Stories

I realized this weekend that it had been over a week since I last wrote. But I have had a dilemma, what to write about? You know the problem, everything now is fairly commonplace, nothing new under the sun so to speak. Just another day, just another leg smashed to bits and torn up like it went through a meat grinder. Just another baby dying of palu (malaria). Just another patient who can’t pay, doesn’t have a penny to their name, until we tell them, “OK, you can go to the government hospital, it is free there.” Suddenly, like in a David Copperfield show, the money magically appears. Just another meal with rice, or pasta, or rice…

So after some reflection I decided to just tell some stories, some sad, hopefully some amusing, but all a snapshot of life in Tchad.

I first noticed her laying quietly on the gurney in the corner. Just a little wisp of a very old woman. She has to be at least 55, I figure, but we will never know, birthdays here are not that important, unless you are rich. Anyway, I figured she probably had malaria and the nurses would let me know about her when they were ready. Soon enough Carlos brought me an x-ray, probably not palu. Distal femur fracture, and it didn’t look too bad, except it was really distal, just above the condyles. However, I have finally learned that x-rays never look as bad as it really is. Somehow I got the history that it was a closed fracture, so I didn’t mess with the dressing, big mistake. When I finally got her to the operating room there was a small hole in the front of her thigh where the bone had poked through. Ugh, now I had a two day old open femur fracture to deal with.

Somewhere along the line I got the story that she was not walking before the accident, and then I finally found out what had actually happened. This is amazing because she is Fulani, and getting the story from them is not easy. It turns out this poor woman was sitting on her chair at home, minding her own business, when one of the big bulls (cow type bull) came along and must have knocked her over then stepped on her thigh breaking it. Not your typical, “I slipped in the bathroom” story.

So now I had her leg open. I was going to just put a plate on it, but I couldn’t keep it reduced, and I couldn’t find a plate that would work. So finally I gave in and put in a intramedullary nail. It wasn’t great but her leg now only bent at the knee.

Post op she was all over the bed, so the family (not the nurses so it was legal) put her in a physical restraint. Notice the picture. Yea, they tied her big toe to the bed post. It is not clear how effective it was, but we took it down out of fear of necrosing her toe.

My little Arab lady with her toe tied to the  bed.

My little Arab lady with her toe tied to the bed.


Sadly, she is doing just as I expected. Despite daily irrigations with dilute bleach water (eau d’javel) her leg pussed out and I opened it today. I should have just done an amputation at the outset, because now the family won’t let me. And she has a cough that is worsening. Unfortunately she is going to linger for a while before she dies, in a hospital bed, with a poorly fixed infected broken leg.

Today I found another family adaptation of care. We have a young man who had previously broken his distal tibia and fibula, which had healed. Last week he somehow broke his tibia, just below the knee, and the femur, just above the knee. I managed to get him together enough to get him in traction for a couple of weeks. Before the operation the family was constantly on our case, “When is surgery?” etc. The night after the surgery Abba came to my door, very upset. “Docteur, I put the traction on as you ordered, but the family keeps unhooking it, every time I replace it.” It seems he was restless so the family in their wisdom decided the traction was bothering him and so they would unhook the sandbag from his leg. Then he would flop all over the bed.

We finally got them to leave the traction on, but then discovered a new problem. Our beds just have vinyl mattresses with a blanket over it, so patients (especially those with traction) tend to slide down toward the foot. One morning we came in and his sandbag was on the floor, with his foot against the end of the bed. Not too effective. So we scooted him up and shortened the rope attached to the sandbag. By the way it really is a sandbag. Our traction is a nylon cord tied to a shopping bag full of sand. Apparently he continued to slide down, so his family stuffed blankets between his foot and the metal bar at the end of the bed. So these folks are not getting the idea of traction. When we took that away, we were then greeted with his traction cord tightly tied to end of the bed. Problem solved, he no longer is sliding down, the traction doesn’t pull on his leg, oh happy day. We have untied it now two days in a row. Will they make it three?

