Life and Death II

At 12:49 this morning another Tchadien baby died. Probably another at 12:48 and 12:50, because Tchadien babies die all the time. But I don’t know about them, I do know about this one. It is the same old story, little tiny baby, a few months old, shows up at the hospital, high fever, grunting respirations, dehydrated, pale conjunctiva. I can’t count the number of times I have seen it since I have been here, malaria with pulmonary complications. Despite all that, the nurses are usually able to get an IV in, and get fluids, dextrose and quinine going. The baby is put on oxygen and over the course of a few hours or at most a day or two deteriorates and finally dies. I think I have seen one baby leave the hospital alive after coming in with those symptoms and being treated like that. But that is all we have, it is all we can do.

Usually I am on the periphery, there really is not much for me to do, it is mostly nursing care, and not even much of that once the IV is in, the oxygen is on and the meds are given. Tonight was different. Around midnight I heard Brandon call out for me. He is in the room at the end of the house and it seems the nurses have decided the best thing is to get him up, and have him call me. So Brandon told me that the nurses needed the keys to get the oxygen concentrator because another baby with fever and respiratory difficulties had arrived. I gave Larpur, the nurse, the keys and went back to bed, waiting. Sure enough 15 minutes later, “Doctor Scott, the nurses need you to come put in a central line.”

My first reaction was, ugh. I was pretty sure what I would find, and I was not disappointed. She was a little tiny baby girl, perfect, cute as can be with an oxygen mask on her delicate little face. She had the usual grunting respirations, her oxygen saturation was 90%, which is not bad, but soon started to fall, 80% then 70%, back to 75%, but steadily down, down, down. Brandon was right, the nurses wanted a central line so they could start fluids and quinine and dextrose (these kids are all hypoglycemic due to the malaria).

I had a dilemma, it was clear this little girl was going to die, and very soon, and an IV with fluids, quinine and dextrose was not going to save her. Her problem was her lungs, and I am not going to start intubating these kids, just not even going to go there. The last thing I wanted to do was to start poking her with a sharp needle, and making her last few minutes even worse. On the other hand my nurses are pulling out all the stops to save this little baby, and now was not the time for a discussion on the ethics of when it is time to stop treatment (read torture) and let someone die peacefully. Besides my French is not good enough to allow for that kind of discussion. So, right or wrong, I decided I had to let my nurses know I cared enough to help them try. Unfortunately, we have these little pediatric central line kits, and I knew where one was. So I used a little lidocaine and spend the next 15 minutes trying to get a femoral line in. All the while the grunting respirations worsen, the oxygen saturation drops to 60 then 50 then 40%, and finally the pulse ox quits working. But she is still breathing, and the nurses continue to look everywhere for a vein. I can hardly get more than a drop of blood from her groin, so I try for the internal jugular a couple of times, feeling guilty the whole time. What am I doing? We need to just let this poor little baby go. Finally, I felt like we had done enough and I told them to call the family, she is going to die, soon. So the grandma came in and was too upset to stay. I tried to get her to hold the little one, but either the message never got through or it is just not done that way in Tchad. It was time for Johnny, Brandon and I to go back to bed.

Usually as we walk back to the house after working together we talk about what happened and I try to do some teaching. Tonight I was too upset, and too conflicted. I had just tortured this little baby, and why? To show my nurses that I cared? How crazy is that? At the house I filled a water bottle and thought about what we could do different, what is the right way to care for these kids. All I could think of was the fact that when I left she was alone, putting all her energy into breathing, probably not really conscious, but still alone. And then I thought about Jon and Lindsay, how would I want them treated if they were babies again and were dying. And so I decided I was going back, that this baby was not going to die alone, not without a human touch, at least I could do that.

Back at the hospital I found that the baby was not alone, well sort of not alone, 2 nurses, 3 nursing students, and a grandma were all in the room. But no one was touching the baby. The nurses were still trying to figure out how to get quinine in her, Larpur was drawing some up in a syringe. I guess she was going to give it IM since there still was no IV. So I went over and laid my hand on her chest and abdomen and tried to gently stroke her. I tried to let her know that another human cared, I didn’t want her to die without feeling some kind of touch. It was probably just a couple of minutes and she breathed her last breath and was gone.

