Leaving?

“I am not sure how much more of this I can take.”

“I wonder what it feels like to have a nervous breakdown, will the GC insurance cover that?”

Such were my musings as I headed over to the generator room for the umptenth time in the last couple of hours to flip a breaker switch and restore power to the hospital. The electrical problems were really taking a toll on my psyche. It is a daily battle, sometimes it was the generator itself overheating, sometimes the generator would switch off because it didn’t like the phase distribution. Other times it was either the house batteries or the hospital batteries not charging, and so either the house or hospital or both were out of power soon after the generator shut down. Or there was the day when every five minutes the power would go out for 40 seconds or so and then come back on for 5 or 6 minutes. Never did figure out why that happened.

I don’t want to forget the arm amputation that I completed in just the ambient light the glass blocks let into the OR. The great thing about operating on a dark skinned patient in the dark is that they don’t bleed, at least not that you can see, that is of course until you notice the puddle around your bare feet (I do wear clogs, but no socks).

It’s not that there haven’t been electrical issues and various breakdowns in places we have lived in the US. I remember operating for 20 minutes in the dark at St. Joes when we lost power and both generators promptly went down. And in that OR, which has no outside windows or glass blocks, it is really really dark. And we have had plenty of occasions to call on Bo when things broke down on our house in Clarkston, or on Gene Augustin when we had problems with the house in Tillamook. But not everyday, multiple times every day. In fact every morning we get up wondering what is going to breakdown today. I remember one Thursday, I had just come home about 6 pm, and as Bekki and I talked and compared notes from the day we realized nothing had broken down that day, we had power all day, it had been error free day. Not five minutes later the house was suddenly plunged into darkness. OK so much for perfect Thursday. You know how businesses have signs posted, “Accident Free For 235 Days”, well we have signs posted “No Breakdowns For 6 Minutes”.

So it was this that was prompting the thoughts of a nervous breakdown, and wondering how much longer I could take this. Sometime shortly after this I received a text from my nephew, Dr. Olen Netteburg, the medical director at the Adventist Hospital in Bere, Tchad.

“Scott, have you seen the new authorization to function for the Surgical Center that puts it in the SDA Church’s name?”

Well as a matter of fact I had not. It turns out he had not either. That story begins 13 months ago when we found out that CCAM (Centre Chirurgical Adventiste de Moundou) was registered with the Tchadien Government under the name of James Appel, who started the Center. This was a problem because I am a Church employee and as such can’t work at a private institution. So the West African Division (WAD) gave us 6 months to rectify the situation. Three months later I received notice that the paper work was now in order, we were an official SDA Church institution. But neither Olen nor I ever actually saw the document.

We called our contact in N’djamena who had done the legwork on getting the proper authorization.

“Oh, no,” he told us, “That paperwork was lost just before the Minister of Health was to sign it. You are still operating under the original authorization in the name of Dr. Appel.”

Oh, boy, this was a problem. Not only were we 7 months past the deadline, we had lied (unintentionally) to the Union and Division Officers, our bosses. The consequence? They could require us to leave Moundou and put us at an official SDA Institution, somewhere. It was a very real possibility.

So we started talking about the various options, Batouri, Rwanda, Nigeria, Guam, or just send us home. It was when I was faced with the possibility of having to leave Moundou that I began to realize that despite all the problems I really didn’t want to leave. I am surrounded by a team of employees and volunteers that I really love and care about. We have worked hard to develop systems of care that seem to work well here. We have built up the infrastructure. We have projects in the works that we want to see fulfilled. We have passed over so many learning curves, the operations, French, the local shopping, many of the idiosyncrasies of the house and hospital, and more. Bekki has her network of contacts in town, we have volunteers who are scheduled to come work with us, we have volunteers who are with us now. I enjoy, for the most part, my practice here. I don’t have to do OB (really, really important). I sleep almost every night (last night being an exception).

I was sitting in church this morning thinking how much I was going to miss church here in Moundou, when we finally do go on permanent return. I will miss the dancing choir, the French hymns, the Sabbath School lesson study, watching poor Alphons try to translate for our pastor who preaches for about a minute then gives him all of 5 seconds to say the same thing in Ngombaye before cutting him off.

