Autoclave

Life lesson 452: When one is in Pittsburgh, PA, make the two hour drive to Erie, PA to actually look at the autoclave before you buy it.

I had no idea the autoclave, was soooo big. It did not look that big in the picture. It is so big we can just autoclave the patient and the instruments together, eliminating the need for prepping. We are pretty sure we now have the biggest, baddest autoclave in all of Sierra Leone, and probably in West Africa. My staff is thrilled, I am, well, frankly embarrassed.

Bekki showing just how big this sucker is.

OK, to back up a bit. Part of the grant from the Winifred Stevens Foundation for the OR upgrade was to be used to purchase a new autoclave. When I came they were trying to sterilize the instrument packs in an ancient dental desktop autoclave that barely worked. As in you have to manually turn it on and off to keep the temperature in the right range. Remy Hirschy got one of our other non-functioning autoclaves to work, but it drips hot water all over the floor when we use it, and it too is a desktop model, so it is fine for a small clinic, but not a real OR, like ours!

Luke Hingson at Brothers Brother in Pittsburgh, PA got us in touch with Rick King who runs Chosen International, a company that refurbishes autoclaves, puts on a new boiler and then renders them “West Africa proof”, with the proper current and plugs etc. They come in several sizes, but the two full size ones were the same price, so go for the big one, right?

Healey Foundation, a Catholic NGO out of New Jersey, who has helped us ship things over here agreed to give us some space on their next container, so it made the move from Pennsylvania to New Jersey, then on the boat to Sierra Leone. We got the call Wednesday morning that they were offloading the container and wanted to know what we wanted done with our crates. Fobbie went to the wharf to check it out.

He called me, “Dr. Scott, the crates are big, we need a crane to unload them.”

I was pretty cool with that, I had been warned the crate was large. Notice I said crate. I was a bit surprised Fobbie said crates, but I just figured it was the oxygen concentrators Loma Linda had sent, and only one crate needed a crane.

Fobbie arranged for a truck with a crane to transport the crates to the hospital. They arrived just as we were starting prayer meeting at 4:30 pm. Two HUGE crates sat on the back of the flat bed truck. Not large, massive. 4000 pounds between them. The oxygen concentrators were with Fobbie in the back of the Xterra. We had no idea what was in the second crate. Turns out the police wanted to know as well.

The truck with the MASSIVE crates on the back. The chairs unfortunately were not for us.

In the the next 24 hours we experienced an absolutely awesome, incredible set of miracles.

Miracle 1: They got both containers off the truck and on the ground without dumping them. They had only one strap around the containers, which was fine for one direction, but containers are 3 dimensional objects hovering in space, even if you have side-to-side covered, they can still fall end-to-end, or vice-versa. And when they tried to lift the big one, the wood bottom of the crate started breaking up. It was clear these guys were pros, but also clear that they were making this up as they went. Bekki and I? Silently praying. We have seen too many unloading disasters in West Africa to not be aware of the risks.

Unloading the big crate, notice the bottom starting to separate.

Unloading the small crate, yea, one direction is supported, but it can still fall to the side.

Miracle 2: Getting them unpacked and moved into the hospital, without damage. I wish you could see the video. I will put it on the blog site next time we are in the US. It was the ultimate tug of war as about 15 guys fought against 2500 pounds of autoclave and gravity as they pushed and pulled this thing up our amusement park ride steep ramp into the hospital. It cleared the first two doors with an inch or two to spare. We only had to take out one door and wall to get it into it’s new home.

Ultimate tug-of-war with Joseph as the anchor.

We had our usual prayer of dedication and blessing Thursday morning before we unpacked the crates and moved them inside. Part of that prayer was that God would send His angels to protect the contents from harm as we moved them inside. God answered that prayer. There is no doubt in my mind that angels excelling in strength surrounded our autoclave as it was heave-hoed up the ramp.

Miracle 3: No rain. We are in the teeth of rainy season, it is raining more often than not, especially at night. And this is not a little sprinkle, man, it pours, it gusts, it storms. Tuesday night, Wednesday morning and early afternoon it rained, beaucoup. Mid afternoon, the clouds parted and the sun came out. As they unloaded the truck it was clear, but it was too late in the day to do anything more. So we put tarps over the wooden crates and prayed.

All night I listened for the rain, it is easy to hear it on the tin roof. No rain. The morning dawned bright and clear. After worship, we gathered outside for the blessing and pictures. No rain. For 2 hours every able bodied man pried apart plywood and 2X4s under blue skies. No rain. The ramp was dry as they heaved it up into the hospital.

