A Day in the Life

Bekki walking one of her Physical Therapy patients

Bekki walking one of her Physical Therapy patients

It is Sabbath afternoon, and the day, like most days here, has not gone according to plan. We were going to go to the Moundou SDA Church this morning after rounds, and then see what would happen after that. Well, Bekki’s sister, Ronnalee who is visiting with us, was up all night sick, and continues to feel very bad. I will spare you the details of the specific symptoms and disease process, but I will say it does not seem to be malaria and it is a frequent problem for travelers. Also the entire Appel family is sick with either a GI bug or malaria or both. Bekki and I are recovering from colds so we are not totally well either, but are in the best shape of anyone.

So I thought I would tell you about my last 24 hours. For me it was rather epic. I did a lot of things I had never done before on my own. In fact as I think about it, the only two things I did over the last 24 hours that I am used to doing on my own were eating and using the bathroom.

Friday started a little late because I had been up coughing most of the night so I skipped morning worship. When I finally caught up with James it was at his house where I found out that he had malaria and was not planning on coming into work. I was on my own. After picking my heart up off the floor, I smiled, lied (I said something like, “Not a problem”) and headed off to the hospital, where two hysterectomies and God only knew what else awaited me.

My first order of business was to extubate the teenager who had had a grapefruit sized goiter removed the day before. First big mistake of the day. (I will try to post gross pictures on a separate page, so those who have a morbid curiosity can look at them, while protecting those of you with sensitive constitutions.) In my defense he was awake and breathing on his own, with a good saturation. And after a rocky few minutes he settled down and seemed to be doing OK. So I started in on arranging the day, and getting some rounds done. The first hysterectomy patient was on the table and had just had the spinal placed. I was sitting in the office reading about hysterectomies (this was my first solo) when I heard strange disturbing noises coming from the direction of my thyroid patient. You know, the noises of someone who is having airway difficulties. Sure enough, oxygen saturation was dropping, grunting respirations, the whole 9 yards. We tried bagging, and got his saturation up to 88% (should be 99%). It was soon clear I needed to reintubate him. I am happy to report that after 2 years (reality was probably 30 or 40 minutes, but it seemed like 2 years) I finally got the tube back in. That was after James came over and found the stylet that had fallen behind the autoclave.

By now my hysterectomy patient had used up half or more of her spinal anesthesia time, which meant we would be using ketamine and diazepam, and the relaxation of the spinal would be gone about the time I really needed it. So here goes my first solo hysterectomy, on a lady with a really big (for me) fibroid. The whole case I was praying and stressing about the ureters, the bladder, the bleeding, you name it, but Abel and I got it out. Although I think the blood loss was a bit excessive. A word about Abel, he is in charge of the OR, and the first assist. He is really good, very much like Andy Schug, (but not as good as Andy), but he has one tiny drawback. He is deaf. Now he reads lips really well, but during surgery that poses a problem. Luckily the handsignals for instruments are universal, so it works. Abel is also a bit impatient so when he thinks it is time to cut that uterus out, he lets me know.

So one hyster down, one to go, after lunch. Eating I could do. The second hysterectomy was for bleeding, and she probably has endometrial cancer, but no obvious mets, and the uterus was not too large. It went much better, especially with Ronnalee as second assist and Bekki as circulator.

Oh yea, between the two I had a four year old with a piece of jewelry in his ear, next to the ear drum. Then a guy who needed a window cut in his cast for dressing changes. Last time I used a cast cutter I burned Jonathan because it was dull. After a few consults a patient who had had an accident a week ago came in, he is now a quad. He had been at several hospitals before ours, and no one could get a foley catheter in his bladder, so he had a small IV catheter sticking out of his very swollen abdomen. The nurses were trying to cath him and there was blood everywhere. So off he went to the OR for a supra pubic tube. Earlier in the week I had used our only percutaneous kit and had foolishly thrown it away after using it. Silly me, disposable means you use it until it disintegrates into the orginal molecular form.

Scott working in his office on a carnet (patient chart), got his translator and surgery book open, ready to go.

Scott working in his office on a carnet (patient chart), got his translator and surgery book open, ready to go.

