Seven Dollars

It has been a really difficult month, wait a minute what am I saying, every month is difficult. But this month has been particularly troubling. I have spent way too much time in administrative committee meetings, which I chair. Unfortunately, most of the time has been spent on discipline issues.

Committée de Gestion (Administrative Committee) meetings are much like church board meetings only more painful. We start with prayer, a good thing, and then start working through the agenda. The agenda items are much as you would find in any American hospital or clinic. We have discussed contracts, mission and values statements, policies and procedures, and of course discipline issues. The meetings however, are very warm culture meetings. Everyone has an opportunity to voice their opinion on each item and we go around the circle, sometimes several times. This is a good thing, the bad thing is that each person has to express his opinion with stories of similar past experiences, and multiple examples. It takes forever, but is a very important part of the process. After everyone has spoken their piece we vote, and it is almost always a consensus, which is a good thing as well.

There are some memorable moments with respect to Committée de Gestion meetings. The first few were held in my old office. A 10X10X10 foot room with no windows, and no ventilation, just a wannabe fan. After 2 hours the place was so full of hot air and so humid we could hardly breathe, let alone think or make good decisions. Sweat would be pouring down our faces, we were dehydrated, and when we finally finished and went outside it was like we had stepped into air conditioning. We finally got smart and moved the meetings into the OR, which is air-conditioned. I am not sure Joan Agee would approve of SJRMC having board meetings in OR G, but since the head of the OR is on the committee all is good.

Then there was the infamous “lights out” meeting. This was before we had our new generator and was one of the times when both the old generators were not working and we had no city power. Hence we were running on residual battery power. So we were in major conservation mode. All power was diverted to the refrigerator to keep it running. So we were using flashlights, and the Goal Zero light. We had a committee meeting scheduled that had to take place, so we met in the living room in the dark, with just a dim light to see by. Bekki, Brandon and Johnnie retired to Brandon’s room to wait it out. It was a good thing too because that was one heated meeting. We had it all, yelling, finger pointing, people getting up out of their chairs. I even got into it, yelling “Arretez, arretez” at the other guys to get them to stop shouting at each other. Bekki, Brandon and Johnnie hunkered down, huddled together in the dark, hoping that they would find more than just carcasses in the morning. Maybe the sugar from the Tops sodas we were drinking made us all a little irritable.

I was a little surprised to see our pastor come to our weekly staff meeting. He is on our committee but doesn’t typically come to staff meeting. And he had a few choice words to say to the staff about trust and confidence and treating people right. Hmm, wasn’t sure what was going on, but I was soon to find out. He wanted to talk with David (our administrator) and me after the meeting. Fortunately my new office is bigger and has two large windows, so is much better for meetings now. Turns out a church member had come to the clinic for a consultation and when the nurse ordered blood tests for him, the nurse took the money for the test and didn’t give him a receipt. He thought that was a little strange, and then the nurse drew the blood himself, instead of having the lab tech do it.

He thought it was a little strange and talked with the pastor about it. And that is why the pastor was here, to tell us. After an investigation we were ready to call the nurse in to talk about this. When confronted he confessed, yes, he had taken the money and pocketed it, and then not written a receipt out so there would be no paper trail. I asked him if he had done this before, no never, this was the only time. Yea, right. I was really sad and discouraged. I really like this guy (still do) he is a good nurse, and fun to work with as well. I looked for anyway I could find to not fire him, but after we reviewed the rules governing the organization, we had no choice. Furthermore, what he did is actually pretty normal practice in most medical facilities in Tchad. For instance in the government hospital I am told the nurses will make the patients pay extra to have the nurse administer their meds. Or the nurse will actually steal the patient’s meds and then sell them and pocket the profit.

We, however, like to think we operate on a higher level, and do not tolerate this kind of behavior. So we went through the process. He appeared before the committee, where he gave his side of the story, which wasn’t much, and then the list of charges and his confession were read to him. He was asked if he agreed, and when he did he then signed the confession. The next day he came back and we served him the papers that fired him. It was actually very heart rending. He took it quietly, no shouting or screaming or crying, but it was still hard. I told him he would always be my friend and I thought he was a good nurse and I was sorry this had happened. Good news is when he sees me now he smiles and shakes my hand like nothing happened.

A couple of days later in staff meeting I talked with the staff about what happened. I read to them from the rules and regs, I told them we would fire every one of them if need be, but stealing from patients and the Center would not be tolerated.