I don’t know for sure why I am even writing about this. It is not to diss my nurses, they really put their hearts into trying to save her. It is not because I did anything special, in fact most people probably would have stayed with her and not gone back to the house to begin with. And people die all the time, even in the first world. Most of you have been with someone when they died, so my story is not unique to Africa or Tchad or Moundou. I guess I am writing about it because it was a very unique experience for me, because it touched something inside me that doesn’t get touched very often. Even though I have had lots of patients die through the years, very rarely have I been with them as they breathed their last breath. And whenever I have been there it is always a very moving experience. But even deeper than that, tonight I put aside the doctor and became a human. I let myself feel something, it was good, a little painful, a little scary, but good. She wasn’t just another patient, she was a dark skinned Lindsay, or a dark skinned Jonathan, and I felt the grandmother’s pain. In a couple of hours I have to get up and catch the bus to N’djamena to meet Bekki, who is flying home as I write this. If I could I think I would cry myself to sleep tonight, but since I don’t cry, that probably won’t happen. I guess a virtual tribute to all who have ever lost someone they loved, which is all of us, will have to do. That and a prayer adapted from John the Revelator, “Even so, come quickly Lord Jesus, and put an end to all this sin and death, amen.”

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. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. 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. For our Francophone friends there is a French translation of our blog that you can find at http://gardnersenafrique.wordpress.com.

We welcome volunteers.

-Scott Gardner

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Life and Death

We had a death today, a tragic, unnecessary death. It was I think the hardest one I have had to deal with here. You may think I am being a bit irreverent when I tell you who died, but I am not, and I will explain why this death has been so hard. The obituary, if there was one, would go something like this:

 

Felipe and Brandon

Felipe and Brandon

Felipe the Bird was killed today. He was only a few weeks old, and was the victim of an unintentional birdslaughter by Samson the Dog. But during that short life he brightened the lives of all who knew him. His life was one of tragedy and difficulty, and it is ironically fitting that it ended so early in such a traumatic fashion. He was found abandoned, on the ground, by Brandon Tresenriter, a student missionary working at the Centre Chirurgicale Adventiste de Moundou. Brandon took him into his home and hand fed him. Felipe had a hard time finding food and opening his beak, so Brandon would gently open his beak and place the bread and corn flakes in his mouth. Brandon became his surrogate father, and even taught Felipe how to fly. In time Felipe would fly to Brandon and happily perch on his shoulder or head. Although he was free to fly anywhere he wanted, he hung out at the residence compound, preferring the company of people to the other birds. He was a much loved addition to the life of the missionaries. Today he apparently flew into the reach of Samson who accidently killed him. It is thought to be an accident because Samson has a habit of playing with other animals and birds much smaller than he is (he is a German Shepherd, not quite a year old) and being a bit too rough, and they end up dead. Such seems to have been the fate of Felipe. He was buried on the compound today in a quiet private ceremony. He is survived by Brandon, and his loving aunt and uncles, Rebecca, Johnny and Scott.  He will be missed.

 

Life and death in Tchad. There is so much death here. Little babies die all the time from complications of malaria. Older people, teenagers, adults all die from chronic liver disease from hepatitis, malaria complications, traumas, and even cancers that would have been curable. We had a death yesterday, a blessing really, a young man who had been in a military vehicle accident. Fractured arm, fractured leg and a depressed skull fracture over the frontal sinus. We put a traction pin in his leg, and casted his arm. Since his arrival he has been unconscious, for the medical readers, GCS 3. No CT scan, so I have no idea how extensive the brain injury was, and I had no intention of plowing through the bloody edema of his facial and skull fractures to do a craniotomy to find out. From the beginning I decided he either gets better or he doesn’t. As expected he didn’t get better. One minute he was breathing fine on his own, the next he was gone.