Not 5 minutes after getting the last of the autoclave pieces under cover it began to rain. Two hours later we had as big a storm as we have had this year. The water was overflowing the drainage ditches. The autoclave? Warm and dry. The ramp? Now a slip and slide.

Jesus calmed the storm on Lake Galilee. He held off the storm over Waterloo Hospital just as long as we needed.

The second crate? We were happy to be able to tell the police it was just more parts of the autoclave, the boiler and a rack to put the instrument packs on.

Next time, I will take the time and go look at the merchandise, but thank God that He doesn’t hold our stupid human mistakes against us.

For more frequent, up to the minute short updates please follow us on Instagram or on Facebook, we are Scott N Bekki Gardner.

For those of you who are 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, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. 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. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. 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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Morning Worship

Three years ago, or so, wow it does not seem possible, I wrote a blog about worship in Tchad. Well it is time to write one now about worship in Sierra Leone. It is similar but also very, very different.

First the similarities, morning worship starts the day. Day shift and night shift are all expected to attend. The only staff exempted are those working the afternoon/evening shift. We sing, pray, a staff member gives a talk, and often we have “contributions”, comments about whatever the topic was.

We don’t do the handshake thing that was so big in Tchad, probably due to Ebola. That scared the Sierra Leoneans from any physical contact. And the singing here is much better. These guys can carry a tune, and harmonize. Then too, we have worship in the OPD (Out Patient Department) which has awesome acoustics. When the staff ramp it up on their favorite hymns it is positively heavenly.

The Staff doing morning stretches.

Led by JP

And worship time is very structured, Monday is administration day, so a staff member talks about their job, like say a cleaner (janitor), explaining what they do with their time, and often share some of their frustrations. There is usually then a long discussion where the most vocal staff voice their opinion on the topic, usually positive, but sometimes if it is perceived that the staff member is whining unnecessarily, they will be called on it.

Tuesday and Thursday are health talk days, so a clinical staff member will give a treatise on hypertension or diabetes or nutrition, or any health related topic. Lately the focus has been on waste management, and this morning our waste management officer (he is also our anesthetist, seems to me like a natural combination) talked again about proper waste disposal. You know like, putting sharps IN the sharps container, not on the lawn. And putting soiled bloody dressings in the proper dust bin (waste receptacle). Little thing like that. In fact, just last week the Waste Management Team did a skit for worship on that very topic, what waste goes where. This is a good thing to talk about in a country that seems to believe that any public place is a garbage repository, and that the entire country is one giant urinal.

Our Waste Management Team doing their best to get the staff to put the medical waste not only in the trash, but in the right trash.

Wednesday and Friday are reserved for more traditional worship talks, which are often very thought provoking, others, well, not so much. But by and large, morning worship is a great time of fellowship and comradeship.
After worship we have the all important announcements, what committee is meeting that morning in my office, or what our upcoming schedule is. And after worship time is when we celebrate staff birthdays, births, and provide support to those who have lost loved ones. It is the time when we welcome new volunteers, or new staff with our “Welcome, Welcome” song, and it is the time when we say good-by to those who are leaving us. It is the time that the staff receive their certificates for attending and completing educational classes taught by our volunteers.

Nurse Karin giving Mr. Conteh his Certificate of Achievement.

The Loma Linda University Pharmacy Team with their Sierra Leone plaques, signed by the staff.

It is the time when we bless new additions to the hospital, from little things like dressing supplies and point of care hemoglobin monitors to larger items like physio beds, cars and even autoclaves. I have come to love this AHS tradition. It emphasizes the fact that everything we have here, everything we do here is for the glory of God, it is by His hand that we survive and function, and we owe it all to Him. So everything large or small is dedicated to be used to His honor and glory and in His service.

Blessing our new Physio table from the UK.

A particularly difficult farewell as the Peter Turay gives a heartfelt testimony about his brother Douglassss Turay at Douglasssss’s farewell.

Morning worship is held, as I mentioned, in the OPD, so it is not uncommon to have patients and families attend worship with us. What is unusual is what happened last week. Two patients wanted to share their testimonies with the staff after the announcements.

The first was Omo. She is a very brave woman who first came to us with a diabetic foot. It was really bad looking, but seemed to be viable and she was walking on it, so I did my best to save her foot. Sadly, the infection got out of control and started to spread up her leg. By the time we got her to surgery we had to do a high calf amputation and leave it open to let the infection drain out. It made me regret my earlier decision to not push for the amputation sooner. Anyway, when it came time to close the wound I had to explain to her that I could not save the knee. A below knee amputation would not leave enough length of bone below the knee to support a prosthesis, or be anything but in the way. Understandably, she was pretty upset. But she pulled it together and we got the job done, and her wound closed.

