AN ANGEL IN FATIGUES

“Fire, Fire!!!!”

The cry went up from the back of the bus, somewhere near the border of Burkina Faso and Mali. It was about 1:30 am when some cables overheated and caught fire in the back of the passenger bus carrying a precious cargo, a part of our AHS family.

The Danquah family, Elizabeth, Rebecca, Samuel, with Nana and Samuella.

Elizabeth Danquah, my very special surgical assistant, her cousin Rebecca and the two Danquah children, Nana, 6, and Samuella, 3, were on that bus, sitting toward the front. They were traveling back from visiting their families in Ghana for the first time in years. So it was the first time the family had met Nana and Samuella.
When the cry of fire went out the children were asleep, the adults mostly asleep. As the bus pulled over to the side of the road people began running forward toward the door, pushing and shoving to be the first out. No one knew when the bus might explode, or become a fireball. In the melee that ensued, little Samuella was trapped, crushed by this river of panic stricken adults.

Somehow, by the grace of God, Elizabeth and Rebecca were able to rescue Samuella and get her and Nana to safety.
In many ways though, it was out of the frying pan into the fire. All the passengers were now stranded in the bush, in the middle of nowhere, with a broken down bus that is on fire and going nowhere. Soon a policeman showed up and warned them that it was not safe in that place. There were robbers around who would take great delight in relieving the passengers of whatever they might have of value. So he stayed with the group, although I doubt he would have been much protection had they come under attack by a band of thieves.

Nana trying to sleep on the ground in the bush.

The angels of God surrounded this stranded group of travelers that first night as they huddled together. Morning brought light (safety) and transport to the next city in Mali. And so the little family boarded another transport to continue their journey home, a journey that normally took 5 days, but already was now a day delayed.
Later that evening, again in a remote area of Mali the driver of the bus realized he had no brakes. He was able to get the bus slowed and stopped on the side of the road, but another night was spent in the bush with little to no protection from robbers, save the presence of God’s angels.

The next day Elizabeth, Rebecca and the children were able to get transport to the nearest city in the country of Guinea. Now only one border was left to cross, between Guinea and Sierra Leone, but it would be a very long day to get to Waterloo. Not to mention all the time that would be spent at the border crossing as each passenger had their documents checked and verified. Then there would be several immigration checkpoints before and after the border.

By this time Samuella was obviously ill. She was complaining of abdominal pain, she was throwing up, unable to keep even liquids down.

Here at AHS the entire hospital was praying. Our worldwide prayer team was praying. Mr. Samuel Danquah, Elizabeth’s husband and the children’s father, and our Director of Spiritual Ministries, had received a brief message about the fire and that Samuella had been caught in the made scramble to exit the bus. But then for 48 hours, nothing. No word from the family. In this case no news is not good news. No news can mean they were attacked by robbers, maybe they had been kidnapped, maybe Samuella was badly injured. Too many unknowns. But through it all his faith did not waiver, he had left them in God’s care and that was that.

In Guinea, Elizabeth knew they were in trouble. Her husband had sent enough money for the trip, but not for extras, like two nights in the bush, a bus fire and bus breakdown. They were down to about 700,000 leones, ($100). Something was seriously wrong with Samuella, she was getting more lethargic, and listless. Still vomiting, and still complaining that her tummy hurt. Although they were getting closer to home, it was still a long way off, with a lot of delays likely to slow things down, and Samuella needed to be seen at the hospital sooner rather than later.

As the family walked toward the bus station hoping to find an express bus to take them to Waterloo a man in military fatigues approached them. He had noticed that Samuella did not look good and he offered to help. Would they like him to drive them in his vehicle to their destination? They had never seen this man before. And they are two young women with two little children. Not a good combination. He wanted 1,500,000 leones ($200). They only had 700,000. Elizabeth was able to get her husband on the phone and negotiate with this army man down to the 700,000 le.

And so began the final leg of this incredible journey. At the first checkpoint he flipped on his siren and lights and the guards saw the military label on the vehicle and waved them though. At the border between Guinea and Sierra Leone he did the same thing and the guards just waved them through. It was the same at each checkpoint. No stopping, no document checks, no questions. They were able to drive straight through to Waterloo in record time.

