Batouri III

“Say what? I am doing what tomorrow?”

It was Friday evening, we had just come back from vespers at the church on the Batouri Adventist Hospital campus. Dr. Olen Netteburg had given a great message in French that he thought up on the 3 minute walk down to the church, and we had just gotten into the house when Dr. Roger, the Congolese medical director of Batouri informed me that I was preaching tomorrow at another church in Batouri. That was my reaction. I can get by at work and with simple conversations in French, but preaching the next day, well, I am no Olen.

The only reason I didn’t flat out say no was that in December our pastor here in Moundou had asked me to preach on January 24. I had already mostly written out the sermon, and amazingly (read miraculously) had printed it off just before we left and brought it with me in case I had a little time to work on it on the trip. So I had my work cut out for me for Friday evening.

On the way to the church the next morning, with Dr. Roger as my guide I got to thinking:

“They know I don’t speak French well, and there are a number of Adventist churches in Batouri, and they sent all of out to preach at different churches, Kermit is at the hospital church, probably the biggest, we dropped Drs. Salomon and Odei at two other more centrally located churches. And now we are headed out of town. In fact this road is starting to resemble an advance dirt bike trail.”

The farther we went, which was a little difficult because I couldn’t find the parking brake to release it (I told Olen later he might need a new one), anyway the farther we went, the more relaxed I became. My thoughts continued.

“Yea, this is on the edge of town, in fact maybe a little out of town, I bet they are sending me to one of those little one day churches, like they have around Bere. I bet there will be 50 little kids and 10 adults, most of whom don’t speak French. So I can say whatever I want and Roger can translate and he can preach whatever sermon he wants, in fact he doesn’t even have to understand me. This way they get to show the white guy around with him embarrassing himself and everyone else.”

The Church, doesn't look like much, but for an African church, it is big, and notice the terrain getting to it.

The Church, doesn’t look like much, but for an African church, it is big, and notice the terrain getting to it.

So as we crossed a dirt bridge over a gulley that was 6 inches narrower than the width of the pickup I was feeling pretty good. Especially since I had not planned on preaching, and had packed light, hence I had on those wrinkled Columbia cargo pants and light shirt that white people wear in Africa, with no tie. And the only closed toed shoes I had were tennis shoes, so I was wearing my black OR clogs.

Just past the bridge the road (path) widened out again and I could see the jungle (remember Batouri is in the tropics and is surrounded by jungle) ahead. In front of it was a church, with people around, probably not Baptist, and definitely not a one day church. This was a bonafide church, about three times the size of Moundou’s church. There were an amazing number of motos parked under the adjacent mango tree. I could feel my confidence deserting me and heading back across the dirt bridge toward Tchad and home, leaving me to face this on my own.

We walked in the back, it was either smile or cry, I chose a weak smile. There had to 250 people (mostly adults) in the church, the deacons were in uniforms (more on them later), most of the men were in suits and ties and nice polished closed toes shoes.   The church was decorated nicely, there were two choirs, one which had a sound system with canned music to accompany them. No Dorothy we aren’t in Tchad anymore.

The church, from the back, very imposing.

The church, from the back, very imposing.

Roger led me to the very front row. I had one consoling thought that I clung to with all my ebbing strength. These people will never see me again, in two days I will flee across the border into Tchad a country caught in 1927, my home, where I belong, not here, not in 2015. A tall very distinguished looking man stood up to speak, he was impeccably dressed in a suit and tie, without holes, (still had the tag on the sleeve though, they never remove the tags from anything, they really take that mattress tag law seriously here). It was the Pastor, of the district, of the 32 church district, with 2400 members, most of whom seemed to be here today. I had only one question, whoever thought it was a good idea to ask me to preach in this church? They obviously had just recently changed their medications.

The view from the platform, even more imposing.

The view from the platform, even more imposing.

Sabbath School ended and Roger led me back to gathering room. Fortunately the service is pretty much the same in Cameroon as it is in Tchad, so I wasn’t too confused, and then we were on the platform looking out over a sea of faces, all miraculously dressed in just their underwear (hey it helps).

I promised a word or two about the uniformed deacons. From the front I watched as they roamed the aisles, alert for a sleeping (not for long) parishioner, or a noisy group of boys. I kind of felt like I was in the 1750’s in Massachusetts.

The uniformed deacons and deaconesses.

The uniformed deacons and deaconesses.