David (our administrator) called me into his office four days later, “Docteur, we have a problem.’’ I just smiled, because we always have a problem, not a day or hours goes by without some problem. He had a carnet (patient chart) on his desk.

“Docteur, the nurse Saturday night took money from this patient and didn’t write a receipt.”

I could not believe it. This nurse had been in the meeting just two days before when I warned them about this very thing. Another investigation, another long Committée de Gestion meeting during the day taking up time that I did not have. Another firing of a good nurse who did a really stupid thing.

So these nurses who stole all this money, how much did they take you ask? The first one took 4500 FCFA (Central African Francs), the second one took 3500 FCFA. The exchange rate is about 500 FCFA to $1. So they took $9 and $7 respectively. What makes someone risk their job for $7? Now granted that is almost a day’s wage, and maybe that puts it into perspective. But still, really? This is worth the risk? I am not sure I will ever fully understand the mind set, the thinking pattern. But chronic poverty does really weird things to a culture and to how we think.

I do not hold even the slightest animosity toward these guys, they are a product of their culture, and I am not sure they really fully comprehend that what they did was wrong. They live where the concept of stealing is relative, and very different from what we consider stealing, it is often not considered stealing if the item was just left somewhere (even if you just set it down for a second) or if you are not caught.

That being said I am really sad and disappointed, and I talked with the staff again today in staff meeting. Hopefully they get the point, and believe the message. We have a higher standard here, this is not the government hospital. I pray that God can continue to use us to help lead the way toward being good citizens in His kingdom, where there will be no thieves.
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 as well as the videos she has made of 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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The Container

Bekki, Scott and Lindsay all dressed up for Church

Bekki, Scott and Lindsay all dressed up for Church

I have waited a long time to write this post. 443 days to be exact. Many of you have prayed diligently for us and for our container, and for that we are grateful. I am happy to report that our container is here, it is parked in front of the hospital and is mostly unloaded. I told Bekki yesterday that if it took until 2 am I was going to set up our bed and sleep in it, with our mosquito net. She beat me to it, while I operated she got the old bed out and the new bed set up. Last night for the first time in 14 ½ months, 443 days to be exact, we slept in our bed. I can’t really describe how wonderful it was to have all my pillows, to have a king size bed again, to not have the guest bed, which frankly is usually not that great. Then tonight we had supper on our table, with our dishes (haven’t found the silverware yet). Yesterday we had Swiss Steak, hmmm, it was soooo good.
Bekki and Jolene surrounded by boxes with the table set, ready for supper.

Bekki and Jolene surrounded by boxes with the table set, ready for supper.

When we made our reconnaissance visit to Tchad and Cameroon in January 2013, Bekki tried to get all the advice she could from the experienced missionaries. They all counseled us to bring a good bed, and bring stuff from home that said “home”, if you know what I mean. I remember thinking at the time and until recently, that I was moving to Africa, I wasn’t living in America anymore, I didn’t need to have a bunch of American stuff, stuff from “home”. Africa would be my home now. Silly me, good thing I have a wife who knows better. Last night when I opened the box with our white dishes, I have to admit there were tears in my eyes. It was so wonderful to see our dishes from home. Now they are on the shelf, the table and chairs are set up, I am sitting in the red recliner/rocker, sleeping in my own bed, there is a pantry full of vegi-food, tomorrow morning for the first time in 8 ½ months I will use soy milk on my cereal, we had real chocolate brownies for desert tonight, all things from “home”.

Our bed, ready for sleep.

Our bed, ready for sleep.

Isaac cutting away the locks on the container door.

Isaac cutting away the locks on the container door.

One of the many things I have learned in the last 8 months is that it turns out all those experienced missionaries were right, you need a piece of “home” in your house. We aren’t Tchadien and never will be, and to keep our sanity we need something familiar, something loved we can cling to. Especially in a developing country where everything is so topsy turvy, and seems so different to us, where everything we do is so difficult, and takes so much energy and effort.

Our container shipped out from LA around November 17, 2013. It took 9 months to get to us. Since we didn’t expect it any earlier than mid March, I would say it is only 5 months late. The container’s voyage here seems to have been, for whatever reason, cursed. It spent 5 months sitting in port in Douala waiting to clear customs. When it finally was ready to leave Douala it was delayed an extra week due to the end of Ramadan. When it arrived here, the usual 1-2 days to get it released from Tchadien customs took 8 days, and only happened because I went down to customs and hung out until they released it. Because it is rainy season the ground is very soft so when the truck brought it to the compound it promptly got stuck in a sink hole and had to be pulled out. They brought a crane to take it off the truck bed (the usual method is to tie the container to stout trees and the driver guns the truck and drives out from under it, letting it drop to the ground with a satisfying thud), and the crane, after digging foot deep holes in our driveway, got stuck before they could do anything. Even when we were able to finally get the container and the crane on solid ground and the crane started to lift it off the truck, one corner got stuck on the pin holding it on the truck bed. It took 15 minutes and a lot of work and discussion to finally get it released, and offloaded.