Last week an Arab man was brought in with a fresh tibia fracture. It was closed!!! Yea!! That night Ramadji came to get me. “Docteur, this patient has a huge family and they are blocking the gate to the hospital and they won’t go away, please come tell them to leave, maybe they will listen to you.” Turns out, no. They didn’t listen to me either. In my very best French I assured them he was OK, there was family with him and they needed to go home for the night. Apparently what I really said was something like, “We have ice cream inside, you are all welcome to come in and have some”, because it was like the storming of the Bastille. We barely got back inside and two or three big Tchadiens were able to get the gate closed and locked. I am surprised they didn’t come over the wall.

I am happy to report that his surgery the next day went well. It was the slickest IM nail I have done. His post op x-ray is almost perfect. And it is an answer to pray because it turns out he is the local representative for the district in Moundou where the central market is. He is a very important dude. Definitely would not have gone well for the Center if I had screwed up his surgery.

Bekki and I went up to Bere this last weekend. I needed to meet with Olen and the new anesthetist, Mason McDowell. Plus we had to take their air compressor back (hopefully my new one will be here tomorrow), and we delivered $1500.00 worth of shopping. Anyway, I left with quite a few empty beds in the hospital. When we got back Sunday afternoon I was greeted by a full hospital and every overflow bed was full as well. It was mostly malaria and typhoid, but one particularly sad case. A young woman was lying in our recovery room/ICU with an oxygen mask. Her eyes were half open but no one was home. The story came out that she had had a headache Thursday and Friday and then had gone into a coma Friday afternoon. She had come in after I left. The nurses had thrown the book at her. They gave her just about our entire pharmacy, and since they had no way to know if this was cerebral malaria, or meningitis, or what I can’t blame them. By the time I got back on Sunday though it was clear she was going to die short of a miracle. We continued the treatment, and amazingly she was still alive Monday morning. On rounds as we gathered around her gurney with her family I asked our head nurse to pray for her and her family. They seemed to appreciate it. It is such a helpless feeling to know that there really isn’t a blessed thing you can do, and believe me I know the feeling well. Later that day her father stopped me and asked me about her. He is muslim, so I told him the same thing. Short of a miracle from Allah she is going to die. I assured him we had done all that humans are capable of doing. A little later her brother asked to speak with me. I was trying to get to lunch and am ashamed to say I was pretty brusque with him. But I had him sit down in my office and listened as he explained that he wanted to talk to me to make sure the family understood everything. He spoke very good French which meant he and I could communicate pretty well. I have found that my French, as bad as it is, is better than most of our patients. Anyway, the Holy Spirit quickly softened my heart and I was able to share with him the situation, and again our desperate need of a miracle in a kind and gentle manner. He asked if the family could take her home and I assured him that would be fine.

After lunch I started the afternoon surgeries. Josué stuck his head in the OR and told me the family wanted to take her home was that OK. I said sure, but it was not 10 minutes and he was back that she had just died. By the time I came out of surgery she and the family were gone. They don’t waste time here, and sadly the nurses are well practiced in the routine. A colorful piece of cloth is used to cover the body and face. They are wheeled out on the back porch and we have a special wood screen that goes around the gurney. Soon enough a car comes in the back gate and the body is taken away. It is not accompanied by any crying, in fact there is almost no outward show of emotion except when the person first dies. After a brief piercing wale, the family is eerily quiet, with the same stone face most Tchadiens wear all the time.

The gurney on our back porch with a body covered with a drape waiting for the last car ride.

The gurney on our back porch with a body covered with a drape waiting for the last car ride.

This afternoon as I struggled to get an orange sized prostate out of an old man’s bladder, desperately wishing that my index finger was a centimeter longer, I again sent up that oft repeated prayer, “Oh God, help me, I don’t know how I am going to get this (whatever the “this” is at the time) done.” I am frequently reminded how inadequate I am, and how much I need God to help me do this, and He always comes through. I got the prostate out, he is still alive, although I expect a pretty rocky recovery.

The malade (patients) just keep coming, there is no end. And I suspect it will just get worse. I had a patient from Kelo (a good sized city 100 km from here) tell me today that he is going to tell everyone in Kelo to come here to get their fractures fixed. He is another of my distal tib/fib fractures. They are all the same; wounds that look like a jig saw puzzle with most of the pieces missing, and both bones in multiple fragments clear down to within centimeters of the end of the bones. Despite that he greets me every morning with a big smile and handshake. His wound is clean and I pray his bone is healing under it all.

