A NEW BIRTH

Rebecca and I were privileged today to witness a new birth of sorts. Those of you who have been with us from the beginning can be fairly certain this is not speaking of traditional obstetrics as you know that that sort of thing is forbidden in our center. We DO NOT do OB here. Just wanted to make that clear, there is a perfectly good obstetrician at the central Hospital just a kilometer away.

No, it wasn’t a new baby human, we got to witness the birth of a new Seventh-day Adventist Church. About 15 kilometers southeast of Moundou is the village of Koutou-bete. Koutou-bete is one of our Pastor’s four churches and has a very active young peoples group, AYA in English, and J-A in French (Jeunesse Adventiste). They also have a pathfinder group with uniforms, although they need the patches, so if anyone wants to donate some either from France or the US they would be very happy to receive them.

Apparently the young people in Koutou-bete were restless and looking for a project, something they could do for Jesus. They found a little village 9 kilometers away (5 miles) and began going there on Sabbath mornings and started a branch Sabbath School. To put this in perspective, they walk the 5 miles each way on a little dirt path through the brush, and they carry their instruments with them. Now granted they aren’t much, a large yellow water container for a bass drum, another drum/stringed instrument and their maracas, but still that is dedication.

The young peoples group from Koutou-bete

The young peoples group from Koutou-bete

The Band with their maracas, and drum set, including the yellow bass drum.  Notice the overflow, late seating, the pole just above the ground in the foreground is really a bench.   I bet if our churches used these for overflow and late seating pews more people would be on time and sit up front.

The Band with their maracas, and drum set, including the yellow bass drum. Notice the overflow, late seating, the pole just above the ground in the foreground is really a bench. I bet if our churches used these for overflow and late seating pews more people would be on time and sit up front.

They have been doing this for some weeks and Rebecca and I were invited to go there today and see what they had been doing, also I am sure in the hopes that we would be impressed to help them financially. So this morning at 0830 Rebecca and I got on the moto and headed off for the village of Betkrim following behind Pastor Dieudonne and Roger our Chaplain who is the head elder in the church at Koutou-bete.

Roger with his three oldest daughters, out of 10 kids.

Roger with his three oldest daughters, out of 10 kids.

The first 7 kilometers were fine, good paved road, no problems at the check point, but then we headed onto the dirt and sand. Now this is rainy season and so there were large puddles to skirt around and much of the sand had been compacted down, but there were still plenty of places where the bike was really hard to control.

Rebecca and I on our moto.

Rebecca and I on our moto.

I was proud of Rebecca, like a good Tchadien she hung onto the moto, not to me. And she has become a very good passenger, knowing how not to upset the apple cart, or moto in this case. I also figured out why most of our fractures are left tib-fib fractures. When the bike starts to go over it is your left foot you naturally put down first, if you are right footed I guess. Well I could easily see that if that foot catches on something, and there are a lot of somethings to catch it on, the lower leg is going to snap like a twig. Anyway, just an aside.

Typical hut in the middle of the field.

Typical hut in the middle of the field.

After 9 kilometers on the path we arrived at the village. People had gathered and the young people from Koutou-bete were there leading the singing. They were easy to spot as they had black pants or skirts and white t-shirts with J-A on the front and “Eglise Adventiste du Septieme Jour” (Seventh-day Adventist Church) on the back. It was what I expected, very bush. We were outside under a giant tree, with roosters crowing and oxen lowing in the background. Lots of little kids sitting on the mats, literally dressed in rags.
Little kids dressed in rags

Little kids dressed in rags

In fact I don’t remember ever seeing, even around Bere, so many kids in such tattered, torn clothes. We were surrounded by the fields of the villagers mingled in with their mud brick, thatched roof huts. Very different from what we are used to here in Moundou. It was a pretty simple service, the choir led the singing for a while, the pastor asked me to have the opening prayer, and then he gave the lesson study, followed by more singing and closing prayer.
VIP seating

VIP seating

There were several things that really impressed me though. One was the Pastor. Dieudonne is an evangelist at heart, on Thanksgiving at morning worship at the hospital he somehow tied the American Thanksgiving in with the seven trumpets of Revelation, and when he gets going, man, Dwight L. Moody would be proud. And when he gets wound up, his poor translator (he is speaking in French and someone is translating into Ngombaye), gets left in the dust. He will talk for literally two minutes, give his translator 5-10 seconds and then just get going again. His whole body shakes in anticipation of what he is going to say next. But today he gave Roger the time he needed to translate, and he kept it simple. The lesson was on the mission of Jesus which he beautifully wove into a message of the love of God, of salvation for all, and the call of all Christians to be missionaries for God.