The last few months we have been able to see how much of a difference we do make here. The people who are walking on two strong healthy legs because we were here, the children who are still alive and well because we and our Center were here when they had a perforated appendix, or malaria or typhoid.

All of a sudden all the electrical, plumbing, cultural, and language issues, all the annoyances that come with mission life didn’t seem that important or overwhelming. I didn’t want to leave. I don’t want to go to Batouri, Bere, Rwanda, Nigeria, Guam, India, the US, or anywhere else, at least not yet. We have work to do here. We are needed here. Someday we will leave, but please God, not yet, not now.

The next morning Olen wrote a beautiful letter to the Division and Union officers explaining the situation and apologizing for the errors we had made. That night we received an encouraging letter from the Division president, telling us they appreciated our efforts and would wait as we worked through the process with the government of Tchad. Not a word about trading us for cash and future draft choices to another Division or Union.

I thank God. I thank Him for letting us stay in Moundou, I thank Him for sending us here, and I thank Him for giving me a glimpse, just a glimpse, into an alternate reality where we are forced to leave, so I could put all the trials into perspective.

It still drives me crazy at times, but we make sure our Goal Zero battery is charged each night so we can charge our phones and run our fan at night, we make sure we have a bucket of water in the bathroom so in the morning when there is no water we can wash our faces and flush the toilet, and we put blocks of ice in the fridge each night to keep it cool when the power goes out. And hey, OR lights, cautery, and air conditioning are just for wimps.

They say that when you have trials and it seems the devil is after you, it means you must be doing something right because you are making him mad. If that is true, bring it on, we have Jesus.

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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Demons

« Docteur, il y a un nouveau cas qui est venu au Centre, c’est une petite, elle est très malade, et il n’y a pas de l’électricité à l’hôpital. »

Roughly translated, “Doctor Scott, please come start the generator.”

And so started my day, not a particularly unusual start to my day, as I often have to start the generator because the batteries are dead, or start the water pump to fill the water tower because we have no water. What made this different was that it was 11:00 pm. We should have had plenty of battery power, at least enough to last most of the night.

I got my scrubs on and headed over to the generator. I first checked to make sure there was no city power, no. Check the batteries, all lights red, not good. Check the generator. Ready to start, but I thought I should check the fuel gauge, empty. OK check the four gas cans sitting next to the generator, empty. OK, check the barrel of diesel outside the generator room, empty. Sooooo…, we have a nice generator with no fuel, and no battery power and no city power, and a sick kid, well actually a hospital full of sick people.

Fortunately, we have our little generator, so I hauled it over to the electrical room, filled it with gas, plugged it in, and started her up. Lights came back on in the hospital! Woo-hoo. Back to bed.

This morning, I woke up to a house with dead batteries, and no water. To get power from the little generator to the house I have to run our two long extension cords, and plug the house in. I got that done before morning worship and voila, lights in the house. I also started the water pump, so we would have water in an hour.

At staff meeting after worship I found out that the air conditioner we installed in the new Lab is not working because no one ever charged it with free-on, or whatever they charge it with. I am guessing they were waiting for my OK to do that, but since no one told me it needed done, I never bothered to give the OK. So I gave my blessing.
During the meeting, and in fact for much of the morning the power kept cycling on and off. 5 minute with lights and fans, 5 minutes without. Still not sure why, I asked why, got an explanation that I don’t think I would have understood in English, let alone French. Myself, I am going with demons.

After worship I found out our anesthetist was not coming back from his grandmother’s funeral today, even though he had been told yesterday, that he was to be at work today. Which meant another day of juggling nurses to keep everything covered. Fortunately, our hospital nurse can do anesthesia, so he has been covering. It also means we will be having a 2 or 3 hour disciplinary meeting next week to meet out a suspension for insubordination for not coming to work, which means another 3 days of being short our anesthetist.

Good news is that Adrian was able to take the ambulance into town and got the gas cans filled with diesel and gasoline. So by 11 our big generator was back on line. However, the power kept cutting out during surgery, which I found out later was due to the generator overheating, which has been a problem lately. Somehow, apparently the coolant system is not working well. Isaac our maintenance guy told me it was the water pump and he fixed it. But it still kept overheating today. Fortunately the only things affected were the air conditioner in the OR and the electro cautery. So I perspired a lot, and tied off vessels instead of frying them.