 

One of the hardest losses was the son of one of our patients. There is a man in the corner of the women’s ward who had a nasty fracture just above his knee. Thanks be to God he is doing really well with two plates, one of each side of the femur. But he is staying with us until he is totally healed. So about 3 weeks ago his son comes in with malaria. He was in the private room right next to his dad. The nurses mostly take care of the malaria cases, so I don’t get involved unless there is a complication. Well I got involved when the malaria went to his lungs and he started having the pulmonary symptoms. Not a good sign, it is kind of like ARDS in the US. So we moved him into the recovery room/ICU and put him on oxygen. Not much else I can do, except throw all the antibiotics I can at him, which we did. Within 24 hours he was gone. A previously healthy young man, dead. I was a little surprised at how stoic his father was, but again death is such a part of life here.

 

So with all this death, why feel bad about one little bird, who really wasn’t very attractive anyway. I think there are a number of reasons. First Felipe was a part of our lives, we had Felipe stories, Felipe and Brandon stories, and even though he was a bird he was part of the family, we knew him. Most of our patients who die are practically dead when they arrive. We never know them as people, with lives, with a personality. We have little emotional connection with them.  Brandon had worked so hard and carefully with Felipe, and to have him taken away like this was really tough. But I think the biggest reason is that Felipe was rescued from death once and given a new lease on life. He represented those who we have helped in their suffering, those who cheated death, and suddenly he became another failure, another loss, another death. If we thought about every death we have, we would not be able to keep going. I guess Felipe’s death kind of rubbed our faces in it.

 

Death is a part of life here, as it is everywhere. I can’t stop it, you can’t stop it, only God can. Too often I have to say, “I am sorry, but there is nothing I can do.” But as I face that here, day after day, I am grateful for the crazy little bird who brightened our lives for a few weeks, and I am grateful for the student missionary who showed me a bit of God’s love for us as he took in, cared for, and raised Felipe the Bird.

 

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. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. 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. For our Francophone friends there is a French translation of our blog that you can find at http://gardnersenafrique.wordpress.com.

 

We welcome volunteers.

 

-Scott Gardner

 

 

Reflections

I had the perfect scenario for my next blog post. (For the nonobservant among you, keyword in the first sentence is “had”.) The older brother of one of our employees died suddenly. Yesterday our administrator, David, told me he was going to the funeral to give comfort and support (at least I thought that is what he said). Later in the day he said that a group of them were going and asked if theycould take the ambulance. Wow, I thought, I am almost done for the day, I can go too. What a great cultural experience, a chance to see a Tchadien funeral, plus I can show support from the Nasara (white person) for Norbert, the one who lost his brother.

So most of the guys who work at the Center gathered together, we loaded up the ambulance and off we went. There were 11 of us, 3 in the front, and 8 in the back, a pretty happy excited group headed to a funeral.

My personal All Terrain Vehicle/Ambulance

My personal All Terrain Vehicle/Ambulance

I soon found out that about 5 kilometers south of town we were going to turn off the paved road onto a secondary road for 26 kilometers. Now a secondary road in Tchad is quite literally a wide (usually 6-8 feet) intermediate difficulty dirt bike trail, with brush on either side, and people and motos going in both directions. Thankfully, I told myself, ambulances are built to go in all sorts of terrain to pick up injured people, so I am sure it is within manufacturers specs, and will not void the warranty if I take it off-roading, especially overloaded with 11 full sized adult men. I was also grateful for the powerful Ford diesel engine so I could keep the speed up when we came to the really sandy stretches, you know, keep it hydroplaning.

We made it just fineto Bora, a fairly nice large village well of the beaten path., Turns out several of our staff were born or grew up in Bora, and there is an Adventist church there. In fact in a few years it will be Bora’s turn to host campmeeting, so we will get to spend some quality time there.