Then there was the little girl with an open tib-fib fracture. She was last for the evening. Got her opened up, washed out, pulled out a chunk of free floating bone, straightened her leg, brought it out to length and then casted it. Last time I put on a cast was—Oh, lets see, 1987! As I headed out the door after 14 hours of work one of the nurses caught me. One of the consults of the day had stuck it out and not gone home. Oh well, it was a hernia consult, easy and straight forward. As I started to fill out the paperwork (Ha, you thought we didn’t have paperwork here, not true, just no computers) the patient says it has already been done, the paperwork, not the hernia. So sure enough we find the form all filled out and the hernia surgery paid for in advance (about $120 for the works). I then realize this poor guy has been waiting all day for his surgery, and it is now 8 pm. Everyone has gone home exhausted, so I had to tell him the earliest I could do his surgery was Tuesday. Imagine pulling that stunt at Valley Medical or St. Joes. These Tchadians are big dudes, I was glad he wasn’t mad at me.

Off to bed about 10 after winding down, but then the coughing started in again, so I finally took a sleeping pill, and blissfully headed off to dreamland, until 2 am. Tap tap on the door. OK I am coming. Hoping no one will notice my drugged state, I arrived at the hospital 30 seconds (literally) after leaving my room, and I was greeted by my thyroid patient in clear respiratory distress again. He had looked so good. So I suctioned him, could not get the catheter to pass, sats (oxygen saturation measures how much oxygen is in your blood) are now in the 70’s, he was awake and looking at me, pleading for help with his eyes. His guardian angel (I believe, because I am not that smart) whispered to me that his tube was blocked, so I pulled it out, and sure enough, there was a nasty clot in the end. We got a mask on him and praise God he settled down, sats back up into the high 90’s. Back to bed with orders to Appo the nurse to call me if he has further problems.

Slept till 4:30, woke up first to the call to prayer, good thing for Sabbath morning, then tap-tap. Appo was back. “Docteur, no power”. The oxygen concentrator had run the batteries dead, and the state electricity was off as usual. Fortunately I had written down the instructions for the generator. So off to the generator and get it started and get power back to us and the hospital. Back to bed.

Tap-tap, now it is 6 am. “Docteur, l’enfant est malade” (the child is ill, (aren’t they all?)), so I make the long 30 second trek to the hospital. They have taken the oxygen off the thyroid patient and put it on a little baby who has malaria and pneumonia. We only have one oxygen concentrator, but fortunately by now my thyroid guy is doing great, sats 95% on room air. Little baby, not so well. Grunting respirations, saturations of 60% and already on quinine and most of the antibiotics we have. Not much else we can do. The nurses suction him, and over the course of a few hours he improves, but still has a very grave prognosis. Too sick, with not enough resources. Shortly after that another little baby is brought over that we have been treating for malaria and meningitis. Now I am no expert, but if this kid does not have nuchal rigidity (a stiff neck), then they need to rename it. So I added another antibiotic to his polypharmacy (no tests, so we treat shotgun style, from the hip, and hope one of them covers it), and had the nurses give more diazepam (valium) to relax him. Also not a good prognosis. As I left the building I found his mother sitting on the ground with her head in her hands. I had explained to her that things did not look good. My French is not good enough to be abstract so all I could do was gently rub her back and shoulders, and hope she understood that I cared, and I shared her pain.

Then we made lightening Sabbath rounds, and I told the nurses that I was not available except for life and death emergencies, and it was Sabbath and I needed to rest or I would be sick as well. They understood, although they did come later and get me because they were out of gloves and I had the key to the container. I agreed that was a true emergency.

And so passed my first day really on my own. I know that all those who are serving or have served in these African hospitals are thinking, “Yea, and your point is?”, because this is everyday here. But your first is always unique and worth remembering, and someday I can read this again, and I will say, “Your point was?”.

Truth is my point is this. I understand a little better Paul’s counsel to pray without ceasing. I spent the entire day breathing a very brief prayer “God help me”, and there was nothing sacrilegious about it. It was heartfelt. We always pray together before each operation, and let me tell you, those prayers yesterday meant the world to me. And He answered those prayers in spades, I don’t think I bagged any ureters, or created any fistulas, I got the foreign body out, I learned a lot, and although there are some I can’t save, I didn’t kill anyone. All in all it was a good day.