At the end he invited one of the village elders to ask questions or make comments. We learned that although there is a school they never are able to finish the school year, so education is lacking. They would love to have a church to worship in. During rainy season worshiping outside is always dicey. They asked us to come hold a medical clinic for them. They have no bibles in Ngombaye or hymnals for that matter. Dieudonne impressed me again as he told them he couldn’t promise anything, except that if they were faithful in worshiping together each Sabbath and learning the Bible truths we would back in two to three months and hold a grand baptism at the river which is quite close to the village (meaning within 20 kilometers (12 miles)).

So where is the new birth in all this? The pastor gave the village elder a notebook and pen and asked him to go around and record the names of those wishing to become Seventh-day Adventist Christians. It is the first record of a church in this village. We look forward to the next step when we return for the grand baptism at the river.

The whole group from both villages in front of their "tree church".

The whole group from both villages in front of their “tree church”.

We are pretty pumped, this week Nick Buchholz our physical therapist comes. He is the final member of our team for the rest of 2015 which includes Rebecca and Diana Hernandez and our SM/Nurse from Southern University, Danny Alvarez. With this team we are hoping to get a mobile clinic program going and get some public health outreach started. We don’t even have to totally re-invent the wheel as they are already doing that up in and around Bere. But today as we bumped along on the moto looking at the road (read 4-6 foot wide dirt path), with low hanging mango tree branches we wondered how we are ever going to get our ambulance to these villages. We have got to start thinking about getting some other wheels for the hospital, something meant to go off road, like a used land rover or Toyota Hilux. I have no idea how we are going to acquire something like that. Which is a good thing, because it means I get to once again see a miracle from God.

Pastor Dieudonne on his moto

Pastor Dieudonne on his moto


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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SORTIE

I almost cried today. For those of you who know me well, you understand the significance of that statement. I just don’t cry. But today as I wrote “Sortie” (Discharge) on Ortega’s carnet, I almost cried. In fact if I had dwelled on it much more, I probably would have choked up anyway. I have said many times that we see miracles here every day, and that every patient who walks out of here alive and well is a miracle, but Ortega, well, I should never have had the privilege to write “Sortie” on his carnet.

Ortega (really that is his name, don’t have a clue where his parents got it from, maybe TV?) is three years old. He came to us 2 weeks ago with the history of having had a fight with his brother about a month earlier. Apparently during the battle Ortega was hit in the upper abdomen and ever afterward he vomited every time he ate or drank anything. Prior to that he was fine, allegedly. On exam Ortega looked emaciated, like a little kiddo who hadn’t eaten for a month. He was so dehydrated the nurses had to put his IV in his scalp. We did the usual work-up (actually the only work-up we can do). He was anemic (normal for here), and his test for malaria and typhoid were both positive (also normal for here). At this point I was wondering if he had a duodenal hematoma from the blunt trauma. But his abdomen was not really distended, and he was pooping. Since I don’t have ultrasound or a CT scanner and I didn’t think a plain film would help much I decided to punt. By that I mean I started him on treatment for Malaria and Typhoid and hydrated him. I have been amazed how often doing those three things magically make everything better.

That was Monday. Tuesday I had to go to N’djamena for three days, which I figured was fine since that gave us three days to treat him and see if he got better. Friday morning I saw him in the Salle de Reveil and he really wasn’t any better. Still vomiting when he tried to eat or drink, but still having occasional bowel movements. At that point my hands were tied. If I did nothing he was going to die for sure. If I operated he was probably going to die whether I found anything or not because he was so weak and malnourished from not eating for a month. I talked to the family and explained the risks. They really wanted me to operate, they were desperate. I find that often the families have much more faith in what an operation can do than I have. In fact if often seems like there are only two opinions here, those that want an operation for everything, medically indicated or not, and those that don’t ever want an operation for anything, medically indicated or not.