Back to the funeral. We got to Norbert’s family compound and were warmly greeted. I had learned on Rosetta Stone the proper way to phrase a condolence, so I said that in my less than perfect French. We were then ushered into the center of the compound and all sat on chairs in a big semi-circle. A word about Tchadien housing. In the villages they don’t live in multiroom houses like we have. They live on a compound, often walled, usually 50 – 75 feet square. There are multiple one room mud brick huts with tin or thatch roofs arranged around an open area that serves as the great room (kitchen, living room, dining room and family room in one). One by one the ladies came by and shook each of our hands in greeting, and one of the younger ladies brought Tchadien tea and offered it to everyone, but me. Somehow she knew I didn’t want any.

Typical Tchadien compound in the village.

Typical Tchadien compound in the village.

But mostly we just sat. It was dusk when we arrived, and soon we were sitting in the dark, the only light being from all the smartphones people were using to check e-mail, text or talk. Seriously, I am not making this up. In fact the compound was right next to the AirTel cell phone tower. My battery was close to dead so I limited myself to checking e mail just once (OK maybe twice). Mostly I just looked at the stars as they appeared, and wondered what was going to happen and when this funeral was going to start and where the body was.

After about 45 minutes, Norbert quietly said a few words to the group. He appreciated our visit, that type of thing. A few minutes later our lab tech stood up and gave the money our staff had donated for the family to the matriarch of the family, our assistant head nurse had prayer and then we headed to the ambulance and left. That was it. Apparently I had not understood properly. This was not a funeral, just a nice way to show our support for Norbert and his family in this difficult time. Which I thought was really cool, even if I missed out on the cultural experience of a real funeral. (I do get to go to a wedding in June though).

Good news is I did not miss out on the chance to drive back to Moundou over the same 26 km of dirt bike trail, but this time in the dark. I am happy to report no livestock, pedestrians or vehicles were damaged or killed in this cultural experience.

So no funeral, but I did have lots of time to reflect, at least when I wasn’t concentrating on my driving. And I realized how incredibly lucky I am to have this opportunity to be here. I thought of the other ten men with me, they are my friends now. We work together, we laugh together, and now we were sharing in the pain of one of our brothers. As I drove I watched the evening life of the villagers unfold. The women returning from the fields, many carrying bundles on their heads with their perfect posture. The innumerable little mango stands (it is mango season, they are now 5 cents each, I had my usual 3 for supper tonight), the other little stands selling everything needed for daily life. People washing, cooking, and playing football (soccer), all the normal daily activities here. It is so different from life in America, but it is so great to be here and be able to be a part of it.

I am also so fortunate to have the chance to expand my medical and surgical horizons in ways I never thought possible, and do it in a foreign language. And I have the chance to learn from some really smart people about how you practice medicine here, how you help people in a place with limited resource. I also get to work under a really cool boss, my nephew, Olen Netteburg, who is the AHI-Tchad Director. In the last 4 months I have really come to appreciate him, his knowledge, his wisdom, his understanding of the culture here. I told him I was going to write a blog about having the world’s greatest nephew but I figured that would make my other nephews mad, so this will have to do. He has really come through for me on several occasions as I have struggled to adapt to mission life, and being a mission doctor.

And of course the ambulance, where else could I take an overloaded ambulance offroading, and say it was a good thing. Only in Africa.

Yea, I am really blessed.

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. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. 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. For our Francophone friends there is a French translation of our blog that you can find at http://gardnersenafrique.wordpress.com.

We welcome volunteers.

-Scott Gardner

The Night of a Thousand Showers

“Docteur Scote (the African French pronunciation of my name), the pastor asked me to tell you that you are giving the health lecture at camp meeting tomorrow at 4 pm.”

I was just finishing a Thursday evening meeting with my administrator and cashier, David and Norbert, when David informed me of the above plan. I just laughed lightly and asked, “French or English?”

He replied, “French, but if you want the pastor will translate for you.”

I then informed David that I wasn’t even planning on leaving Moundou until 4 pm, and it is a two hour drive to Doba where camp meeting was being held.

“OK”, was his reply, “Friday evening or Sabbath will be fine.” Always helpful, that David.