Anyway, next thing I knew I was in the receiving line shaking 250 hands, wishing them a “Bon Sabbat”, “Salut” and “Bonjour”. A handful even politely said thank you. The good news, I didn’t pass out, they laughed at the right places, and said “Amen” at the right places. On the other hand they haven’t asked me back, and at church in Moundou this week I found out I had been replaced on the schedule. Don’t know if the Batouri Pastor called our Pastor, or if he just forgot he asked me 2 months ago. My pride says he forgot, but…

After church Roger and I were ushered into a small room with a low table covered with food dishes. Apparently we were to eat lunch with the Pastor and his wife. Let’s see, boule, fried plantain (like a fried banana), fish heads, chicken, and meat in a peanut sauce. I politely explained I was vegetarian, and ate the plantain (excellent), boule (palatable) with the peanut sauce without the meat (spicy and not bad).

The after church spread, my first meal of boule with sauce.

The after church spread, my first meal of boule with sauce.

Then it was time to head back to the hospital for lunch, where we had, fried plantain, rice, fish heads, a sushi looking thing with fish, chicken, and some really, really good greens.

Dr. Roger is on the left, the Pastor and his wife on the right, me in the middle, if you couldn't tell.

Dr. Roger is on the left, the Pastor and his wife on the right, me in the middle, if you couldn’t tell.

That evening I realized how emotionally and physically exhausting the preaching had been, how much of a toll it had taken on me. I was wasted. I finally went to bed. I woke up during the night with stomach cramps, and feeling on the verge of nausea. My first thought was the boule and peanut sauce. Man I really wanted to throw up and have diarrhea, but was denied the pleasure of either, just the cramps and nausea, and the aches.

Sunday I got up had a cup of hot chocolate, looked at breakfast and decided it looked better on the table than on my plate. I saw a few patients, most of whom I could do nothing to help, but after being on my feet for 90 minutes all I really wanted to do was crawl back in my tent, on my mat on the floor and close my eyes and wish the world away. By evening when the GI symptoms had not progressed, I faced the inevitable truth, despite the lack of fever, I had malaria. So I tried to eat a bit and started on Arthimeter. The ride home on Monday was long and miserable, but thankfully by Tuesday I was almost back to normal. Good thing too because I got really punished at work for being gone.

Be it ever so humble, there really is no place like home.

After the last blog, Batouri II, I had several questions as to what we were doing in Batouri, Cameroon. We had gone to the hospital to take badly needed supplies, and give them support and encouragement, and do some education. It was all successful, I believe, so a good trip, well worth the effort.

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 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.

We welcome volunteers.

-Scott Gardner

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Batouri II

“Well, we can’t just leave him behind and go on.”

“Right, we are a team, all for one and one for all.”

So it was decided, really without much debate, that if the police kept Dr. Odei, we would stay with him, and not continue on our trip to Batouri, no matter the cost.

We had left Moundou the afternoon before, a team of 5 headed from Tchad to the Adventist Hospital in Batouri, the same hospital I visited in March 2014 (hence Batouri II). The team was headed by Dr. Olen Netteburg, the medical director and head of the famed Adventist hospital in Bere, his father, Pastor Kermit Netteburg, Dr. Odei, a recent Tchadien medical school graduate, now working at Bere, Daniel, the health director for the Northern Cameroon Conference, and me. We were packed (Tchadien style) in Olen’s 5 seat Nissan pickup. Olen and his dad were in the front, with their seats pulled forward, knees to chest style, to give us room in the back. Although there were three seatbelts in the back, I don’t think the Japanese engineers seriously thought three adult men, not of Japanese descent or size, would sit scrunched together in the backseat, for the 16 hour trip each way .

The border with Cameroon is 120 kilometers from Moundou, it closes at 6:00 pm, so we left Moundou about 2 pm, and made it in plenty of time to the border. Actually we had no problems at the border, our passports and visas were in order. Daniel is Cameroonian, so they were happy to take him back. Dr. Odei is Tchadien, and like most Tchadiens does not have a passport. He had his identity card and paperwork from Tchad giving him permission to travel. The border police were happy with that. We made it to Ngaoundere by 7 pm and spent the night with Daniel’s brother-in-law who is the local Adventist Pastor. Thursday morning we were up early and on the road by 7 am, headed southwest.

