation for administrative costs. However, AHI also provides us with invaluable support, and we believe strongly in the mission of AHI. We feel that AHI is an organization worth supporting. And remember that your gift is 100% tax-deductible.

missionarydoctors.blogspot.com

 HYPERLINK mail to: danae.netteburg@gmail.com.

Olen Tigo: +235 98 07 46 28

Olen Zain: +235 62 16 04 93

Danae Tigo: +235 98 07 46 27

Danae Zain: +235 62 17 04 80

Olen et Danae Netteburg

Hopital Adventiste de Bere

52 Boite Postale

Kelo, Tchad

Volunteers Welcome!!!

#20 Merci Baystate

I am very grateful to all of the experiences I had at Baystate.  I could never thank everyone, all of the patients, co-residents, nurses, attendings, and staff.  Everyday brings new and interesting cases here, and these are just a few reflections.  I think of my friends back at Baystate often.

Thank you Dr. Bailey-Sarnelli for helping me with my one and only hymenotomy during residency.  Today I was able to perform the same surgery.  

This beautiful Arab 14-year-old girl had abdominal pain for 20 days.  She had never had a period (menstruation). My hypothesis of imperforate hymen was confirmed with an ultrasound and external vaginal exam.  Her vagina was closed off and there was no way for the menses (blood during your period) to exit.  Of course in the states you would do extensive imaging to prepare for surgery (like maybe an MRI to see if there is another kind of malformation that is more difficult to repair).  But this young girl is not in the states, she is in Tchad.

Samedi gave an injection of ketamine intramuscularly.  I made a small cruciate incision in the bulging vagina, which immediately freed the dark blood behind the wall that had caused her so much pain.  We evacuated 800 ml of dark blood from her vagina.  She is recovering well.  Tonight the family sent over a piece of fig bread/cake as a thank you gift.  I wish I could share it with you.

Thank you Dr. Burkman for allowing me to discuss “what would I do in Africa....without certain things” during morning rounds.  I remember him discussing giving magnesium IM for preeclampsia with large syringes if you didn’t have a IV pump.  Let me see...yep, we DEFINITELY don’t have an IV pump here to measure the exact amount of medication running each minute.  

Thank you also MFM attendings (Dr. Bsat, Dr. Markenson, Dr. Healy, and Dr. Plevyak) for allowing us to take care of quite complicated preeclampsia/eclampsia patients.  I am greatful for the experience, though I have never had a patient quite as complicated as the one last week.  

Olen told me one evening, “This patient’s for you Dear!”  “She’s 9 months pregnant and breathing really fast, like 40 breaths/minute.”  

I think in my head on the way over to the hospital, what could it be?  Asthma, Pulmonary edema, Heart failure.......???

I don’t remember now how long she had been in labor (most of the time it’s not a good history anyways by the time you go through all the translations), but she was in labor, semi-conscious, and breathing 50 breaths/minute.  

Oh, no...this will be my first maternal death. I think a little negatively I guess.  But death is definitely a reality here, and she did not look good.  There was a maternal death my first week here, but it was my first morning rounding, and she had just died (of hepatic origin).  

Her lungs are wet.  Her blood pressure is high (but not extremely high), 150/90.  I check her vagina.  The head is at +2 station, and the baby has a lot of edema on the head.  (I hoped the baby was still alive).  Sometimes it’s hard for me to tell here how “with it” a person is in labor because often they have been laboring for days and are just tired or ignoring me.  Plus, I don’t speak their local languages, so it’s hard for me to communicate.  No magnesium for her because of wet lungs.  I need to deliver the baby though.  

I ran over to the office to open the locked door and bring the portable ultrasound.  No heartbeat on the baby.  The baby had already died.  The baby has to be delivered, but this patient would not wake up to push.  I tell the family to have her push, but no movement on the baby’s head.  The family “helps” me by plugging the patients nose and mouth so she will have to push.  I say no, and tell them to just explain that it is absolutely necessary.  No luck.  I started my barbaric oxytocin drip.  