I soon found out the topic choice was mine, just something about health. So what do I talk about with no time to prepare? Teaching them how to do an intramedullary rod, or fix a hernia probably was not going to work, even if I could show slides. So I thought, I can probably wing a NEW START presentation. So far so good.

Ambulance is all over-loaded up and ready to go.

Ambulance is all over-loaded up and ready to go.

Friday at 4:15 pm we loaded up the ambulance with Tchadiens from the Center with their families and headed off to Doba. I don’t even bother to count them anymore. It was really a nice drive through the Southern Tchad countryside. Very picturesque and very African, with the mud huts, thatch roofs, donkeys, chickens, children, cows, bulls, and assorted people all trying to cross the road in front of us. The young men in the back were singing Tchadien Christian songs, everyone was excited and happy, eager to get to camp meeting. This camp meeting was for our district, one pastor for 4 churches, the two farthest being about 60 miles apart. So every April all the churches get together for 4 days of meetings, fellowship and singing and dancing. And once again as I drove along, talking with Patrice, one of our head nurses, I had that feeling like I was in an Eric B Hare story. And although I know that mission work is more than feeling like that, it was still a really good feeling.

When we arrived at the church and school in Doba where the meetings were being held, we were swarmed as everyone was so glad to see us. Camp meeting here is no different from the US, a chance to see your friends, hang out and have some good spiritual encouragement. Definitely a have your cake and eat it too experience. I soon found out that there was no more evening meeting and I would be speaking Sabbath afternoon. The pastor then took us to the Hostel where we would be staying. It was the best one around that Pastor could find, but at $12 USD/ per person/per night, well let’s just say you get what you pay for.

Our version of Motel 6

Our version of Motel 6

Supper and Breakfast, scrambled eggs, bread, and mangoes, and good company.

Supper and Breakfast, scrambled eggs, bread, and mangoes, and good company.

The hotel was clean, we each had our own room, and I did not see any cockroaches or snakes. After a supper of scrambled eggs, bread, and mangoes, we checked out our rooms. Pretty simple affair really, a room, bed, pillows, complimentary TP and soap. concrete walls, single bathroom, shower, sink, and toilet . I was set for the night. But I had one slight, OK, not so slight problem. I had convinced myself it was not necessary to bring the Goal Zero battery and fan. The room had a fan after all, and I am really tough, I don’t need no stinkin extra fan, and if I sweat a little it will be good for me. I live in Tchad, it is time I live like a Tchadien. Or so I thought.

The sweat room

The sweat room

On this side of the experience I recognize the value, mostly as material for a blog post, beyond that, not so much. Yes the room had a fan, and yes it worked, and I believe the number of air molecules that actually moved because of said fan was a number south of 10. That combined with sleeping in my mosquito net tent meant it was really really hot and humid. Fortunately I had not brought any sleeping pills or else in the morning Johnny and Brandon would have found a shriveled dehydrated body. So I dealt with the problem by taking a shower every time I woke up and getting back in bed without drying off. That would give me about 10 minutes to get back to sleep before I was hot again. An hour or two later I would wake up and do it again. Hence the title, “The Night of a Thousand Showers”. But morning finally came and I was able to leave the sauna for my breakfast of, you guessed it, scrambled eggs and mangoes.

Inside the church in Doba

Inside the church in Doba

So what is a Tchadien camp meeting like? Well now that I have the vast experience of one, I can tell you. Really it is not much different than a US camp meeting. There are meetings with sermons and also classes on finance, health, and Christian growth each day. Sabbath is of course a high day, with an extra long service. There was an eight person baptism at the river Sabbath afternoon, complete with the crowd of non SDA onlookers. And of course the usual Sabbath afternoon repose in the shade on an incredibly hot day with your friends, just hanging out. Just like the States. Even the questions after my talk were the same. “What do we do about our teenagers who sneak out of the compound after we go to bed and stay out until midnight, and then they want to sleep until noon?” I told them I sent my kids off to boarding school so it was someone else’s problem.
The baptismal candidates

The baptismal candidates

Baptism at the River, with an audience.

