The Baby II

« Docteur, ce n’est pas nécessaire d’allumer la groupe. La bébé est parti. »

It is 4:20 am here. Josué came to the door at 4 to ask me to turn on the generator because the hospital was out of power, and the little baby was still alive but needing oxygen. Without power the oxygen concentrator doesn’t work very well. I went to turn on the generator but the tank was empty, the gas cans were empty. The barrel of diesel fuel was full, but the hand pump to fill the gas cans was locked up in Isaac’s maintenance office, at least that is where I assume it is.

So I went to get our little generator. It had only a little fuel in it. As I was putting gas in it, Josué came back and told me, « Docteur, ce n’est pas nécessaire d’allumer la groupe. La bébé est parti. », “Doctor, don’t bother, the baby died, we don’t need the electricity anymore.”

Just thought you might want to know the end of the story we started last night. This little baby died because the parents waited, out of ignorance and poverty, for too long before bringing her in. Even just a few days ago we could have easily treated and cured her. This little baby died because we don’t have the personnel, the medications, the resources necessary to take care of a little one that is so very ill. This little baby died because we didn’t do our job and make sure fuel was available to run the generator when necessary.

Hug and kiss your kids tonight, and thank God that you and they, by some weird quirk of fate, were born where these kind of tragedies happen only very rarely, not everyday.

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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The Baby

The following is a fairly accurate translation of a conversation between a nurse and doctor in a small surgical hospital somewhere in West Africa.

“Docteur, what can we do for the little baby who is here?”

“What baby?” I asked the nurse.

“The little baby just outside your office who came in this afternoon. She has a very high fever, and is having convulsions. Her oxygen saturation was 36% (normal 95-100%) when she came in. Now that she is on oxygen it is 96%. I have given her quinine, ampicillin, ceftriaxone, and Tylenol, so her temperature has come down a bit, but she is still not breathing well and…well what can we do?”

(A word of explanation, in the evening and nights we have no lab, so no way of doing diagnostic tests, and even if we did our tests are so limited and of such poor quality that it doesn’t really matter the results, everyone gets treated the same. Quinine for malaria, ceftriaxone for typhoid, ampicillin if you are a kid, IV fluids and sugar. Most people get better)

“Did you check her hemoglobin?” (These kids are almost always anemic.)

“No, no one has the key for the laboratory, and the lab tech is gone for the day.”

“Well, it really doesn’t matter anyway, we can’t do anything about it, if the hemoglobin is low. We have no blood, because the refrigerator that holds our blood bank is not working, so all the blood is clotted in the bags.  Also because we have no refrigerator we do not have ice to cool her with.  How long has she been sick?”

“Two weeks. Oh yes, and her pulse rate is high, over 200. What can we do?” Josué repeated plaintively.

“You can give her 250 cc of lactated ringers. And we could give her 50% dextrose, since most of these kids are hypoglycemic, but oh yea, we don’t have any of that either.”

“But docteur, the family is out of money, they have no money to buy any more medications.”

“We could send her over to the Regional Hospital, treatment for emergency care is free there.”

“In her condition, she won’t survive the trip.”

“Josué, you are right, besides they won’t do anything more than we are doing, and likely they don’t have blood either as they often send babies and kids to us for transfusions. Give her whatever she needs and give me the bill, I will deal with it.”

Josué left my office to do what he could, I walked home. It’s been a while since we had a baby like this. But never again would be too soon. This perfect little girl, 8 months old, struggling to breathe, fighting for her life. She is going to lose, tonight or tomorrow. Even if we had all the right stuff, when they look like this, they all die.

Even still my thoughts are tortured. Should I call in Solange our lab tech? Maybe she could find someone with the same blood type and give the baby fresh blood. The problem is our other lab tech is on vacation this month, so Solange has to work every day. Do I call her in now and wear her out with a lot of work on a hopeless case, or save my call for a case where she can really make a difference. The chances of finding someone tonight, with the right type blood and no AIDS, hepatitis or syphilis, are pretty low.