I run back to the office to look for one of the few remaining kiwis (disposable vacuums we use to pull babies out).  I WISH I had some obstetrical forceps.  To make a long story short, I cut an episiotomy, and after 10 pop-offs with the kiwi (also not good to do), eventually delivered the term dead baby.  (This patient was not one who would have done well with surgery).  

I started her on IV lasix.  That night she had 2 big seizures.  We gave diazepam.  I told the night nurse to PLEASE check her BP at least 2 times that night (hey, you gotta ask for what’s feasible).  

The next afternoon her breathing sounded much better and slower, but she was still unconscious with wet lungs (though improved).  Oh yeah, did I mention there is no oxygen here?  Continue the lasix and antibiotics.  

The next day Dr. James (who has spent the last 7 years here) arrived.  I told him about her and asked if he had any suggestions.  Maybe it’s cerebral malaria he says.  So we started her on IV quinine.  The next day she’s awake!  She was discharged home a few days later.  

Thank you Labor and Delivery nurses and lactation services for your dedication to helping mothers with breast feeding.  I WISH you were here to help all hours of the night and day.  Yesterday evening I delivered a 2nd twin.  The first one had delivered at home the night before.  It was small and appeared to be less than 2 KG.  I was quite focused on the remaining twin to be honest.  I confirmed that twin #2 was still alive, cephalic (head first, though here it doesn’t matter), and was not having contractions.  She was only 8cm and the head was quite high.  I started her on oxytocin (I think I have mentioned that this in itself is NOT easy here).  I usually aim for 7 drops/minute, but sometimes it’s hard.  

Anyways....while waiting for the contractions, I ask how baby #1 is doing.  Has it eaten?

“No”

I’m unfortunately NOT shocked by the response.  This baby is 1 day old already and hasn’t had any hydration or nutrition.  So I try to milk the mom’s breast, but no colostrum yet.  One of the two family members is breast feeding her own child.  I ask permission, then put the tiny little baby on her breast instead.  The baby can suck!  Praise God.  It’s hard to get anyone to give milk through an NG tube to the baby (even the nurses), so this baby at least has a chance.  

The second baby delivers and is a little bigger and vigorous.  Two premature baby girls alive!  If only I could ensure they stay alive.  

The next morning on rounds I spend quite a while putting the babies on their mom’s breasts to feed and make sure both can suck.  I am definitely paying more attention to the babies now after many died in the first few 2 weeks.  I am doing what I can, but I would sure love to have my old L&D nurses here to help keep these babies alive.

Thank you Dr. Case for not being afraid of breech babies.  I had twins come in last week.  The first was breech.  In the states it would be automatic c-section.  But....it was her 13th pregnancy.  (yes, that’s common here!).  Anyways.....I ended up breaking her water with a large needle.  Eventually, the babies bottom came down lower.  Two of our visiting volunteers were with me.  Luckily one person (Dr. Doug from CA) had gloves on to catch the first baby that shot out like a bullet.  Jessica from Oregon caught the second one (which was head first).  The volunteers and the living baby twins have all since gone home healthy and happy.  The mother of the twins also received my first tubal sterilization (of which I am promoting here; still no takers on the vasectomy).  

Yesterday I gave oxytocin to a breech singleton.  She also had had more than 10 babies.  She was “8 months” and had broken her water 5 days before.  She was 4cm and had thick particulate meconium (amniotic fluid with baby poop).  While I was in doing a c-section, the nurse delivered the breech baby.  It died shortly after delivery when the resuscitative measures did not work.  

Thank you Dr. Harmanli, Dr. Jones, Dr. Haddad, and Dr. Metz for all of the teaching you gave me in vaginal surgery.  I attempted my first vaginal hysterectomy on my birthday, 2 days ago.  It would have been the perfect case.  She had prolapse and a cystocele.  The problem was that she had had previous surgery, but didn’t know what kind to help with her bladder.  