Omo

That morning she stood there on one leg, supporting herself with the walker and led the staff in singing “To God Be the Glory.” She then proceeded to praise God for His mercy, love and grace. I was so moved. Here was this woman who had just lost her leg, praising God in spite of it all. We are pretty good at praising God when He heals us, saves us or delivers us, but after losing a leg in a place that does not make it easy for the handicapped. Never saw that in America.

Then a couple of days later, an old Muslim man wanted to share his testimony. He is recovering from a stroke and is still very weak, but he managed to walk a few steps and he too started to sing,, “Tell Papa God Tenki (thank you)”. It is a Sierra Leonean favorite, but I didn’t realize the Muslims sang it too. The staff joined in lustfully as they say here. It is a praise chorus, “Tell God thank you for what He does for us, He saved us, He does everything for us.”

Our Muslim brother leads us in singing, bring those hands together.

Paul tells us in everything to be content and to give thanks for all things and in all circumstances. I would do well to learn from a woman with one leg and an old Muslim man.

For more frequent, up to the minute short updates please follow us on Instagram or on Facebook, we are Scott N Bekki Gardner.

For those of you who are 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, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. 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. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. 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

KABIA – PART II

Last Sabbath I posted a blog about our lab technician, Amadu Dalton Kabia. Because of the power of the internet and social media, and the faithfulness of Christians everywhere, people were praying for Kabia in homes and churches literally around the world. We received responses from Taiwan, the Philippines, Europe and the Americas. Since then I have received a number of requests for an update.

Earlier this week I had a chance to sit down with Kabia and hear from him what happened.

As you recall he had been ill for a couple of weeks and just didn’t seem to be improving. Or, he would get better then relapse. Last Friday morning at 5 am, after a difficult night sleeping, his family came to take him home. He just wasn’t improving here at the hospital and it was time to do something else.

Kabia tried to resist, but as he told me, they were his elders and so he really had no choice but to obey. He was told they were going to take him to another hospital, but instead, he was taken directly home. As he suspected, once he arrived home plans were made to take him to the native healer. I addressed the problems with that in the last blog. He flatly refused to go, elders or not. So, they brought the native healer to him.

This lady has a lipoma on her left shoulder that I took off this week. However, notice all the scars. These are cuttings from the native healers, presumably to get rid of the evil lipoma on her shoulder.

At that point, he was not feeling well at all, but was with it enough to resist the power of the witch doctor in his heart. He said they did some kind of ceremony which he was unable to describe. They told him his illness was all due to the man we had fired earlier this year. He told them he didn’t even work with that guy, and had nothing to do with the firing. He told them if they could give him some natural remedies, herbs and such, to make him feel better, that would be fine. Otherwise, he said, forget it. With that, they left, presumably to leave him to his fate.

From that point on, he began to improve. By Monday he was strong enough to come back to the hospital and do a little work but mostly he rested and hung out with his friends. Tuesday, he did a bit more, and so on. I told him to come late, leave early, whatever he needed to do, but make sure he rested. Much of the burden has fallen on Sallie, his assistant in the lab. She has been able to do many of the tests, as they are automated ones, or use test strips. But those tests that require a microscope are harder and she is not really trained to do it. But, here in West Africa, you try anyway, you do your best, you never give up. So, we would find Sallie huddled at the microscope, just shaking as she tried her best to read the slides. She was so relieved when I told her she didn’t have to do that. I told her to Just do the tests she knows how to do.

At this time, Kabia is much better, still a little weak and tired, no doubt partly due to his Ebola history. But he looks bright (healthy), and he has his smile back. I am so proud of our lab, they really went through the testing fires this month and came out shining.

This is our lab crew, Michael on the left, Sallie on the right and Kabia in the middle. A truly indomitable group!

The devil is strong here, but the power of our God, unleashed by the prayers of the saints around the world, is stronger than all the forces of hell for those who submit to Him.

“Submit yourselves then, to God. Resist the devil, and he will flee from you.” James 4:7 NIV

For more frequent, up to the minute short updates, please follow us on Instagram or on Facebook, we are Scott N Bekki Gardner.