The ambulance got stuck in the mud and ruts outside our door.

The ambulance got stuck in the mud and ruts outside our door.

To say that the last few months and especially last few days as we anticipated and worked to get the container released have been stressful would be an understatement. But now that we are unpacking and finding things we have been wanting and in many cases desperately needing, the pain of the last few months is already starting to fade. And it is not just personal items, 2/3 of that container is material for the hospital. And not only that, but Nick’s life will now be much easier as he has tools he can use in working on the container apartment (La Petite Maison). His eyes lit up as we came across the boxes of tools (Kelsey’s eyes lit up when we came across the brownie mixes and the teapots). It is truly a blessing to finally have it here.

Our local longshoremen hauling off our things to the house.

Our local longshoremen hauling off our things to the house.

That being said, I have to be honest, I have many times asked God what is the deal here? Why is this taking so long, can’t You just give us a break? Like I said earlier, it was like the container was cursed, nothing went right, for anyone. And I know hundreds or thousands of heartfelt prayers ascended to heaven in our behalf, but seemingly without an answer. The container could not have come at a worse time, except during September when we will be in the US. It is the height of rainy season, so moving it is very risky, we have to hire an extra guard to watch the container because it is outside the wall of the compound, we need it for storage but it is incredibly inconvenient and difficult to take some stuff out and put other stuff in. Besides we want to get it inside the compound walls soon so we can stop paying for an extra guard. Furthermore we leave in less than 2 weeks, and need to have things buttoned up before we go.

But when I really start to feel sorry for myself, I go outside and watch Francis, our yard boy, mow the lawn by hand with a slightly bent power mower blade with a crude handle attached. I watch Frederic, our contractor, and his workers do their work with all hand (almost no power) tools. I look at all the “stuff” we brought over, I look at all the food in our pantry, and then I think, yea, they aren’t ever going to have a container. The people I work with day after day are grateful if I give them a headlight I got in a three pack from Costco. Our cook, Victorine, if I don’t put the milk left in my cereal bowl down the drain, she will drink it when she gets to work at 12:30 in the afternoon. All the packing paper, you know what we do with that? We take it to the back door of the main building of the hospital and leave it on the ground and the staff, and patient families come and take it away, it is wanted, it will get used. This afternoon as we worked on getting more stuff from the container into the ambulance we passed out empty cardboard boxes as gifts. Then I look around me and see all my things, and I realize that this is not even anywhere close to all my things. We sold and gave away a lot before we left, and we have a houseful of stuff in Tennessee. Yea, I do not have thing one to feel sorry for myself about.

I don’t know why it took so long to get our container. I don’t know why it took so long for our house to sell, or why we got such a low price for it. I don’t know why, especially after we prayed so earnestly, and had so many other people praying for those very specific things. I mean really God, we left our comfortable home and our family to come to Africa to serve You, doesn’t that give us some kind of, you know, special dispensation or credit or something? Instead, it seems that everything was harder and took longer. Maybe Nephew Olen was right, it means we are doing something good and Satan is attacking us. I don’t know, maybe. Or maybe it will someday be clear what God was doing behind the scenes, but then again maybe not. I really don’t know.

But I do know this, God asks us to trust Him, even, no especially when, it doesn’t make any sense, and the way is not clear, and things are not going well. I haven’t done a very good job of that the last few days, and I am ashamed. Because I am, more than most people on this earth, truly a blessed man, and have absolutely no reason to doubt our heavenly Father. I also know that what we do for God doesn’t change our status in His eyes. There is nothing we can do to make Him love us more or less, or care for us more or less. I forgot. It wasn’t pretty. Thanks be to God that I can confess my sins and know that He will forgive them and love me as always. And thanks be to God for our container.

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 as well as the videos she has made of 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

Un Jour Férié (A Holiday)

Today we celebrated Tchad’s Independence. I was told there was a big festival downtown in Independence Square, but no fireworks. It was a three day weekend, which frankly doesn’t mean much unless you work for the government or a bank. Here it was a day just like any other except I told the OR crew to knock off early, they really worked hard last week.