Around 10 we came to the checkpoint outside of Garoua-Boulai, on the Cameroon-Central African Republic border. We showed all our paperwork and then they had Dr. Odei get out of the car. Not a good sign. Hence the proactive decision, that we were sticking together through thick and thin. After standing around for 30 minutes (which really felt good), the police hired a klondo (motorcycle taxi) to take Odei to the police station, and we were told to follow in the truck. We were there for an hour and finally taken to immigration where we were ushered into the office of the major in charge of the border station. Right imposing I would say, we could see CAR from where we were standing, although had absolutely no desire to do anything except maybe reach a toe over the line to say we had been there.

Well, it turns out, that according to the major, the paperwork Odei had was for children. He was required to have a passport and visa. Furthermore, he was not on the invitation letter from Batouri, thus had no reason to be in Cameroon. However, he was stuck. We were now 450 km inside Cameroon, what was he going to do, jail us? Tell us to turn around and go home? Send us into CAR? Finally after another 45 minutes, including a phone call to his boss, and lots of silent prayers, he “reluctantly” gave us an official document with lots of stamps and signatures giving Odei permission to go to Batouri and then back to Tchad. Whew, after 3 hours we were back on the road again.

Now for the behind the scenes look. This is a common problem in these countries. On our trip I don’t know how many checkpoints we passed, total probably around 50 or 60. Most waved us through, but some pulled us over and reviewed our paperwork or inspected the truck. Each is an opportunity for the officer to “find” a problem with something. A quick 10 spot (a 10,000 franc note, $20USD), and poof, the problem magically disappears. Or you can wait them out, until they decide you are not going to give them anything and they let you go. On our way home Monday evening we talked with the border guards on both sides and there is no other paperwork we could have gotten for Odei. He had the proper credentials. Also there is a multi-country agreement (including Tchad and Cameroon) that allows citizens of these countries to pass freely (relative term) between countries without passport or visa.

This is what the final 90 km to Batouri is like, you can't see the washboard, but you can see the red dust that covers everything, kind of like snow from hell.

This is what the final 90 km to Batouri is like, you can’t see the washboard, but you can see the red dust that covers everything, kind of like snow from hell.

The trip back was relatively uneventful. Just long as we made it in one day. We left Batouri at 5 am and got to Moundou about 7 pm. As requested by our new friend the major, we stopped in Garoua-Boulai and looked him up to show that we were really going to Batouri for the weekend then heading back. We had even covered the pickup and our luggage and plantains with dirt from the road to Batouri as proof we had been there. He was surprised and pleased we had kept our work to check in with him. Those Adventists, go figure.

Constant log truck travel, and these are logs, the most I saw was 4 logs on a truck.  One truck lost it's load with a giant log left in the middle of the road as a surprise.

Constant log truck travel, and these are logs, the most I saw was 4 logs on a truck. One truck lost it’s load with a giant log left in the middle of the road as a surprise.

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 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.

We welcome volunteers.

-Scott Gardner

Happy New Year

Issa

“His name is Issa.”

“Has he been awake at all?”

“No docteur, not at all since the accident.”

The little boy lying on the gurney just outside my office looked to be about 10 or 11. Cute little guy, but obviously unconscious. A quick check showed that his pulse and blood pressure were OK, no obvious skull fracture, lungs were clear, abdomen soft, but his legs were a different story. No wounds, but his femurs were bending in too many directions. He not only had a closed head injury of some sort, he had bilateral (both sides) femur fractures. This was not good, but I was so glad to have Dr. Orie Kaltenbaugh, an orthopedic surgeon from the US with me.

From what we could gather (histories are always taken with a huge grain of salt, they have a tendency to morph as the days go by) he had been hit by a moto and struck his head on the pavement. And he had been unconscious ever since.

After reviewing his head CT and the MRI of his legs (yea right, the closest thing to a CAT scan here is when I wave our cat over the patient and say “scan”), so really after doing his physical assessment we decided to splint his legs together and see if he would wake up. Not only would operating on his legs with an unknown type of head injury be dangerous, it would also be futile if he didn’t wake up. We did our best to explain this to the parents, and tried to lay plenty of black crepe, doctor speak for preparing the family for the worst. After getting him tucked in under the care of our nursing staff, we headed off to Bere for the day.

Sunday when we reexamined him, he was a little better, with some imagination that is. At that point I really was doubtful he was going to wake up with much brain function. However, by Monday, he was moving a bit. Tuesday, the lights were on, but there was still no one home. His family started giving him some bouille (thin rice milk), and he seemed to be swallowing it, and he wasn’t choking.