Every day starts out with something akin to disorganized chaos. Today was no exception. People show up by 8 am and want to be seen right away…by me…even though they have been told I don’t see patients till after 3 pm. So they sit there, all day, not eating, drinking a little… and often by 3 pm, they are tired, hungry and cranky. The more aggressive ones will just walk into my office, at which point we have to chase them out. The quieter ones just sit and seethe. Some days I can see some patients in the morning, today was one of those days. It was good because we ended up operating until 5:30.

Yesterday I felt terrible because I had seen this man in the morning and prescribed some ibuprofen (I know, but that and Tylenol are my two most prescribed meds). Later in the morning some pushy man stopped me outside my office and shoved his carnet (medical record), in my face. I am usually about 30 minutes behind, so when that happens I just take the carnet, tell them to wait outside and I will call them when it is their turn. If I take the time to figure out what they want I will now be 40 minutes behind. So I took this guy’s carnet and put it on the bottom of the stack, and he went outside to wait. Finally about 6:30 in the evening I got to his carnet. We called him in, and as I looked through his carnet I realized I had just seen him that morning, so I asked what the problem was.
“Oh, doctor, the medicine you prescribed (ibuprofen) gives me an upset stomach, is there anything you can do for that?”

I felt like such a heel, this poor guy had waited all afternoon just so I would give him another prescription for cimetidine for his stomach.

Back to today, I started the day telling a lady in her late 40’s early 50’s that she had uterine cancer and was going to die, that there was nothing I could do for her. Actually I told her daughter who speaks French. I don’t know what her daughter chose to tell her. Her hemoglobin is down to 8 from bleeding. I did not say anything about transfusion, nor did I give her any iron. Hopefully, her hemoglobin will drift on down and she will slowly bleed to death, because all she has in front of her is untold pain and suffering from this cancer that is filling her pelvis.

I then went to the OR and opened a wound on a man who had bladder surgery (elsewhere) last fall. They found he had bladder cancer and closed him up. Problem is he didn’t heal. So today I opened the wound that is draining pus and debris and found a mess of necrotic (dead) muscle and bladder. By the time I got done he had a quarter sized hole in his bladder that I can’t repair. So I put in a catheter through his lower abdominal wall and packed off his wound. I am not going to check his hemoglobin either. There is nothing good in his future, except to finally die and be out of his misery. Most days when I see him on rounds he is lying on a vinyl mattress without any sheets, and his clothes are soaked with urine because he is incontinent.

I fixed a hernia, took out several hydroceles and a lipoma and finished the day re-fixing a leg that I fixed earlier in the week. A 12 year old boy with an open tibia/fibula fracture that I put an external fixator on. Last evening he got up on his own, with one crutch and he fell. He bent one of the screws and his leg was now crooked, again. So we took him back today and straightened his leg, again, and found that our muscle flap was happily intact. Unfortunately, I found out later that the family is blaming our Mexican volunteer nurse, Diana, for his fall because she had him get out of bed earlier in the day, with appropriate assistance. Not sure I follow the logic in why she is responsible for him later getting out of bed on his own and only using one crutch, and why they are not responsible for the fact they left him alone. Well, I actually do follow it, it leads to money, as in Diana should pay for the second operation. Not!

As I was sitting in my office contemplating the day and marveling that this day, like every other day, had started out with an impossible work load, that had no hope of ever getting done, and yet magically now all was done. At least all was done that was going to get done. I thought about how that was truly the way every day goes. I thought about how I need to stop stressing at the start of the day, because it always works out in the end. Then suddenly, all was black. The power was out again, despite the gentle throb of the diesel engine of our generator. I flicked on my headlight and headed, once again, for the electrical room.

We spent the evening resetting the breaker switch every 5 minutes, until we finally gave up and went on battery power. Is it a short? Is it a bad circuit breaker? Or is it still those demons. I am sticking with demons, and I have proof. Just read 1 Peter 5:8.

It is almost time for bed, but since the batteries for the hospital are not charging very well, I expect they will be dead shortly after the city power shuts off around midnight. Tite, our night nurse will probably be on our doorstep soon after.

« Docteur, il y a un nouveau cas qui est venu au Centre, c’est une petite, elle est très malade, et il n’y a pas de l’électricité à l’hôpital. »

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