But in the midst of all the death and suffering was one really bright spot, a miracle of life, a regeneration, almost a resurrection. Saturday afternoon a man about 30 years old was brought in, comatose, with decorticate posturing. He had been sick about 5 days and had worsened during the last 36 hours, and had been unresponsive for most of the last 24 hours.

I figured it most likely was cerebral malaria, a lethal complication. Indeed the parasite count in his blood was 15-20%, pretty high. So we started through all the motions, IV fluids because he was almost certainly dehydrated since he couldn’t drink or eat, catheter in his bladder, IV quinine for the malaria, IV glucose for the hypoglycemia that comes with malaria, broad spectrum antibiotics in case it was something else like a bacterial meningititis, and something for the fever. All pretty much futile, but you try to let the family know you are doing everything possible, which we were.

He was in the Salle de Reveille, our ICU and recovery room. He was in the bed right next to the door to my office. I was pretty impressed with the dedication of his family, they stayed right with him, fanning him to keep the flies off, keeping him covered, watching the IV to let us know when it was empty.

Sunday morning when I came in for worship I was surprised to see him still alive, albeit still comatose. All day I waited for the familiar wale from the female family members that signaled a death. I wrote for another day of IV medications, not wanting to write for more as I still didn’t expect him to live.

In the late morning I saw an handsome young 8 year old boy. He didn’t look so good either, distended abdomen, grunting respirations, sick for a week, but worse the last 48 hours. We got things going on him, IV fluids, blood tests for malaria and typhoid, empiric antibiotics and quinine. I was worried about his abdomen, but he was in no shape for surgery at this point so I figured I would check on him in a few hours after we got him hydrated and meds started.

About three hours later Abba the nurse came by the house and told me the boy had died. What? He was sick, but I didn’t think death was that imminent. Abba told me the boy had been talking with his father and Abba went to do something else and when he came back the boy was dead. I have seen that so many times here, they compensate to a point then fall off a cliff and are gone.

Abba called me back in later that evening to attend a moto accident, with several lacerations and a fractured femur. While I was sewing up lacerations another man came in with a stab wound to his back. I quickly looked him over, 3 inch laceration mid right upper back, straight down to lung, but no respiratory distress, lungs clear and equal and no air bubbles from the wound, not even much bleeding. After I numbed him up I found out why. As I explored the wound I found it tracked forward along his ribs, all subcutaneous. Whether he appreciates it or not, his angel saved his life.

As I was finishing up Abba asked me if my unconscious patient could eat. “What? He’s awake?” I went over to check on him, and sure enough, eyes open, talking, wanting something to drink. So I told Abba he could start with Bouille, the local rice gruel everyone eats for breakfast.

By this morning he was still awake, more hungry and able to start on pills instead of IV meds. I told the family it was a miracle of God. We had seen a dead man brought back to life. It was a blessing for me too, as the day progressed and I had to tell a young woman that the 7 month old fetus she was carrying was dead, as I faced horrible orthopedic infections, and as I faced administrative head-ache after administrative head-ache, I could revel in the thought of a life saved.

Our miracle patient in front of my office door, he is alive!!

Our miracle patient in front of my office door, he is alive!!

Tonight the compound is quiet, no barking because Samson the dog is gone. Bekki, Nick and Kelsey took him to another mission station tonight, the first stop on his journey to Abeche to be reunited with James and Sarah Appel. We will see how our security plan of razor wire, and nighttime rounds by the guards works for keeping out thieves and robbers.

Tomorrow we face the challenges of a new day, trying to get our container out of customs, trying to get a package picked up from DHL, disciplining one my nurses, possibly firing another, trying to figure out how I am going to get all four fractures I now have sitting in the wards needing surgery, fixed in a timely manner. I am slowly learning to keep my expectations low, stay calm, roll with the punches, and let things play out. However, it is a tricky balance between having low expectations so you don’t go insane and feel like you are constantly beating your head on a brick wall, and having them so low that anything goes, which isn’t good either. I hope that by the time I leave here I will have figured it out, although that might be too high an expectation.

Thanks for listening, thanks for reading, thanks for supporting and loving us. We know that everyone has challenges and difficulties they face everyday, ours are no worse than anyone else’s, just different. Twenty-one days from now we start the journey home for a badly needed break. In the meantime, eat a Taco Bell bean burrito for us, s’il vous plait.

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 as well as the videos she has made of 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