Four hours later we were done with my first attempted vaginal hysterectomy here.  The problem was that someone had done previous surgery to attach her uterus to her sacrum (I have no records, and the exam did not allude to this).  So...my Dad and I (yes, very thankful he is here), did most of a vaginal hysterectomy, then switched to an abdominal hysterectomy, then attached her closed vagina (without the uterus) back to her sacrum, and ended with a vaginal repair of her bulging bladder.  She had the right surgery in the end, but.....it was a very exhausting birthday for me.  

I have many more thank you’s to write to everyone at Baystate, but this blog is already way too long.  

So last but not least....

Thank you Springfield weatherman for waiting until after we left to predict the coldest winter in history in Massachusetts.  “Cold season” if you can even call it that, is just ending here.  Things are starting to heat up on this side of the world.  

You might be in Tchad if....you ask for a single use foley catheter to see if the laboring patient’s bladder can be emptied for the baby’s head to come down.  There are none in maternity.  There is one in the trash that the nurse just attempted to use.  You say no, but then realize it is better than nothing, so just pour betadine all over it before using it again on the same patient.  

You will notice on our blog, missionarydoctors.blogspot.com, that we have a link for donations. This is through Adventist Health International’s website. Please keep in mind that AHI takes 10% of the donation for administrative costs. However, AHI also provides us with invaluable support, and we believe strongly in the mission of AHI. We feel that AHI is an organization worth supporting. And remember that your gift is 100% tax-deductible.

missionarydoctors.blogspot.com

danae.netteburg@gmail.com.

Olen Tigo: +235 98 07 46 28

Olen Zain: +235 62 16 04 93

Danae Tigo: +235 98 07 46 27

Danae Zain: +235 62 17 04 80

Olen et Danae Netteburg

Hopital Adventiste de Bere

52 Boite Postale

Kelo, Tchad

Volunteers Welcome!!!

#19 Videos from Olen and Danae

Editor's Note:

While they were in France learning to speak the official language of Tchad - that's French! - Olen and Danae taped several short videos about the hopes and dreams for mission service in Africa. Clink on the links below to learn more about what they thought mission service would be like - and then compare with the blogposts you see on this site.

Présentation du couple de médecins: http://www.youtube.com/watch?v=E2Id3ItYF3Q
Conditions de travail : http://www.youtube.com/watch?v=kqJXGNrV2I0
Partir avec un enfant : http://www.youtube.com/watch?v=lynEbmA4dJs
Soigner l'être humain dans sa globalité : http://www.youtube.com/watch?v=SYpBpvlM5o0
Quelques conseils pour partir en mission : http://www.youtube.com/watch?v=u7sE0C6M8Ug

You will notice on our blog, missionarydoctors.blogspot.com, that we have a link for donations. This is through Adventist Health International’s website. Please keep in mind that AHI takes 10% of the donation for administrative costs. However, AHI also provides us with invaluable support, and we believe strongly in the mission of AHI. We feel that AHI is an organization worth supporting. And remember that your gift is 100% tax-deductible.

missionarydoctors.blogspot.com
danae.netteburg@gmail.com.
Olen Tigo: +235 98 07 46 28
Olen Zain: +235 62 16 04 93
Danae Tigo: +235 98 07 46 27
Danae Zain: +235 62 17 04 80
Olen et Danae Netteburg
Hopital Adventiste de Bere
52 Boite Postale
Kelo, Tchad
Volunteers Welcome!!!

#18 Urgent Need

 

If there’s anybody willing to adopt a Burkitt’s Lymphoma child or 100, we’re in desperate need of Cyclophosphamide. They usually require three doses... and each dose is $80 +/- shipping/handling from America. For $250, you can save the life of a child (usually about four to fourteen years old).

Please write urgently. When we have the money, we can order the medications and have my aunt and uncle bring them in a week. Or we’ll even pay for the shipment. At any given time, we have two or three patients at the hospital waiting for their treatment. These patients are coming from all across the country, because we have been donating this extremely expensive medication. Nobody would ever be able to afford it otherwise. In a country where 65% of the population live on less than $1/day, $250 is almost a year’s wages for some people.