So there are some stories. As I think about what I wrote I notice it seems pretty sad. Sorry about that, but unfortunately most of my stories are pretty sad, that is life here. The good news is that despite it all we find a lot to laugh about it, in the OR, at meals, on rounds, where ever we can. I imagine Jesus laughed every chance He had when He found Himself at the end of the universe for 33 years.

A bright spot, sisters enjoying the dolls Bekki gave them.

A bright spot, sisters enjoying the dolls Bekki gave them.

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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Chickens, Rice and Blood

Chicken droppings, chicken feathers, rice, and blood. Not exactly the combination you typically find on the floor of the back of your run of the mill American ambulance. But here in Tchad, yea, pretty typical. That is what Daniel cleaned out of our ambulance today after our weekend trip to Bere.

Our Ambulance with the CCAM logo painted on the door.

Our Ambulance with the CCAM logo painted on the door.

Our story starts Friday morning. We were happily getting ready to work in the bloc, about to do a hysterectomy when we noticed the silence. As I have mentioned before our generator is just this side of the decibels of a 747 taking off, so when it stops, we notice. We also notice because it means something really great, city power. Or it means something really bad, it is broken again. Since the air conditioner didn’t work during the hysterectomy, (Brandon pointed out that people pay big bucks in the west for saunas like this, I was not amused) I was pretty sure it was the latter. Hoping it was just another broken belt (two already this week) I went to check it out. Nope, the belts were fine, it was just another broken piston. Oh.

I had three choices, cry, laugh hysterically as I entered into a well deserved nervous breakdown, or just say, “Oh”, and shake my head. I chose the latter. Actually it wasn’t all bad because this made the following decision that much easier. We had to buy a new generator, now.

Now just to refresh your memory, here is the cascade of dominoes when we have no generator:

No generator: No autoclave, hence no sterile instruments do operate with.
No generator: We have to use a small generator to charge the batteries.
No generator: The small generator can only charge the hospital batteries or the house batteries, not both at once. Hence we must move the generator from place to place.
No generator: No washing machines, hence all clothes must be washed by hand.
No generator: We can’t fill the water tower, except with the small generator.

Bekki doing the laundry by hand, obviously does not have it down yet, as she is covered in water.

Bekki doing the laundry by hand, obviously does not have it down yet, as she is covered in water.

It really puts a crimp in our style, if you know what I mean. So, this was the final straw, we had to have a reliable generator, now. We could not wait for a shipping container from Europe or the US. And I figured, somebody has to sell big generators here somewhere. Fortunately David found a 22 KW Perkins diesel generator still in the box in Moundou. Hopefully, we can buy it tomorrow.

However, this all took place Friday. We needed a second small generator to charge our house batteries, and I thought I knew just the place. Our local Home Depot, Bere Adventist Hospital. I called Olen and he said, “Sure, we can scrounge up something for you.” So arrangements were quickly made for Bekki and I to head up to Bere Friday afternoon and pick up the generator.

Just as quickly word got out that we were going up to Bere, and since many of our staff have family and friends there, we soon had a full ambulance. Stated departure was 4 pm, actual departure was 5:30 pm. But we were on the road. It was a beautiful drive as always, with a gorgeous African sunset over the Subsaharan bush. But as we turned east at Kelo, and headed toward Bere on the dirt road, we saw lightening in the distance. Soon enough the wind kicked up, and we headed into the teeth of the African Monsoon. So through night with the driving rain we drove, on the slick muddy road, with really weak headlights, and Bekki calling out, “People on the right”, then “People on the left”, then “People on the right, bicycles on the left.” I tried to stay in the middle and as far as I know never hit anyone.

It was a blessed relief to see the Bere Vous Souhaite Bienvenue (Welcome to Bere) sign, just outside of town. And by the time we pulled into the residence compound of the hospital the rain had stopped. It is always such a joy to spend a few hours with our friends and family at Bere, and this time was no different. Even with Lyle, our 5 year old grand nephew, standing out in front of our door at 6:30 Sabbath morning yelling “Bekki, Bekki” at the top of the his lungs. He was still better than our Imam who starts out at 4:15 am.