We have been dealing with the refrigerator for a month now. Isaac gets it running and it breaks down again. He is going to look at it tomorrow, again. Problem is Isaac is an optimist, and he can fix just about anything. But I need it fixed to last, not work for 3 days and then break down again. I probably just need to buy a new one. But I feel like I have replaced just about everything here in the year I have been here. Oh, yea, it is not just a feeling, I have done that. Everything here breaks. Anything electrical from the US doesn’t stand a chance. If anyone tells you 50 hertz doesn’t matter, don’t believe them. 60 hertz electrical motors do not like 50 hertz power supplies. They will run, but not happily and not for long. But the stuff you buy here is mostly made in China, apparently in the factories with little quality control, so they don’t last too long either, and they are very expensive.

We are out of a number of commonly used medications. Why, you ask? Because, our supplier, the government pharmacy here, is out of them. Why are they out of these meds you ask? Because their supplier, the central pharmacy in the capital is out of the meds, or maybe they are in a warehouse somewhere and haven’t been unpacked yet, or maybe someone took them and sold them all, who knows? So why not just import meds from say, Kenya, you ask? Because that is against the law and is forbidden, because their meds are better quality, cheaper, and more available, hence competition. And why you ask is this important? Because we make a large part of our money on selling medications, and when I have to send people to outside pharmacies to buy medications it cuts into our income, which is barely adequate as it is. Also the outside pharmacies are way more expensive than we are.

Speaking of medications, today I reviewed the inventory of meds from our pharmacist. We prescribe a lot of Cipro, and I noticed we had 4000 tablets of Cipro in stock, set to expire the end of April, 2015. And in Africa using expired meds is a huge no no. They are very very sensitive to that, the general belief is that we dump our expired meds on them so they just get second rate stuff. I thought we had just bought a lot of Cipro. A trip to the pharmacy confirmed just that, we bought 5000 tablets the first of March. The Central pharmacy sold us 5000 tablets of Cipro set to expire in less than two months. Thanks a lot.

So I am trying to run a little hospital here, and make it self-supporting (that is the goal anyway, admirable, but ridiculous) with unreliable power, unreliable water, limited medication, limited lab support, limited radiology, limited staff, equipment that is constantly breaking down, patients with no money to pay for their supplies, doctors with limited training and experience (at least at first) in what they are expected to do…etc, etc, etc. And then I sit back and realize I have described life at every mission hospital I know of, Bere, Batouri, Koza, here.

Most of the time I can just ignore it, or bury the feelings it brings. Not tonight. As I looked Josué in the eyes and saw the pleading look, “docteur help us,” and I had to tell him over and over, there isn’t anything else I or you or anyone can do, all the anger, frustration and pain found its way to the surface, and I have to deal with it.

Tomorrow, I will be better. The little girl will probably be gone, out of sight, out of mind you know, and I will hide those negative feelings back down deep where they belong. I will face another day of unknown challenges, hoping that God will show me the right directions to go, the right decisions to make.

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

 

Ben

For the past 3 weeks we have enjoyed having Ben Moresco with us. Ben is a special volunteer. He is actually the first person to volunteer to come spend time with us. He is a fourth year medical student at the University of Washington. I first met Ben 3 1/2 years ago when he was a freshman. I was his preceptor the fall of 2011, so he was with me every Tuesday morning. We got to be good friends and when he found out we were headed to the mission field he told me he wanted to come out to do a senior elective with me. What makes it even better is that Ben grew up speaking French so he is fluent. He and I have been planning this month for 3 years, and it is finally here. He has only one more week here, then it will be over and he will be greatly missed by us, the staff and the patients.

Ben hard at work changing a dressing

Ben hard at work changing a dressing

He wrote out his impressions and his thoughts last week as a kind of guest blog. I always find these interesting because they are a window into what other missionaries are thinking while they pass their time here with us. Below is what he wrote, totally unedited.

The Church, The Market, and The Hotel

You know, it’s funny. I wake up in the morning now and I feel tired, but what goes through my mind is not what is there in the states. Here, instead of just understanding that I was up late or maybe worked hard or didn’t drink enough water, I think about whether I have Malaria, did a mosquito get into my netting last night? Are my mouth sores any better (no)? Is there an animal on the floor, or a worm in my foot? Will I have enough bug spray/lotion/wipes to last me until I leave? Followed by the thoughts about the patients: Will he have less pus forming in his wound today? Will he get the amputation he needs? Will she walk today? Did she vomit again last night? Is he still alive? And then the day starts, and I figure out the answer to most of the questions about the patients. Over the weekend, the regular flow of the days fragments a little bit, and I got a chance to explore more of what Moundou is and how people live.