For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital, where we initially were to be. Soon there will be a new video about Moundou. You will also find links to other missionary blogs such as Olen and Danae Netteburg, Jaime and Tammy Parker and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

-Scott Gardner

ps. The kid with the huge goiter is doing well, the baby with meningitis is still alive but still critical, the baby with pneumonia and malaria died sometime on Sabbath, the little girl with the broken leg is gone, apparently the family took her home on Sabbath sometime. They will probably go to a local healer and get the cast removed and splint her leg with sticks and rags. The hysterectomy ladies should go home tomorrow or Tuesday. Thanks for your prayers, they make a difference without a doubt. sg

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Blessings

I am so far behind in writing that I hardly know where to begin. So I will begin with a huge thank you. After our last blog, which is usually posted just before we go to bed, we woke up to a number of comments from you, our beloved readers. I don’t think either one of us realized how much those comments were going to mean to us. And I don’t think you all realize how much those comments mean to us. Your words of support, encouragement and love were just what we needed to get through those first difficult days.

The first 10 days or so in Moundou are ones neither of us really want to repeat. James and Sarah have been gracious and loving and generous, and the hospital workers have also been good to us, but despite that we both were absolutely overwhelmed. Bekki asked me one day how I was feeling and I simply said, “Numb.” And that was totally true, I didn’t feel anything, I wasn’t happy, sad, discouraged, elated, just numb. I wasn’t upset when patients died, I wasn’t happy when they recovered, just numb. Our mantra was that of Dory from “Finding Nemo”, “Just keep swimming”. And by God’s grace that is what we did.

I am happy to tell you that we are both doing much better. We are both enjoying our work, and we have feeling again. And yes Bekki found a job. She is the head of the Physical Therapy/Occupational Therapy Department. We are a small enough facility that we needed to combine them. And no she has no qualifications for either, other than a willing heart. And she has made a huge impact on the patient population. When they see her coming, they reach for their crutches and walkers, because they know it is time to walk. They don’t fight her anymore, because they know it will do no good. And their shared “suffering” at her hands has caused them to become friends with each other. And of course those of you who are friends with us on facebook have already heard about her exploits in the OR as a first assist and as an anesthetist.

So why the title “Blessings”? Well that comes from last week when we weren’t feeling so great about this missionary thing and we decided to spend some time counting our blessings, so here is what we came up with.

It is a blessing:

To have this time with James and Sarah Appel to learn from them.

To live where every morning we wake up to blue sky and sunshine.

To have an air-conditioned OR.

To have such wonderful friends in Bere, who support and love us.

To have such wonderful friends around the world who also love and support us from afar.

To have much better internet than we expected. (In fact we found out about the lockdown at Southern today here in Tchad almost before Lindsay did a mile from Campus).

To have such strong support from AHI.

To have very little night work. We sleep pretty much every night until 5 am when the Imam starts the call to prayer.

To have a very comfortable house to live in, that is much cooler inside than outside.

To have lots of pretty plants and flowers in our yard, and our own papaya tree.

To have less than a minute (literally) walk from our door to the hospital.

To have a job for Bekki, and have jobs for two Student Missionaries.

To not have had malaria yet.

To have had the three months of French study in Collonges.

To have our two wonderful kids who have been such a support for us.

To have Archie and Dee who take care of us from Clarkston.

To have Ronnalee and Kermit visit us here in Moundou.

To have all of your prayers.

So if you ever feel like your prayers for the missionaries don’t make a difference, think again. And if you ever think that your comments won’t be noticed, think again. And if you ever think that what you can do for God is too small, or won’t matter, think again. We would be lost without you.

For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital, where we initially were to be. Soon there will be a new video about Moundou. You will also find links to other missionary blogs such as Olen and Danae Netteburg, Jaime and Tammy Parker and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

-Scott Gardner

First Days of School

Scott on his first day of Mission Doctor Training with Dr. James Appel.

Scott on his first day of Mission Doctor Training with Dr. James Appel.

In our family we have a tradition, we take a picture of each “First Day of School”, and since Monday was my first day of school, Bekki obliged and took the picture you see of me operating with Dr. James Appel here in Moundou. This is our first blog from our new mission station, and it is kind of exciting. Sometime I may be able to share the kaleidoscope of emotions we went through on Sunday as we traveled here from Bere, met James and Sarah Appel, and started getting settled in. But I don’t think I can really describe it, something akin to a mixture of fear, despair, excitement, curiosity, loneliness, anxiety. Yea, you noticed, mostly negative emotions. That first 24 hours was pretty tough. I didn’t think I would ever be homesick for Bere, but I was. We are doing much better now though, so I can share with you what I have learned or relearned in my first three days of school.