Samuella in the hospital, on the road to recovery

When they arrived later that same afternoon, Samuella was nearly unconscious. She was severely dehydrated, suffering from malaria, typhoid and anemia, an often lethal combination. Our nurses are experts at getting IV’s in little dehydrated children, and this was no exception. She was started on IV hydration, Ceftriaxone and Quinine. When I went to see her, she barely acknowledged my presence.

Samuella and Nana are two of the cutest kids you would ever hope to meet. And they faithfully greet Dr. Scott and Mommy Scott in the mornings and afternoons as we walk by their house. It was hard to look at this beautiful little child of God, knowing that the odds were not good. I comforted myself that at least her lungs were still clear.

I went home that night not knowing what would happen, it literally could go either way. I stopped by her room the next morning before worship and was relieved to be greeted by a cry from a cranky little girl. She was better!!! She was going to be alright. That morning in worship there were plenty of praises for God’s grace and healing power.

The military man in fatigues? He took off right after dropping the family off at the hospital. Was he their guardian angel masquerading as a man? Perhaps. Was he just a mere mortal military man with a compassionate heart that was tuned into the Spirit of God? Perhaps. Does it matter? Not really. To us at AHS he will always be our angel in fatigues.

Elizabeth with a now recovered Samuella.

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

THE ACCIDENT

(I wrote this some time ago, but never posted it.)

The call came in Sunday afternoon, November 27, the call I had been dreading that is. Pa Sanko had been in an accident with the van. I was dreading it because I knew how Pa Sanko drove, like a Sierra Leonean, but more importantly I knew how the others on the road drove. It really was not a question of if but when there would be an accident. This is why we pray so sincerely each time we set out on a journey.

The problem is that the van is our source of transportation, it is how we get people to and from the airport, it is how our mobile clinic team goes out, it is how we get to Freetown. Mr. Fobbie has his car sure, but often both are in use. Plus the van holds a lot of people and a lot of material. It is a true work horse and will make our job much more difficult without it. I had been dreading this day since April.

Sanko had been bringing home a group of women from the yearly women’s retreat at Masiaka. They tell me (I was not invited) that it had been a great weekend, very spiritual, and they were singing and praising as they neared Waterloo. Suddenly an Okada (motorcycle taxi) pulled out from among the traffic waiting to cross the highway. He pulled right into Sanko’s path. Sanko had no time to react or stop, and the van plowed into the moto. The unhelmeted passenger, a woman in her 50’s went flying off the bike. The driver fled, leaving a badly damaged motorbike and an unconscious, bleeding woman on the pavement.

Our poor van with the smashed nose. It is still in the shop, they are trying to find a radiator for it.

A crowd quickly formed around the van and the accident scene. The windshield on the van was smashed as was the radiator. The location of the accident had to be a God thing. It happened a hundred yards from the Emergency Clinic, and the local police station. There is an Italian NGO who has a very nice Emergency hospital in Freetown, and most accident victims are taken there. They have an orthopedic surgeon on staff (the only one in the country), and all care is given for free. They have also established several Emergency clinics, like the one close to the accident scene where accident victims are taken, triaged and first aid rendered, before being taken in their ambulances to the main hospital in Freetown. So the woman was quickly taken to the Emergency clinic where she was found to be unconscious, with an open depressed skull fracture. Fortunately, everyone in the van was fine.

The second serendipity is that the local police station is also located within a hundred yards of the accident. Sanko was immediately taken to the police station and placed in protective custody. At that point it was not clear if the woman would live or die, or how serious her injuries were. Mob justice is alive and very well in West Africa. In Tchad we were taught that if you were in an accident, especially if it appeared someone died, or might die, even if it was not your fault, you do not stop. You drive to the nearest police station. If you stop, the crowd will at best beat you to within an inch of your life, at worst kill you. This is not a joke, it is real. We were driving through a suburb of Freetown and noticed a commotion. Turns out some sap had tried to steal something and had been caught. They were beating the tar out of him, quite literally.