Since it was Saturday Sabbath, I got a chance to go with The Gardners and many of the staff to their Seventh Day Adventist church in Moudou. We all piled into the ambulance, stopped at the front gate and loaded up with staff before heading to the church. Nagging in the back of my mind, I’ve had this apprehension about going too far away from the compound here, I’m not sure exactly what it is, but it’s likely related to the fact that I always feel like everyone is watching me, there’s turmoil in Tchad, and, honestly, I’ve never felt supremely comfortable around the Muslim community or really the Black community just because of my complete lack of knowledge and understanding for the culture, the people etc. True ignorance but important to note as to how far out of my comfort zone this weekend was. Much like anything in my life though, once I take a step towards the water, it’s not long before I’m diving into the deep end.

The church looked very much like the outside of any of the other buildings in the dusty, dirty block it was on, but inside it looked much like any other small town rural church except when the service began and “BOOM” cultural explosion. Turns out, Tchadiens frequently sing their prayers out-loud, and church was no exception. Family members introduced themselves with songs and the whole church would stand up and start dancing along with them. It was the Sabbath so several churches had come to visit for a big celebration so there were two bands, and they did a sort of battle of the bands (keep in mind their instruments are all home-made with animal skins, pieces of wood with exposed nails, and strings but they make beautiful beats and music that entrance you into feeling like you need to stand up and dance. I was so shocked though, that all I could do was tap my foot (which I got laughed at about later by some of the hospital staff). After the service, the whole group of people filed outside to start a feast which consisted of drinking from the communal water bucket/drinking bucket (likely full of Malaria, worms and other diseases) and Boulle (which has a distinct look of rice-play-dough in a freshly killed goat meat sauce). I tried my best to escape the situation without having to eat Boulle, but Rebecca Gardner convinced me to at least try it, so I did, and didn’t get sick. Afterwards Scott told me that he got Malaria last time right after he ate some Boulle, but he was sure it had nothing to do with the Boulle…great.

The next day we had another really short day at the hospital, and Dr. Scott encouraged us to go out and explore Moudou. Adrian suggested we seek out the local Hotel Residence for Wifi, and after a week without any connection to family, friends or internet, I was eager to go. It’s 1km away, but it’s a million miles away from anything resembling Tchad. We walked into the 12 foot high gate into a kind of French paradise hidden away in a completely different world, with green gardens, glass windows, and a pool in the middle of the hotel that is clean and being used by mid-40s white Frenchmen in speedos. Some things I don’t miss… It costs 10 dollars for a full day of internet which I was happy to oblige and what followed was a frantic upload of blog posts, followed by a long conversation through Gchat with my Dad. Meanwhile Vadim, our compatriot from Ukraine, got a beverage by the pool, and Adrian, the volunteer from the states, talked to his friends and family through his computer. It was a huge throwback to what life is like back in the US with technology being used for everything from communication, to socialization etc. and the comforts of home by the pool, with air conditioning and shade. A very different world. It felt strange but also very sad because the hotel is a symbol of everything that Tchad doesn’t really have. It’s also likely too expensive for any Tchadien to stay there, so really it’s just another example of how broken this society/infrastructure really is here in Tchad.