However, first I must share an answer to prayer. One of my greatest fears has been to be stuck somewhere with no one to show me the ropes, and I am too old to have to figure it all out on my own. And I really don’t know much of anything about OB-GYN or ortho, so I am really happy to have a couple of months working with James, who has 10 years of hardcore mission experience to share with me, so I really am back in school (I call it Mission Doctor Residency).

What I Have Learned in Three Days Of Mission Doctor Residency

Africans are really tough people.

African flies do not carry germs, they are part of the operative team, assisting where they can by landing on the drapes, instruments and wound.

Orthopedic cases, especially intra-medulary (IM) rods do not need to be sterile, see number 2.

You can do big cases without cautery, good instruments, sponge counts, suction or good anesthesia. Case count after 3 days: Four hernias, hysterectomy, bilateral oopherectomy, c-section, giant nephrectomy, arm amputation, assisted on 3 IM nails, chest tube placement, toe nail removal.

Scissors that cut are for kindergartners. Real doctors use dull scissors, more of a challenge that way.

Speaking the same language as the patients and staff only complicates matters.

Africans grow really large pathologic body parts, like giant ovarian cysts, huge kidneys, massive squamous cell skin cancers (like 15 cm across) and big hernias.

Praying before surgery, really does make a difference, praying during surgery makes an even bigger difference.

Computerized medical records are unnecessary.

Disposable items really are reusable, over and over and over again.

You can operate just fine with a deaf assistant who reads lips (try that when everyone has a mask on).

Nurses do run the world, (at least the health care world).

People function amazingly well with a hemoglobin of 3 (normal is 12-15).

Starting the day with staff worship, which includes anyone else who wants to join is a great way to start the day.

Death happens, a lot.

Life is hard

Africans are really tough people.

Our new home in Moundou

Our new home in Moundou

For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital, where we initially were to be. Soon there will be a new video about Moundou. You will also find links to other missionary blogs such as Olen and Danae Netteburg, Jaime and Tammy Parker and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

-Scott Gardner

Home?

Our bus from N'djamena to Bere

Our bus from N’djamena to Bere

We are finally here. Home for the next who knows how long. As we were descending into N’djamena I was looking out the window thinking, wow, this is home now. We aren’t just going to be here for three or four weeks. We won’t be headed back to the land of hot water, reliable power and internet anytime soon. This is real, this is crunch time. I have to be honest, I did not have that thrill of anticipation, the joy of Christmas, it was more of a resigned feeling, such as one has on the way to the dentist for a root canal. We had made a decision and it is too late to back out now.

We landed at 10 pm after traveling for 24 hours, and I stepped outside and walked down the stairs to the tarmac (no jetways here) and I breathed in the comfortable night air, my feelings started to change. Then we went through the chaotic process of going through immigration, getting our bags, having everything x-rayed before we left the airport (don’t know why, so don’t ask), and then off to the parking lot.

There were ten of us in the group with a total of 21 checked bags and 20 carry-on items. Antoine, our contact, had brought a Toyota Tacoma to transport us to the Lutheran Mission for the night. In his defense it was four door. Then the discussion of how to get us all there began. It was finally decided to hire two extra taxis, so we and all our stuff piled into the three vehicles, trunks packed full, and with trunk lids tied down. These were typical third world taxis, created sometime in the ancient past. They have led hard lives, ridden hard and put away wet I believe is the term. Mirrors all askew so as to provide no useful information, no working gauges, questionable floor boards, doors and windows, and of course no seat belts. But equipped with airbags, well sort of, we were packed in so tight with carry-on luggage that our backpacks served as our all ready deployed airbags. In case of an accident we were not going anywhere.

By now it was close to midnight, New Years Eve and just about everyone was up and on the streets. People everywhere, deafening noise, trash, honking, a big African city. We made our way to the peace of the Lutheran mission and settled in to our rooms. Beds with mosquito nets, cold and cold running water for a shower, razor wire and glass shards on the walls around the mission, bars on all the windows, just a few more of our favorite things.

The next morning, well actually later the same morning to be precise, we were ready by the appointed hour of 0730. The chartered minivan showed up at 0830, right on schedule. You can’t really appreciate the badly padded church pews we sat on, the balding tires, including a spare in even worse shape, or the badly overloaded suspension from the picture, especially with 10 Americans, all their luggage and two drivers. Again in defense of our African brothers, we passed many similar vans with at least 20 Africans and their luggage crammed in. We only had 3 people to a row, they usually had at least 6. After a very sincere season of prayer for safety and protection we headed for the 8 or 9 hour drive to Bere.