Baptism at the River, with an audience.

But then there were a few differences I had never seen before at Stateside campmeetings:

• The pathfinders guarding the doors to the church with their bright green swords, I am guessing referencing the Garden of Eden.

Pathfinder guardians

Pathfinder guardians

• Sabbath lunch was also a bit different, boulle (a rice or corn play dough) that you dip in a sauce, this time it was sauce with goat meat. Johnny said it was pretty good, Brandon and I elected to wait for supper.

• Toilets were a bit different. Basically one toilet for everyone, which was a hole in the ground surrounded by a 4 foot high woven grass wall. The only way to see if it was occupied was to look in and see. Again Brandon and I chose to wait till we got home.

• The dancing during the church service. I asked later and these are apparently traditional Tchadien Christian dances. And everyone of every age really got into it. OK, not what I am used to, but clearly it works for them as an expression of their joy in the Lord.

Our Tchadien dancers

Our Tchadien dancers

Johnny and Brandon chilling Sabbath afternoon with Daniel, our anesthetist.

Johnny and Brandon chilling Sabbath afternoon with Daniel, our anesthetist.

Next year I will be ready, with my fan, my goal zero battery, and a different health talk. It’s our new Redwood Camp meeting.
The overflow crowd outside the church.

The overflow crowd outside the church.

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. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. 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. For our Francophone friends there is a French translation of our blog that you can find at http://gardnersenafrique.wordpress.com.

We welcome volunteers.

-Scott Gardner

Traumatisme

“What you just saw, was not how you do a proper trauma evalua…..and that is why.”

About 8:30 this evening I had just sat down at my desk to write my admit note and hospital orders (don’t feel sorry for me, all that was done on the same space as a 3X5 inch card), and my two pre-med SM’s, Johnny and Brandon were sitting across from me. We had just admitted a man who had, surprise surprise, a moto accident. He has a broken jaw, broken collarbone and maybe a broken arm, not quite sure about that one. Anyway I sewed up his lip laceration and looked him over and then I told the nurse on duty for the night that he probably should be in the recovery room, which doubles as our ICU. At the time he was in our minor surgery room, same building, the rooms are about 20 feet apart.

So as I wrote out my orders, I thought this was a good time to again warn my SM’s that “What happens in Africa, stays in Africa.” I don’t want them raising their hands in med school and telling the professors about the crazy stuff we do here. So I thought I would teach them a little about proper trauma evaluation, not Tchadian trauma evaluation. So I started off with the, “What you just saw, was not how you do a proper trauma evalua…” About then I looked out my door to see my patient being moved to the ICU.

There were about 7 or 8 family members around him in a circle. One brother had his arms under the armpits of the patient, another had him under the knees, his butt was nearly dragging on the floor as they carried him to his new bed. Yea, broken jaw, broken collar bone, possible broken arm and all. It had to hurt like…uh, hurt really really bad. Hence the ending…”and that is why.” He came from a distant village, and that is probably how he was moved around. If he had a broken neck of any consequence he would be dead or paralyzed by now.

So tomorrow we will get xrays of his chest, arm and jaw, although I have yet to see a useful jaw xray here. Then if his family pays in time we will wire his jaw fracture, and if he does have a humerus fracture I will put on another hanging arm cast. That is how we manage trauma here in Tchad. Hopefully no officers of the American College of Surgeons are reading this, or I will be drummed out. But honestly everything here, every day comes down to triage. How will our resources be used to get the most benefit to the most people.