This is an extremely aggressive cancer. Due to its aggressive nature, it responds very well to chemotherapy and usually resolves with just three treatments.  Also due to its aggressive nature, it will soon kill any child who has the disease. First it grows into their eye and they lose vision or develop double vision. Then it displaces their nose. Eventually, it grows across their nose and mouth until the child suffocates.

Four-year-old children who can easily be cured and prevented from having a slow, disfiguring death by suffocation. For $250.

I feel like this is the point where I should lay on the guilt trip really thick-like and put it in terms of Frappuccinos or BigMacs or something. But I’m too exhausted right now to do the math. Or to figure out how to spell Frappuccino. Frappucino. Frapuccino. Frapucino. Nope. Spellcheck doesn’t like any of them.

I realize that ‘in these tough economic times’ (how many times have we heard that phrase) $250 is a lot of money for most people. The vast majority of people, even in rich America, would need to work for days to earn that much money. And then to turn around and donate it all is a very difficult thing to do.

If you can’t donate that much, simply donate what you can. Or maybe pool your resources with coworkers, with family members, with your church family, with that guy at the YMCA who helps with your workouts, with the bank teller who always smiles, with your kid’s teacher, with anybody, I don’t care who. Maybe together you could sponsor a child and save a life. I don’t know of any other disease so highly aggressive, so highly curable and so completely dependent on a specific missing medicine. You are genuinely needed. You could genuinely save a life.

In exchange for your donation, I will send you before/after pictures of your specific sponsored child. In fact, I’ll even do it before/after each treatment. That’s six pictures! You can include them on your Christmas card even! What a deal! Wondering what to do with $250? Fix my Burkitt’s kids, save a life, have a sweet picture for a Christmas card!

I gotta be honest. I really don’t care what your motivation is. I don’t care what you do with the pictures. Just help me fix my kids. I’m out of IV cyclophosphamide. I have nine more doses of oral cyclophosphamide (which I don’t even have a clue if that’s gonna work). Then I’ve gotta look these kids and their parents in the eye and tell them, ‘Sorry.’ Please don’t make me do that. You can truly save a life.

Click on the link on the right to donate money to AHI. I hope the link works now. It wasn’t working earlier and I only have email, so I can’t fix it. If it doesn’t work, go to adventisthealthinternational.org and search for the way to donate. I believe their are a few options. If you send a check, write in ‘Bere, Tchad - Burkitt’s’ on the memo line. If you use the PayPal option, write in ‘Bere, Tchad - Burkitt’s’ on the memo line.

You Might be in Tchad if...

Although initially put off by the sight of bats swarming your Emergency Room, you quickly accept them as a reasonable means of keeping the mosquito population under control.

You will notice on our blog, missionarydoctors.blogspot.com, that we have a link for donations. This is through Adventist Health International’s website. Please keep in mind that AHI takes 10% of the donation for administrative costs. However, AHI also provides us with invaluable support, and we believe strongly in the mission of AHI. We feel that AHI is an organization worth supporting. And remember that your gift is 100% tax-deductible.

missionarydoctors.blogspot.com

danae.netteburg@gmail.com.

Olen Tigo: +235 98 07 46 28

Olen Zain: +235 62 16 04 93

Danae Tigo: +235 98 07 46 27

Danae Zain: +235 62 17 04 80

Olen et Danae Netteburg

Hopital Adventiste de Bere

52 Boite Postale

Kelo, Tchad

Volunteers Welcome!!!

#17 Medical Update

There have been a few questions for follow-up:

1. ‘Did the baby I stuffed under my shirt live?’

Yes and no. The baby lived for a few days. The family refused to feed him. It’s very common here to not feed the baby for three or four days after birth. Then, they feed the child water only. No matter how hard we try to convince them otherwise, it’s often useless.

This particular child wasn’t fed, so I ordered for a tube to be placed through his nose and into his stomach. The neighboring patient agreed to donate milk to be put through the tube to feed the child. The next day, the tube still hadn’t been placed by the nurses. Danae put it in herself. The next day, the neighbor still hadn’t given milk. The next day, Danae found the nasogastric tube laying on the bed and nobody around.