For those of you who are 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, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. 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. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. 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

OUR STRUGGLE IS NOT AGAINST FLESH AND BLOOD

Yesterday at the end of worship the entire staff stood up and held hands, making sure there was an unbroken circle, and we prayed for one of our own. Our lab technician, our Ebola survivor, was ill. He had been ill for a couple of weeks, and wasn’t responding normally to treatment. It could be because he kept going back to work too quickly, and wasn’t getting enough rest, or because he really never let us finish an adequate course of treatment, or maybe he has something else wrong that we can’t diagnose, or maybe it is a result of his Ebola history. There is some thought that Ebola survivors are relatively immune comprised. Whatever the reason, he just wasn’t getting better.

However, that is not why we were praying. We were having this special season of prayer because at 5 am that morning his family had shown up and taken him from the hospital against his will. The staff did not need to be told what this probably meant. When families come and forcibly remove someone from the hospital they typically are planning to revert to the default–take the patient to the natural healer. Every village, every community has at least one natural healer. These are not naturopaths as we understand them. No, these are witch doctors in every sense of the word. I actually had no idea how evil these men and women are until just recently.

The AHS family was upset because just three weeks ago we buried the Seventh-day Adventist wife of a prominent staff member whose family had taken over her medical care. The husband shared with me the story.

Josephine had been ill for several weeks. The labs tests were all normal, and there was nothing wrong on physical exam, except she didn’t feel “bright”, meaning she was weak and tired. Different medications were tried without much success. Now, it has to be said that this happens in the US as well. Patients have some unknown malady that doesn’t respond to treatment. Eventually they get better, most of the time, or something shows up to steer us in the correct direction. However, in Josephine’s case the family was not going to wait. So, they took her home. Her family is not Christian, although to be honest, it really would not have made much difference. I have observed that whether you are Muslim or Christian, when the going gets tough the vast majority of them will revert to their animist roots. And who do they turn to for medical help? The natural healers.

So, these guys were brought in. What I am about to tell you will sound made up,like something out of a horror novel, but it is not, I assure you it is real. First, they found some masses or lesions at various locations on her body. These were removed. Without surgery, without incisions or scars. Cutting, actual cutting with a knife, and blood letting is a very common treatment here. Many of my patients have multiple scars on their bodies as the result of natural treatments. But then they reached into her abdomen and pulled out the real source of the problem, a snake like creature, 8-9 inches long, with a discernable head and tail, that was moving. I have seen the picture of it. It was fortunately destroyed so it would not bother anyone else.

I asked if there was a scar. I was concerned these guys had made a hole in her intestine and not closed it and she had died from sepsis. I was informed that these natural healers have magic and the wound just closes over spontaneously and very quickly, leaving no trace of a wound.

Josephine seemed to recover some after her “natural” treatments. But then 4 Sabbaths ago her family called the husband saying that she was very ill. She was brought to the hospital and died a few hours later, at the age of 39.

Did she die because of the natural treatments or despite them? Did she have some unknown ailment that was to doom her no matter how she was treated? We will never know. But what I can assure you is that as soon as the natural healers became involved with all their magic and potions, God was pushed out. How can God answer the prayers of the church for healing when the devil is involved? Who is going to get the credit if He does work a miracle?

It was with those thoughts in mind that we prayed about our lab tech. I am sure most everyone in the room knew the stakes involved. It is extremely unlikely the family took him from the hospital to try to get him into one of the fancy expensive European hospitals in Freetown, or that they are going to airlift him to France for treatment.
He knew as well, what was in store for him, which is why he vehemently protested leaving the hospital. But individuals here have no say, it is the family, specifically the ranking member of the family who decides for everyone.

So we prayed, we prayed that somehow God would intervene and the family would allow him to come back to the hospital, allow us to continue treating him. We may not have much for diagnostics or treatment options, but we have something greater than that, we have the Great Physician. And in this war, that is worth more than all the soldiers, all the armaments, all the captains and all the kings.

Here, the evil, the darkness is so “in your face”, so blatant it is impossible to miss. But it is just as real in the “developed” world. We just call it by other names, or we rationalize it away with our smart scientific theories and ideas, but the evil is there.

I don’t know how this will end, but I know God will not force Himself where He is not wanted, so ultimately it is up to us, we choose which side we will be on. And that is a decision we all have to make, whether we live in Sierra Leone, Tchad, France, England, the US, or any other country in this world.

I am happy to report that we just received a message from our faithful lab tech wishing us a Happy Sabbath, and telling us that he is home and will not let anyone mislead him. Praise God, but, he will need all the power of heaven to stand against the will of his family.

“For our struggle is not against flesh and blood, but against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms.” Ephesians 6:12 NIV

For more frequent, up to the minute short updates please follow us on Instagram or on Facebook, we are Scott N Bekki Gardner.

For those of you who are 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, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. 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. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. 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