We decided to send him over for an x-ray, which confirmed our suspicions, he had broken the proximal femur on the left and the distal one on the right. Now it was a judgment call of when to operate, we wanted to give as much time for his head to heal as possible, but also needed to get those legs fixed. Remember for a little guy like this we have two choices of anesthesia, ketamine with diazepam, or diazepam with ketamine. After careful consideration and much debate we went with the diazepam and ketamine. Some of you medical people may criticize our choice, but I will give you the end, it worked, he was still alive when we wheeled him out of the OR. I was more than happy to hand the knife over to Dr. Orie, and as the operation progressed I realized what an absolutely brilliant move that had been on my part. But he did a masterful job getting the fractures reduced and fixed with plates. Now we surgeons are not known for our patience, but Dr. Orie patiently sorted through our screws looking for just the right one for each new screw hole. In our defense I will point out that we do have our screws sorted by size, small, medium and large, although it is a rather arbitrary sorting, and I will admit there could be some debate about whether this particular screw deserves to be in this particular packet.

So now we have a semi-conscious little boy with two broken, but plated legs. The next day we decided to move him out of the ICU and into the ward, he would either get better or he wouldn’t. We still had no idea of what better was going to be. However, over the next number of days, he gradually improved. He went through all the stages of recovery from a head injury, as the confusion and cobwebs cleared. Just before I left for vacation he was well enough to get up in a wheel chair and go outside. Then, with a week left of vacation I got an e-mail from Diana, our volunteer nurse from Mexico, Issa wanted to go home. He was standing on his legs with crutches. I wrote back and asked him to wait till I got back.

January 2, 2015, I made rounds. The picture is Issa and his family. If you didn’t guess, Issa is the one smiling. A perfectly normal little boy, with bright eyes, straight legs, and a happy heart. He is a little miracle, one of the ones we see all the time here, but just a bit more obvious. So many things should have gone wrong, he got next to no care for his head injury, he didn’t get blood clots or a fat embolism from his broken femurs, he didn’t get an infection, he didn’t get malaria, he just got better. I told him to not walk on his legs and come back in a month with another x-ray.

Issa with his family, he is the one with the big smile.

Issa with his family, he is the one with the big smile.

Mahamat

“I need to amputate your leg, if I don’t you are probably going to die.”

I was talking to Mahamat. He had come in with an old open distal femur fracture. It was badly infected when he arrived, with pus pouring out of the wound. I had taken him to surgery, washed out his leg, reduced the fracture as best as I could, and put an external fixator on his leg, to hold the bone in place. It looked great for about two days and then the pus started pouring out of the wound again. We faithfully washed it out with betadine every day, had him on antibiotics, but it didn’t get any better. I knew Dr. Orie was coming so I waited until I could show it to him. I was pretty sure he would agree with me that the leg needed to come off, but knowing the fight I was in for, I figured every bit of firepower I had would help.

I was right, Dr. Orie agreed with me, hence the statement above. After Patrice, our nurse, told him this in Ngambay, Mahamat talked to Patrice for a long, long time. When Patrice translated it into French for me, it was not what I expected to hear. Mahamat agreed with me that he needed an amputation. But he said that if he had an amputation, even if he had a prosthesis, when he went home to his village he would be shunned, his family would abandon him, he would be a cripple and alone. He would rather die than face that. It was hard to swallow. I knew exactly what was going to happen. I have seen it too many times. He would drain pus for several weeks, get malaria or something else in his weakened state, but eventually the infection would track up his thigh and he would be septic. At which point he gives in and we do a high amputation with little hope of getting a good prosthesis, or he dies from sepsis. But what could I say, he was in an impossible situation. I had prayer with him, shook his hand, and reassured him we would do everything we could to save his leg, but that he needed a miracle.

When I left for Italy he was still there, not septic, but still draining pus out of his leg, although I optimistically hoped it was less pus.

January 2, 2015, we unwrapped his leg and I inspected his wound. There was no big defect, in fact the bone was almost completely covered. I probed with a q-tip, no defect, no pus. His thigh was soft and not swollen, not hot or painful. No infection at all. He had the biggest grin on his face as we shook hands again and I told him it was a gift from God, a miracle as sure as the paralytic, blind Bartemaeus or any other miracle you have heard about. I don’t know that I have ever been so happy to be wrong.

Mahamat with his external fixator and healing leg.

Mahamat with his external fixator and healing leg.

Happy New Year dear friends.

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 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.

We welcome volunteers.

-Scott Gardner