This is an ongoing problem. It’s unbelievable that they won’t feed newborns and when they finally do, it’s water only.

A similar child was born shortly thereafter. Danae gave them a bottle from our house filled with formula from our house. The next day, the baby was dead, the patient was gone, the bottle gone with the patient, apparently.

2. ‘Was the baby with the neck abscess cured?’

Yes and no. A week after our incision, he spiked a temperature. The day after that, his father found me and told me his son was suffering. I found him with his trachea pushed over the left. The place where the trachea should be was now also occupied by abscess. I put a needle into his neck and pulled out 20cc of pus. The baby could still barely breathe.

With no anesthetic, I made a new incision a half inch behind Danae’s first incision. The baby didn’t budge. All his strength was going into breathing and he couldn’t be bothered to move to avoid the pain caused by my scalpel. I used an 11-blade (pointed) scalpel and just pushed farther and farther. I came in behind the carotid artery and internal jugular vein (but not before I nicked the external jugular vein). At one point, I removed the scalpel and held it in front of the boy’s neck. The length of how far I was putting in the scalpel was far enough to reach the boy’s trachea and esophagus.

I looked at Samedi and said, ‘If we can’t find the pus, the boy will die. We have nothing to lose.’ He agreed, we said a quick prayer and I plunged the scalpel into the neck once more. I pushed it in farther and farther. Eventually, the entire scalpel was in the neck and I could only see the handle anymore. After pushing three inches of scalpel and handle into the neck of an eight-month-old infant, I saw the satisfying rush of pus. It just kept coming and coming. When it finally stopped, we pushed on his neck and more and more pus kept coming out. He immediately breathed better. We packed the deep hole with gauze.

The next morning, I heard that he had cried all night. His father and I rejoiced together. This was the first time in three weeks that he had the strength to cry.

It’s been almost a week since then. He’s still in the hospital, having his gauze changed every day or every other day. Pus still comes out, but at least it now has an exit. He smiles, he eats, he breathes. His fever’s gone. He will be here a long time yet until the hole in his neck heals from the inside out. But he will go home on his mother’s back someday, not wrapped up in a colorful, sad cloth like so many others.

3. We have a 15-year-old boy from a neighboring village, about six or seven kilometers away. We had an abdominal wall abscess, about 4x6 inches. It gets packed with fresh gauze every day or every other day. He’s been here a month. He’ll be here at least another month. He doesn’t speak French or the local language, Nangjere. After all, his village is far, about four miles.

Danae brought him a jigsaw puzzle. The next day, it was finished. With a big smile.

He hasn’t been in school for a long time (I don’t know if he ever was). He won’t be for a long time. Danae and I asked how much the private school costs, the one right next to the hospital.

‘Oh, it’s too expensive. Nobody can afford to go there.’

‘How much?’

‘It’s 5,000 francs.’ $10.

‘A month?’

‘A year.’

Danae and I bought him a uniform and paid his tuition. He started yesterday.

4. A man brought in his sister-in-law because she had funny spots on her arms, legs and trunk. They were relatively circular darkenings about 2-7cm across. Something clicked in the back of my brain. I pinched her. She said it hurt. I pinched a circle. She could feel it. I touched her lightly. She could feel it. I lightly touched a circle. She couldn’t feel it. It’s been going on for a long time. I think she has leprosy.

5. I had a case of loa loa, confirmed by the lab.

6. I had an infant who couldn’t pee. I ultrasounded a 4x6cm mass in the bladder of a baby. The next day I couldn’t find him. The parents took him home, still not peeing. I hope he comes back.

7. I had a 12-day-old who hadn’t peed for nine days. His belly was firm with a distended bladder. The foreskin had shut and wouldn’t allow the urine to exit. His penis and scrotum were too edematous for a circumcision of his phimosis. Danae was able to force a catheter into his bladder. We’re waiting for his edema to go down before Danae performs a circumcision.