By 5 pm Sabbath afternoon we had our generator loaded in the ambulance and all those who were going back with us were packed in as well. That is where the chicken and rice come into the story. Just about everytime we head back we take with us at least one chicken and a 50 or hundred kilo bag of rice. And the rice usually spills on the floor and the chicken, which is tied up, still poops on the floor. But this is Africa, and everyone seems pretty good with sharing the ride with a chicken, generator and giant bag of rice.

We got to Kelo and turned south onto the main paved road in Tchad towards Moundou. By now it was again dark and my headlight were no better, but about 30 kilometers out of Moundou I drove past a lump in the middle of the road on the other side. It took a few seconds for it to register that the lump was a person, lying in the middle of the road, in the dark. Not a good combination for an extended life. I got the ambulance stopped and turned around and headed back, and sure enough there was a body lying motionless in the highway. I flipped on the lights and flood lights and the two nurses who were with us and I hopped out to investigate, fully expecting to find a dead body. But she moaned as we gently turned her onto her back. She was alive!! This certainly changed things.

I did a quick assessment, and she seemed to be breathing OK, abdomen was soft, but her right hip seemed a little floppy. We were about the first ones on the scene but within minutes, out of nowhere, in the middle of nowhere, a crowd of probably twenty people appeared. All talking at once, everyone giving advice and input. The nurses and I just kept working, getting ready to get her into the ambulance and get her to a medical facility. We found out she was a pedestrian who had been hit by a moto. It was a miracle we came along when we did because the first vehicle headed north would have finished her off without a doubt.

Now comes the painfully embarrassing part. In order to make room for the generator we had taken out the gurney, and we were already transporting a sick kid from Bere, so we had no place to put her but on the floor with the rice and and chicken poop. Also, I still had not stocked the ambulance with medical supplies, even though this was at least the third or fourth time we have picked someone up on the side of the road, so no gloves, no compresses, no nothing. Now in my defense…OK I don’t have a defense, I was just negligent, derelict in my duty. But you will be happy to know that I gave Abel and Daniel a list yesterday, and the ambulance is now stocked and ready, complete with backboard.

We did have a sheet however, (thank you James and Sarah) which we gently put her on and got her into the ambulance on the floor next to the generator. Appo, one of our nurses, stayed with her in the back, mostly just watching her, because there really wasn’t a blessed thing he could do, while we headed toward Moundou. Although she was blooded up, and blooded up the floor of our ambulance, she wasn’t actively bleeding. For those of you concerned about c-spine injuries, yea, I have one collar, it was in Moundou (I know, I know), and if you have an unstable c-spine fracture here you are in trouble because there is no one in Tchad who can do anything about it.

I lived every little boys dream. I drove an ambulance through the dark night with the siren going, lights flashing. Cars, pushcarts, motos, little kids and big people getting out of my way. And Bekki calling out, “People on the right”, then “People on the left”, then “People on the right, bicycles on the left.” I felt the power, the adrenaline, and would have enjoyed it more if I hadn’t been worried she was going to die on us before we got to the hospital.

I am happy to report that we arrived at the hospital with two living patients (the moto driver was with us too), and without causing any more injuries. Since the family of the victim wanted her to be taken to the government hospital, sadly I do not know how she is doing. If she has a broken hip she will probably end up here anyway in a few days (nothing happens quick here).

The inside of our ambulance with rice, chicken feathers, blood from our patient who laid on the floor next to the generator.

The inside of our ambulance with rice, chicken feathers, blood from our patient who laid on the floor next to the generator.

So there you have it, if you have chicken feathers, chicken poop, rice, and blood on the floor of your ambulance you are probably in Tchad.

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

Our old generator

Our old generator


Daniel with our new generator on the delivery truck.

Daniel with our new generator on the delivery truck.


Getting the generator into the generator house, in typical Tchadien fashion, lots of yelling, everyone talking at once, giving input, advice and counsel.  It works.

Getting the generator into the generator house, in typical Tchadien fashion, lots of yelling, everyone talking at once, giving input, advice and counsel. It works.


Our new generator.  22 KW of silent power.

Our new generator. 22 KW of silent power.


PS. We bought our new generator today. Isaac already has it up and running. It is so quiet. I ask the staff, “Have you heard the new generator?” Then they say “No”, and I respond, “Good”. We have power. However it came with a steep price tag, so anyone who feels so inclined can help us out toward a smaller back-up generator by donating to AHI Tchad/Moundou. sg