First thing we noticed as we took off was the funny sound from under the van. Fortunately it disappeared when the driver changed gears, apparently the tranny needed warmed up a bit. After 15 minutes we stopped so the driver could get breakfast, a good thing as we didn’t want a hypoglycemic driver. Then about a half hour later we started slowing down and pulled over, with a dead engine. Next thing we know he hops out of the van, flags down a motorcycle and heads off down the road, without a word to us. I have not mentioned yet that our driver does not speak French or English, so we have no way of communicating with him except by hand signals.

After about 15 minutes here he comes with diesel fuel, and soon we are on the road again. Fortunately he made sure we now had an extra 5 gal can of fuel with us, unfortunately, it was hot and bubbled over so we had diesel fuel running down the floorboards of the van. About 45 minutes later we stop again, and next thing we know we have a new driver because the first one (who is still will us) has a severe headache. Off again. And so it goes through the day, stopping every 30 to 45 minutes for one thing or another, each time with no explanation other than what we can deduce, sometimes for fuel, sometimes a potty break, sometimes for prayers, and at least once to have their sandals polished (really I am not making this up).

Now the road between N’djamena and Kélo is paved. The last fifty kilometers to Bere is dirt. So at one stop we noticed the drivers getting surgical masks, well OK whatever. Soon enough we learned why. There is a major detour where they are repairing the road. The detour is dirt, the minivan has no air conditioning, hence the windows are open, I think you get the picture. At least the drivers could breathe fine. But we have nothing to complain about, the transmission is working, there is fuel in the tank, we are headed in the right direction…

Direction, oh yea, kind of important. It seems these guys had never been to Bere before. In addition to Bekki and I the other eight Americans were Maranatha volunteers headed to Bere to work on the building project there. We had all been over this road before, and so eyebrows went up when we headed off the paved road at Kyomo instead of Kélo. And of course we have no way of talking with these guys. So we passed kilometer after kilometer on a dusty dirt road, through millet and rice fields, with the every half hour stops. Even more disconcerting was the habit of stopping each van we passed and having the drivers chat away in their native language. We of course imagined the conversation:

“We are trying to get to Bere, where is it? Are we on the right road?”

“Yes, keep going straight, turn right at the 14th mango tree on the left.”

The last line I just made up, but who knows. The road we were on had no intersections, it was the ultimate limited access highway. Our only two choices were straight ahead or turn around. Being good Tchadians our drivers plowed ahead. And just a word about these Maranatha volunteers, these were all seasoned travelers, and it showed, not a word or murmur of complaint, they met each new challenge and situation with humor and grace. What a joy to travel with them.

The sun set, darkness settled in and we were all relieved that the van did have working headlights. Finally we pulled into a major town, Lai. Glory be, cue the angel choirs, we knew this town Lai. It is east of Bere, so our “shortcut” had put us on the wrong side of Bere, but we were closer, we were headed in the right direction. After a short visit in Lai (again doing who knows what) we headed off for Bere. We crossed two bridges that were just the width of the van, with no rail, but fortunately it was not too far a drop off, and also it was dark so we couldn’t really see what shape the bridge was in, probably a good thing.

And there it was, “Bere Vous Souhaite Bienvenue” (Welcome to Bere). Soon we were at the hospital and our friends and family were around us, hugging and telling us how worried they had been as our 8 hour journey had stretched into 11 hours, and they couldn’t reach us by phone.

Yesterday we made the rounds in the hospital, lots of hugs and greetings with the workers we have come to know and love here as well. We met new people, volunteers who have come since we were here last, and some made comments such as, “So you are Scott and Bekki, all we have been hearing is that Scott and Bekki are coming, Scott and Bekki are coming.”

Home, yes we are home, with all the dirt, trash, danger, corruption, disease, and differences, we are home. Home is where you are loved and accepted, where your friends and family are. And we are so blessed because we are home when we are in Tchad, when we are in Collonges, when we are in Chattanooga, when we are in Silver Spring, when we are in the Lewis-Clark Valley, and when we are in Tillamook. Home.

ps. Someone asked recently why I always spell Tchad wrong, what is with the “T”? Well it is because Chad is the American spelling, and Tchad is the Tchadian spelling, and I figure it is their country, I should spell it the way they do. sg

For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital, where we initially were to be. Soon there will be a new video about Moundou. You will also find links to other missionary blogs such as Olen and Danae Netteburg, Jaime and Tammy Parker and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

-Scott Gardner