8. Danae sent home the baby she had delivered at 33 weeks.

9. I sent home my patient I diagnosed with HIV/AIDS and syphilis. Our lab proved those infections, as well as a parasitic stool infection, a urinary infection and malaria. I sent him with ciprofloxacin, doxycycline, bactrim, quinine, mebendazole and metronidazole, all antibiotics.

10. A man came in with a swollen, hard, tender, red right calf. I gave him some of our precious stock of expired lovenox and five aspirin a day. After a week, it wasn’t really better. Then I noticed drainage. After cutting open the leg, we found a massive abscess. And he bled a little bit too.

11. I was called to the ER to see a women who was hypotensive, 90/60. They said she was ok otherwise. When I saw her, she was barely breathing. I asked the family if she was walking and talking. They said she hadn’t spoken, eaten or moved her right side for a week. I went to my office to grab a pulse oximeter. I put it on her finger and couldn’t get a reading. I asked the nurse to check the blood pressure again. He couldn’t get one. I noticed she wasn’t breathing. I put my stethoscope on her chest. I hugged her daughter and the family began to stream in, hugging me while beginning the ritualistic mourning wail for those dear ones lost.

12. I had another patient who hadn’t spoken or moved his right side for a week. I asked him to move his left and he complied. He could understand, but he couldn’t talk... or walk or write or... I explained the situation to him and his family, gave him intravenous aspirin and sent him home.

13. I had another couple stroke patients... but you get the idea.

14. I had a child come in with a Burkitt’s Lymphoma tumor. I gave him my last two boxes of cyclophosphamide, free of charge. He refused to pay for the dexamethasone, IV and tubing and hospitalization. So I still have two boxes.  ed.note, Mega thank-you, Global Services in Loma Linda, California for the cyclophosphamide that was Fed Ex'd to Maryland, where Danae's parents took it to Chad, Jan. 16.

15. At morning report one morning they mentioned that the nurses had admitted a 15-year-old boy with malaria seizures. That seemed odd to me. ‘Did he have a fever?’ No. ‘Did he have any other symptoms?’ We don’t know. ‘Did he ever seize before?’ We don’t know. ‘What was the seizure like? Was it full body shaking? Was it a little twitching?’ We don’t know. ‘Why do you think he has malaria?’ He had a seizure.

I see the boy later that day. He’s having a seizure. Tonic-clonic. Incontinence. Check a temperature. Normal. I talk to the parents. Does he have any other problems? Has he ever seized before? Yes. When? Oh, about every week or so. For how long? Since he was little. I stop the quinine. Start Phenobarbital 100mg twice a day. My only other anti-epileptics are Thorazine and Diazepam. If those don’t worry... bummer. If they do work... well, they’ll need to decide if they’re worth the side effects.

Anyways, more than I can recount.

You Might be in Tchad if...

You finally decide it’s time to learn to aim properly because you don’t own a toilet seat.

You’ve decided it’s easier to just spend the day on the toilet instead of making thirteen trips in twelve hours... And you pine for a toilet seat.

Your legs go numb every time you go to the bathroom because you don’t own a toilet seat.

It’s over. Our most recent volunteer, Jessica, brought us a toilet seat!!!

You will notice on our blog, missionarydoctors.blogspot.com, that we have a link for donations. This is through Adventist Health International’s website. Please keep in mind that AHI takes 10% of the donation for administrative costs. However, AHI also provides us with invaluable support, and we believe strongly in the mission of AHI. We feel that AHI is an organization worth supporting. And remember that your gift is 100% tax-deductible.

missionarydoctors.blogspot.com

 HYPERLINK "mailto:danae.netteburg@gmail.com" danae.netteburg@gmail.com.

Olen Tigo: +235 98 07 46 28

Olen Zain: +235 62 16 04 93

Danae Tigo: +235 98 07 46 27

Danae Zain: +235 62 17 04 80

Olen et Danae Netteburg

Hopital Adventiste de Bere

52 Boite Postale

Kelo, Tchad

Volunteers Welcome!!!