Yesterday was a good example. A little boy came in around 2 or 3 in the afternoon. He was breathing hard and fast, but not deep or clear, he was hot, and had a hemoglobin of 6 (actually not bad, but not good either). Rebecca, our Danish nurse ran and got the pulse oximeter, oxygen saturation (supposed to be 95-100%) low 70’s and dropping. She got our oxygen concentrator, and with five liters of O2 going his sats kept dropping, 50’s, 40’s, but his heart still beat and he kept breathing. Diagnosis, probably pulmonary malaria. When malaria starts causing either lung or brain symptoms, it is usually fatal no matter what you do. I had already decided these kids were not going to be intubated, they will get O2 if the concentrator is available, but we just don’t have the resources to intubate and ventilate them. In this case, I also had a laparotomy coming up in a few minutes where I might need the O2 concentrator. Turned out the young women for the laparotomy had a sigmoid torsion, so I did a sigmoid colectomy (first hand sewn anastomosis in a while). Part way through the case the little baby got worse and next thing I know my anesthetist is gone in a vain attempt to resuscitate the baby. Fortunately our patient on the OR table was stable, but again I was ready to call him back if needed. The baby died while we were closing. I think only once have I seen a little one with this scenario survive. But it is all a question of how am I going to manage the resources I have. Who is likely to die no matter what I do, who can I save, who can I help?

Funny how things come in spurts, we haven’t had any deaths for awhile and this week alone I know of at least 3, with one other sent home to die. Then 2 weeks ago I swear our administrator put out an ad for a great deal on intramedullary rods for long bone fractures. I put in 6 nails in 6 days. This week has been internal fixation with plates, three so far, two of them on 10 year old boys with femur fractures.

To end on a lighter note, tonight the volunteers coaxed me into going to the new hotel down the street. This is a western style hotel with a real swimming pool and a restaurant with a French chef. The restaurant is climate controlled, there are table cloths and CLOTH NAPKINS (this country does not believe in napkins), real chairs, wall to wall carpeting, and food, real western food. Yea, even my cynical heart was touched. Then we went back into the hot night, came back to the hot house and had popcorn, mangoes and skittles, before heading off to the traumatisme (trauma). So ends another day in paradise.

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. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. 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. For our Francophone friends there is a French translation of our blog that you can find at http://gardnersenafrique.wordpress.com.

We welcome volunteers.

-Scott Gardner

Batouri

The OR in Batouri Adventist Hospital, with my hernia patient ready to go.

The OR in Batouri Adventist Hospital, with my hernia patient ready to go.

Sweat is sterile, right? Please someone just tell me sweat is sterile, even if it isn’t, say it is because despite the nurses best efforts to keep my forehead mopped I am dripping sweat into this guys hernia wound and all over the sterile drapes. It is hot and humid and the air conditioner, along with just about everything else here, is broken.

During the same case I am silently praying, “God, please work another miracle, and don’t let this mesh get infected.” I know that is a similar request to turning the water to wine thing in Cana because I am pouring sweat into his open hernia wound, the drapes and OR gowns all have huge holes in them, we are using all the wrong instruments for a hernia repair, my gown is about 4 sizes too small, so there is a chronic gap between my glove and the sleeve. Yep, short of a miracle that mesh is doomed. And the hernia was so big, there was no way I was going to get it closed without the mosquito net mesh we use.

The entrance to Batouri Hospital.

The entrance to Batouri Hospital.

I was at Batouri Adventist Hospital last Thursday. I told Dr. Roger, the Congolese doctor who serves there that I was sure he had me do the hernia with him so I would see first hand what lousy instruments he had to use, and what lousy conditions he has to work in, and so I would be sure to bring better instruments next time I came back. He laughed that knowing, “you caught me” laugh.

The jungle comes right up to the hospital.  I was told there are green mambas in that jungle.  Lets just say I did not go exploring.

The jungle comes right up to the hospital. I was told there are green mambas in that jungle. Lets just say I did not go exploring.

To rewind a bit. One of my jobs is to provide help and support for two of our Adventist Hospitals in Cameroon. Last week I was on the first of what I hope are monthly trips into Cameroon to find out what the hospitals need and help the doctors (both Congolese) there with some extra education. The plan is for our mission pilot, Gary Roberts, to fly me in and out of Cameroun from Moundou. This time we planned a week trip, visiting both hospitals and making a stop in the capitol, Yaoundé, to visit with the Union officials and get their support. That was the plan.