Vadim our Ukranian surgeon

Vadim our Ukranian surgeon

Monday ended up being another pretty relaxed day and Vadim wanted to get a watermelon, and Rebecca wanted to get some things from the Market so I offered to go with my buddy Victor. So Victor and I hopped on the motorcycle together with Vadim on a Klondo (Rental Motorcycle) and off we went to the Market in downtown Tchad. It’s a quick 3km to the middle of the market, and at first I wasn’t really sure why everyone thought this was an impressive market. Mostly there were a bunch of people sitting on the floor around me selling Avocados and beans. I went into the Alimentation store (grocery store hole-in-the-wall) and bought some cheese and Mustard, but when I asked for Cacahouettes (roasted peanuts) and Poivre Noire (Black pepper), I was met with an out-of stock response. Little did I know, this would turn my trip to the market into something crazy. This guy in the corner grabs me by the shoulder and says, I’ll find you Poivre Noire. So I’m like, “Great, another person I’m going to have to pay”, but I let him lead me to the other store which is across the market and then I land in front of 50 Muslims praying to Allah in the middle of a dark market blocking my path. Then the guide says, wait here… in front of all the praying Muslims. Internally I’m very uncomfortable in this situation. I feel boxed in, and I feel like I’m in a movie where I’m being chased by bad guys and now I’m at the end of the alley blocked on all sides by A LOT of people I don’t know. Meanwhile my guide returns quickly and says that he cannot find my roasted peanuts but he will go on his moto to get some, so off he goes without giving me a chance to say no… “Great, another thing I’ll have to pay for…” but also “aahhh, what am I doing here, how do I get out!”. I start to realize that I’m turning in concentric circles unconsciously. I’ve made the 3rd circle before I realize that Vadim and Victor are behind me, and 10 minutes later (20 circles later), the Muslims stop praying and the store owner shows up to tell me that, no, he also has no black pepper, and then ANOTHER guy grabs me by the arm and asks what I am looking for….I say “Poivre noire” and then he says to follow him. Off we go into the most suspicious of hallways. Basically, think about all the corner stores in the US crammed into one hallway that branches like a maze, with urine all over the floor in spots, and a mosque in that corner, a pharmacy with all their medications for sale on display, and a group of people in all the stores calling out their wares. Oh, and need I forget the numerous dead-ends, the winding hallways, the random people popping out of doorways and the sketchy-sketch ceiling that doesn’t seem to hold really anything up. It felt like we were walking through a completely different world, which is apparently what the Moundou market is supposed to be like. We end up in several pitch black stores asking for black pepper and finally, without any luck, find our way back to the street and back over to our guy who went on the Moto to get some roasted peanuts. He arrives, we barter, I pay him a dollar more than I wanted to (of course), and then I tell Victor that I’m not waiting any more for anyone else to come back and try to get me to buy their unground black pepper, so we shake off the barters and make our escape out of the Market place. Speeding along, dust flying into my eyes and hair, we try a couple more stores on the way asking for black pepper, and Vadim buys a Watermelon at a random store front for $3 which turned out to be amazingly delicious.

Diana our Mexican nurse

Diana our Mexican nurse

I continue to be surprised by the people in Tchad. I figured that immediately I would be unwelcome as a white man from the United States, but the response has been very different for most people that I meet. Occasionally I am helping people with their English, sometimes I’m having conversations with Tchadiens about their dreams of visiting the United States but knowing that they will never have enough money or political capital to make it happen. I have begun to realize how good we have it in the US. We have reliable water, power, security, food safety, sanitation, and really anyone can get thru a Highschool education if they just show up to class. Here they struggle with everything, and “just good enough” is excellent whereas most often, they just have to settle. The people we care for in the hospital are really upsetting in a lot of ways. First, none of them really have any money to spend on their health, in many ways it feels like they are here because it has become necessary for them to work in order to live, but they get stuck in the hospital recovering from surgery for days while their financial worries worsen. The other thing that makes me really upset is the fact that society in Tchad seems to encourage corruption and dishonesty. If you consider the successful people in Tchad, you are looking up to someone who has stolen money from the people, and is only giving money to the infrastructure now because they are “so rich, now they are overflowing with money and need some place to put it”. It’s no wonder the Adventist Health International groups are struggling so much with thievery and dishonesty among their employees, it’s what they are used to, it’s how they appear to understand success, safety, comfort etc. through the tactful hand that steels his neighbor’s money. Then you put them among a bunch of westerners who are so packed full of money, they don’t understand that the stuff they steal, although it gets replaced, is resulting in the harm/suffering of their brothers. I would say the society here is broken, in every sense of the word. Recovery seems impossible, guarded by as many barriers as there are people in this country. I knew prior to coming here that making an impact would be almost impossible, but those who are committed missionaries here, seem to be serving a need that is desperately required here. Dr. Scott frequently is using funds from the US to help families pay for their kids to have needed emergency surgeries and he has made a huge impact on that scale, but a larger scale impact (goals like building a large Adventist hospital here, or improving the infrastructure of preventative care and health) is likely not going to happen for years if ever. How do I see myself practicing medicine internationally in the future, I’m honestly not sure. It appears to be useless in short time periods, but could I ever commit to a long-term medical mission, I’m thinking probably not at this point, but who knows what opportunities will present themselves in the future. God only knows.

Ben the future pediatrician teaching a health class on hydration at the local Adventist school.

Ben the future pediatrician teaching a health class on hydration at the local Adventist school.

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