#16 Writings from an almost 2-year-old missionary kid.

Today is Sunday.  I am happy because Mommy stays home on Sunday while Daddy sees patients at the hospital.  I had hot cereal for breakfast, and mommy even cut a mango to put in it.  Mommy says mango season is not usually until March, but I am happy that many mangos are coming on early.  

I am finally getting started at this talking thing.  Mommy hopes I learn English, French, Nangere, AND Arabic.  She says I have a better chance than her!  When I’m at the table, I just say “man-go”, and mommy gives me this yummy fruit.  I can’t wait until they are really in season and we have loads and loads of them.  

Yummy mangoes & I'm not sharing!  Get your own.

I also eat many bananas a day.  They are a little expensive right now because it’s not really their season either, but mommy buys them for me anyways.  They are about 10-20 cents each.  I could eat 10 bananas a day!  

I still take a nap in the morning and afternoon.  Mommy insisted on bringing many books for me (even though we didn’t have that much room), so I am happy to read them all day.  Many times I even cuddle with one or 2 when I fall asleep taking a nap.  Mommy hopes that someday I will want to sleep with a stuffed animal.  

Speaking of sleeping, I am VERY happy that I don’t have my own room yet because that means I get to sleep with mommy and daddy every night.  Mommy and Daddy are planning on remodeling though so I can have my own room!  I used to sleep in my own room, but now I am spoiled!

I love my new home.  I miss talking to my grandparents on Skype like we did in France though.  Two days ago my Gamma Netteburg and Auntie Kristin called on our mobile phone.  It was so fun to talk to them because I miss them.  

I can’t wait to see my Nana and Papa Bland.  They are coming to visit in less than a week!  They are planning on bringing my 2 sisters.  Mommy and Daddy call them our dogs, but they are like sisters

 to me.  The white one is Sheba and the black one is Midnight.  I still call all dogs here “Ba”, which is short for Sheba.  

Since I am growing up, it’s time for me to start using the toilet.  I like to say “caca” when I think I need to go poop (or if I already have gone).  Sometimes I think I pooped, but it’s just pee.  So I say it a lot.  Hopefully someday I’ll get the hang of this.  Mommy is happy we have a flushing toilet in the house!  There is no seat though, so I would fall in if mommy or daddy didn’t hold me.  I don’t really like the toilet yet.  But mommy is already tired of cloth diapers even though it’s only been a few weeks of using them.  

Monday through Friday I have a babysitter.  Her name is Luise.  She is from the Nangere tribe.  I can’t understand her yet, and neither can mommy or daddy, but they sometimes find a translator to help.  Most kids don’t wear diapers here, so she didn’t change my diapers enough at first, but now she is getting better (by the 3rd week).  Mommy doesn’t think older women here get the idea of playing with their kids.  Usually they have 10 kids, so the kids just play with themselves.  We also pay her to wash our clothes.  

We have a cook!  He comes in the morning and makes us lunch.  Sometimes he bakes bread too!  Mommy is happy he sifts the flour for her so she doesn’t have to see all the little black bugs!  He is Nangere too, but he speaks french.  Mommy is always worried that I won’t eat lunch because Luise has no sense of time.  For lunch, we eat white rice with some sort of vegetable sauce usually.  Sometimes we have spaghetti.  

I am excited to reunite with Brischelle, who will be my new babysitter!  She has been on a vacation in the states, but will be back next week!  I met her when I was 5 months old, and I really liked her!  She will be also doing homeschool, so mommy hopes she has time to fit both in.  She is just like a local because she has lived here for 1 1/2 years already.  

I’m also very excited about meeting my new best friend Cherise.  Her parents fly airplanes a couple kilometers away.  They’re missionaries too.  Cherise is four years old and everything I want to grow up to be. She’s very nice and plays with me and keeps me safe.