The hospital kitchen, where families fix the meals for the patients.  No complaining about hospital food is allowed.

The hospital kitchen, where families fix the meals for the patients. No complaining about hospital food is allowed.

This was the trip from hell. First Gary could only get last minute permission to land at the international airports, so there was no going to the hospitals by plane. Hence I had to take the public buses to Batouri. That was a 12 hour ride. You learn pretty quickly not to drink too much on these bus rides because the bathroom breaks are stops by the side of the road, but there are no bushes to go behind. You just face away from the bus and let it go. But that means you are facing the houses on the side of the road. Also it is the usual men go right and women go right. Yep, kind of a group thing. I haven’t been in Africa long enough to get into that depth of camaraderie. Besides my white skin kind of stands out, if you get my drift. So I hold it until the bus station where I use the regular facilities (it costs 20 cents, but is worth it). Oh, the regular facility is also coed, but individual rooms with a tin door that kind of closes. In one corner is the hole, with lots of “fluid” and other stuff you don’t want to think about around it. But, hey I will take it.

The nonfunctioning hand pump for the well, which I was told has plenty of water, just no way to access it. Any thoughts or ideas?

The nonfunctioning hand pump for the well, which I was told has plenty of water, just no way to access it. Any thoughts or ideas?

And in Moundou, before we left, the local version of TSA wanted to charge us $160USD to check my bags. This is for a private plane, a four seater Cessna 172, with two pilots and one passenger. So after two hours of haggling they agreed to let us go without paying, but first they had to paw through my bags, and then proceeded to put baggage tickets on my bags and gave me the claim checks, and get this, a boarding pass. We then walked the 50 feet to the plane together, where we put my bags in the seat next to me (that’s right these are all carry-ons) and made sure I returned the boarding pass. Fortunately, thanks to their diligent efforts I did not bring down or hijack the plane, and my bags safely reached their destination, and at the same time I did. However, we beat them at their own game. Coming back Gary and I flew into Moundou by 6:10 am so they were not even at work yet. I was back at the hospital and he was back in Bere before they knew what happened. Ha.

Enough fussing, because after getting to Batouri, I realized that no matter what it took to get there, it was worth it all. And, no matter how difficult it was for me, they have it much worse. This is supposed to be a regular functioning bush hospital, and it is, but without: power, water, supplies, money and equipment. What they do have is a dedicated hard working staff, who often go for months without being paid, a decent physical plant, and mosquito nets for their patients.

Rounds in the medical ward with Dr. Roger and the nurses.  They have very nice mosquito nets for all the beds, which is a step up from Bere and Moundou.

Rounds in the medical ward with Dr. Roger and the nurses. They have very nice mosquito nets for all the beds, which is a step up from Bere and Moundou.

They use city power which is often not working, and when the city power is out they can’t get city water, and the hand pump on their well doesn’t work. So the five days prior to my visit they had power only when their old diesel generator is on, and they had to haul in all the water by hand from wherever they could find it, maybe a couple kilometers away. With Dr. Roger they are getting busier, but still 25% in the red each month, and their equipment is either broken or nonexistent. But you know, I saw smiles, I saw people doing their best in an impossible situation. And I thanked God I was sent to Moundou.

Hopefully Gary will get his full permit next week or so and we can fly to the other hospital, and pay them a badly needed visit. These hospitals without western doctors are really hurting. They have no advocates. We are able to present our needs to our friends and colleagues back home and in Europe. But the other hospitals do not have that kind of support. And although they are supposed to operate in the black, that does not include nearly enough money for capital improvements or repairs, or replacement equipment. That is why I was asked by AHI to go visit these hospitals. And so next visit we will fill the plane with decent surgical instruments, towels and whatever else I can scrounge up here and in Bere. And hopefully I can take some encouragement and hope to good people doing impossible work in an impossible place. And God willing my hernia patient will have gone home without any infections.

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. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. 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. For our Francophone friends there is a French translation of our blog that you can find at http://gardnersenafrique.wordpress.com.

We welcome volunteers.

-Scott Gardner