Since probably going to die trumps absolutely going to die, I operated. It was not one of my stellar moments as a surgeon. I went in not knowing what I would find, but thinking hematoma in the duodenum based on the history. Once I got him open, I found a huge spleen, and was about to close when I realized it was not his spleen but his stomach, wow, he did have an obstruction after all. And it was in his proximal duodenum, and I could then feel a mass. Hematoma or maybe pyloric stenosis. But it felt kind of soft like a hematoma, not the hard olive I remembered from my pediatric surgery rotation 25 years ago. So I carefully started peeling away the layers of the duodenum, unfortunately forgetting to use the blunt end of the scalpel. I was looking for either a hematoma or a big pylorus to pop out at me, but instead it was his duodenal mucosa beyond the stricture that popped out. Oh man, now I had done it, opened his duodenum, not good, but at least now I could tell for sure what was wrong. It was indeed pyloric stenosis, and his stomach was full of a lot of bouille and boule (Tchad’s native dishes). We suctioned out his stomach and then I closed the hole transversely (first thing I had done right) and covered it with his pathetic excuse for omentum. Not a single fat cell to be found on it.

All the time I am thinking, there is no way this kid is going to heal this. I am quite sure Ortega’s albumin was south of 1 (really low) and prealbumin even lower. He had no building block to heal with. He needs an NG tube, he needs intestinal tube feeding, he needs TPN, he needs a pediatric ICU, he needs, he needs… I closed him up and tried to console myself, it didn’t work. At supper that night I told everyone what we had found and that if he lived would be an absolute miracle. We had of course prayed for him before surgery, we prayed after surgery, we prayed at worship that night, because at this point all he had going for him was prayer.

The next day he was alive, but looked pathetic, this little boy in this big bed, just laying there, too weak to cry or move. Sunday was the same. We managed to keep him on IV’s and keep him hydrated, we gave him a little blood, we kept the antibiotics going, and every morning he was still alive. He was still being treated for Malaria which causes hypoglycemia so I had the mom mix some honey in water and give him a bit to drink by syringe. By Monday he actually opened his eyes and looked around. Tuesday he sat up a bit. Wednesday we transferred him out of our “ICU” and into the general ward. He started passing some gas, he wasn’t throwing up, he started taking some bouille (like rice milk) and kept it down. Friday he pooped. (Those three words are really really big, they indicate GI function).

Sabbath morning when I made rounds, Ortega was now eight days out from surgery. Tummy was soft, no pain or tenderness, wound was clean, he was eating, pooping, and peeing (the big 3). Mom asked when he could go home. I started to choke up when I said “Today”. I shook his little hand and taught him how to give me five. And then we prayed together, a prayer of gratitude for a God of love who cares about a little three year old boy in the south of a forgotten country, and Who saw fit to save his life. I wrote “Sortie” on his carnet and fought back the tears, just like I am now, and turned to the next bed, grateful to have been a part of yet another miracle.

Little Ortega in his crib, dressing on his tummy and IV in his scalp.

Little Ortega in his crib, dressing on his tummy and IV in his scalp.


Since I wrote this two weeks ago I have seen Ortega back in the office and he continues to do OK. Eating small amounts but keeping it down. I will see him again in a couple of months, God willing, and hope to find a robust little three year old.

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

ARGENT

Tite called me into the petite surgery one day about 6 weeks ago. “Doctor please come look at this wound with me”, he asked. Tite is our nurse in charge of outpatient dressing changes, and throughout the day he often drags me into the Petite Chirurgie (where we do our outpatient dressing changes) to look at this wound or that wound. As he undressed Bria’s leg, I had to choke back my exclamation of shock and horror (it is not professional to say, with emphasis, “OH MY GOODNESS, THAT IS HORRIBLE”). Most of her leg was one huge weeping wound, with rotting, infected, necrotic skin. I gulped, told Tite to rinse off the leg and redress it, turned around and headed for my office. I filled out the fiche operatoire (operative form) and wrote “Cas d’Urgence” (Emergency Case) on the top and then took it back into TIte and had him explain to Bria and her family that she needed urgent surgery to debride the leg. By writing “Cas d’Urgence” on the fiche operatoire, I was telling the administrative staff that we could accept a down payment on the operation and then they could pay it off later. It also meant I would guarantee that the Center got paid if they reneged on their obligation. (For elective cases we insist on full payment up front.) The next day we debrided Bria’s leg and found that only the skin and subcutaneous fat and fascia were necrotic, the underlying muscle was fine.