I love all the animals here!  They are right outside our door.  There are lots of chickens.  There are 3 horses we are watching for the Appels.  James and Sarah’s dog is called Caramel.  We have a little kitten in the house called Garfield.  Garfield had an traumatic accident before we came and now doesn’t walk very well, but I love him, and am happy to take care of him.  There are 2 or 3 other big cats that I like to pet, and sometimes pull their tails!  Outside our compound I can see pigs, goats, cows, donkeys, sheep... and all their cute babies right from our kitchen window.

Except for the yucky disease of malaria, the even yuckier medicine Quinine and my lingering fever for almost three weeks, I’m really enjoying it here.  I also enjoy that Mommy and Daddy are home more. I hope we stay forever.

You will notice on our blog, missionarydoctors.blogspot.com, that we have a link for donations. This is through Adventist Health International’s website. Please keep in mind that AHI takes 10% of the donation for administrative costs. However, AHI also provides us with invaluable support, and we believe strongly in the mission of AHI. We feel that AHI is an organization worth supporting. And remember that your gift is 100% tax-deductible.

As always, we can be reached at danae.netteburg@gmail.com.

Olen Tigo: +235 98 07 46 28

Olen Zain: +235 62 16 04 93

Danae Tigo: +235 98 07 46 27

Danae Zain: +235 62 17 04 80

Olen et Danae Netteburg

Hopital Adventiste de Bere

52 Boite Postale

Kelo, Tchad

Afrique

Volunteers Welcome!!!

Olen's Mother's note

This is Ronnalee Netteburg, Olen's mother.  Since Olen and Danae pay per second of internet usage, they send their blogs to me, and I upload them.  They ask that you do not send pictures or forwards, because those are often very large files that take a long time to download.  They do, however, love to get personal notes from you.

Some people have asked for more information about AHI.  AHI stands for Adventist Health International, an Adventist NGO (non-governmental organization) based in Loma Linda, California.  AHI collects funding, equipment, and personnel for Adventist health institutions around the world.  AHI serves as a conduit for people who wish to support Olen and Danae's work at Bere Hospital. 
Please continue to pray for Olen and Danae and Lyol.  They face personal health challenges, even as they seek to help others with critical health needs. 

Friday I got through on the phone line...a first.  The international access code is 011 and Chad's country code is 235.

#15 Tchad by the Numbers

0- Physicians per 1,000 people (2.2 per 100,000, compared to Washington DC with 752 per 100,000)

1- Ranking on Transparency International’s list of most corrupt countries in 2005.

1- Number of TV stations in the country (government-operated).

1- Number of movie theaters in the country.

2- Ranking on Fund for Peace’s list of most failed states in 2010. (We lost to Somalia. Again.)

2- Percent of pregnancies resulting in the death of the mother (compared to 0.001% in Ireland), most world-wide.

2- Number of flights/day to get out of the country (one to Paris, one to Addis Ababa).

5- Number of Internet hosts, 225th in the world.

8- Number of paved runways in the country (46 unpaved).

8- Percent of population with HIV (18th in the world).

9- Percent of women who die while pregnant or within six weeks of delivery (compared to 0.02% in Ireland).

10- Percent of population who read well enough to use it to earn a living.

11- Number of radio stations (2 AM, 4 FM, 5 short wave).

12.4- Percent of infants who die at childbirth (compared to 0.2% in Singapore) (190th out of 195).

21- Percent of children who die before the age of five (compared to 0.39% in Iceland).

40- Percent of children suffering from chronic malnutrition.

65- Percent of population living on less than $1/day.

80- Percent of population living below the poverty line.

80- Percent of population relying on livestock and subsistence farming for survival.

105- Degrees for an average high in April (76 is the average low).

120- Number of distinct languages in the country. Distinct means one village can’t understand the next.

171- Ranking (out of 177) on UN Human Development Index.

267- Kilometers of paved roads (33,400 unpaved).

13,000- Number of phone lines in the country, 199th in the world.

40,000,000,000- Dollars required to give basic health/education to the world without it.

1,200,000,000,000- Dollars allocated to the military by the US for 2011.