About a week later, Tite called me again to see a new wound. I could not believe my eyes, this one made Bria’s leg look like a minor abrasion. The skin on Abdoulaye’s entire leg from his knee to ankle was rotting off. The next day we got his leg debrided and found the exact same situation. The muscle was healthy. Both had some kind of flesh eating bacteria that confined itself to the skin and fascia. (I am still waiting for the culture results, ha ha.) Fortunately with aggressive debridement and antibiotics we were able to stop the necrosis and infection, and their wounds are now clean. Unfortunately, I now have massive wounds that need skin grafts. It is going to take several more operations to get these legs grafted and healed up, operations that are expensive and require expensive wound care as well.

It seems like since I got back from annual leave we have had a plethora of complicated cases requiring multiple trips to the OR, like infected amputations that need two or three surgeries, Bria and Abdoulaye, and then the usual open fractures with little to no soft tissue coverage. And although $300 USD sounds cheap for an operation to most of us, that is a huge sum for people paying for it out of pocket who make less than a dollar an hour (that is a really good wage, most make less than that). So we have had a lot of patients who don’t have the money to pay for their subsequent surgeries. Therefore, I use money from our loyal friends who have donated to Restore a Child or to the Clarkston Church to pay for their care. Last month I spent around $3000 USD for indigent care.

I recently got an e-mail from a new friend who asked how she could help us. To be certain, remembering us in prayer, and sending encouraging comments either through WordPress or facebook are the top two. But we also really appreciate those of you who have helped financially, either through Adventist Health International (AHI), or the Africa Mission Fund at the Clarkston SDA Church, or through Restore a Child. It occurred to me that most of you probably have no idea how a mission hospital operates, where funds come from, etc. So I thought I would give you a little primer on how we operate, and what happens to the money you donate.

First, I need to destroy a few myths. Even though we are a Seventh-day Adventist hospital we receive no funding from the Church, other than my salary. The Church expects its mission hospitals to be self- sufficient. The church has basically turned support of mission hospitals over to AHI, and we do receive materials and supplies from them, for which we are eternally grateful. AHI is also a way people can donate money to various mission hospitals around the world. To see what all they do go their website at ahiglobal.org.

Second, the idea that a mission hospital can be self-supporting is ludicrous. US hospitals aren’t even self-supporting, everyone I worked in had a fund raising auxiliary attached to it. Our goal is to generate enough income to cover our monthly expenses and hopefully build up a reserve. Our income is solely derived from our patients, and we have set our fees high enough to cover expenses with a bit left over. As it is many patients (as I referenced earlier) cannot afford to pay for surgeries here, and if we raised prices high enough to generate income to cover capital expenditures we would have no patients.

So what does all this mean? It means that we rely heavily on donors to help fund our capital improvements and replacement of equipment, and to help pay for the expenses incurred by the indigent. When you donate money to either AHI/Tchad/Moundou or to the Africa Mission fund at the Clarkston SDA Church, the funds are controlled by independent boards. We make requests and they are approved or denied by the boards, not by us. Sometimes people donate for specific projects and their wishes are of course respected.

So what have we done with donated money? Well as I indicated above, indigent patient care is a biggie. But we have also replaced a lot of dead equipment, generators, air compressors, refrigerators (for blood and medication storage), construction of sidewalks and laboratory, adequate housing for long term volunteers, just to name a few. At least once a year a full report on our activities is given to each board that oversees our funds.

When I first started I tried to be tough and wait patients and families out. So patients with broken legs would lay on their bed for days while the family tried to search for money. Finally I couldn’t stand it anymore and decided that if a patient needed surgery (cas d’urgence) I would pay the difference and get their surgery done in a timely (for Tchad) manner. I just couldn’t see how I was being like Jesus when I insisted this poor suffering fellow human pay me before I would help him or her. Since I started doing this I am much happier, and patients are doing so much better, and I feel like God can bless us more. I plan on doing this until I run out of money.

There are a couple of great stories in the Bible, one in 1 Kings 17 and the other in 2 Kings 4. Both involve poor widows who found that the oil kept coming as long as they needed it. I am pretty sure as long as I keep spending God’s money to take care of His children, He is going to keep filling our barrels with oil.

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