So, although this was a moment I had been dreading, God was way ahead of us. When we had our strategic planning meeting in April, one of the plans was to add a 4 WD vehicle and an ambulance. I, the skeptic, went along with it, thinking maybe in a year or two we would find the money for another vehicle. I really did not believe we had a prayer of getting an ambulance. But then in late September the Loma Linda Auxiliary chose us as one of their projects. That was great, they typically raise enough to give each of their projects $10,000. I was pretty happy. But they typically finish their fund raising by the following spring, and distribute the funds in April or May. Bekki and I had never met these ladies before, so when we were at the Global Health Conference in Loma Linda in October we asked if we could meet them. So it was that Friday afternoon we ditched out of the meetings and had spaghetti and mizithra cheese (not available in SL) with the leadership of the Auxiliary at the Redlands Spaghetti Factory. We got a chance to tell them the story of our little hospital, and they were so touched that they gave us the $10,000 on the spot. Furthermore, they really wanted to money to go for a 4 WD vehicle. They were very specific on that.

Our staff with the new Nissan XTerra, thanks to the Women’s Auxiliary of Loma Linda University.

I let Fobbie and Koroma know the good news. They wasted no time and found a used Nissan XTerra in great condition, never driven in Africa, imported from Germany. It was 4WD, manual and diesel. An unbelievable combination. And they purchased it literally days before the accident.

We were taking Dr. Gaede, our board chairman, to the airport in the new Nissan and were able to stop by the hospital and police station. It was there that I got a first hand taste of how quickly things can get out of hand. Mr. Fobbie, Mr. Abu and I had walked over to the Emergency Clinic to try and check on the woman, but as we got to the entrance her family showed up, and recognized some of our ladies that had been in the accident. I am not sure what was said that acted as the spark, but suddenly I was in the middle of a major fight. The relatives were pushing and shoving and shouting, others were pushing back. Thank God that within seconds the police were there coming between the groups, getting people separated and kept the fight from escalating. I got out of there as quickly as I could. I kind of stand out if you know what I mean. And white skin is often a flashpoint when tempers are already thin.

Sanko was held for a couple of days, then had to report daily to the police office for a week or so until the police finished their investigation. The driver of the Okada never showed his face again. Neither did the owner of the motorbike. The Okada’s are usually owned by someone other than the driver, and if it was the driver’s fault the owner never comes to claim the bike, figuring he would be required to pay damages for the vehicle as well. I asked why they couldn’t track down the owner through the motorbikes registration. Ask a stupid question…I was told, yes that is possible, but you have to pay the police extra to do it. We have a saying for that TIA (This Is Africa). Eventually the police decided it was not Sanko’s fault and so he is not in trouble. The XTerra is working out great (I even drove it last Sabbath), and there was enough money left over from the Auxiliary donation to get the van fixed.

What about the injured woman? You will have to wait for the next blog.

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

TAASLA

Sometimes in life you make snap decisions that turn out great and sometimes not so great, sometimes even terrible. About 4 weeks ago I made one of those snap decisions. This time I believe it was the Holy Spirit who prompted me, because it turned out better than I could ever have hoped for, especially for an introvert like me who relies on Bekki to make the friends and contacts.

One Sabbath evening Pastor Daniel Sandy, our new Sierra Leone Mission President, came by the little guest room to chat with us. There were a couple items of business he was following up on, but mostly it was to talk about the hospital, the mission and the future of the SDA work in Sierra Leone. (Pastor Sandy is a vice-chairman of our hospital board.) In the course of the conversation he mentioned that he was going to Maryland the first weekend of August to attend a campmeeting of the local SDA Sierra Leone ex-pats living in that area.

When he said that, it was like someone flipped a switch in my brain. “I have to be there”, was the thought. Right on heels of that thought were the rational, how, why, who.

How are you getting there?

How are you paying for this?

Why are you going? You weren’t invited.

Who is going? Are you taking Bekki? Are you really going by your introverted self?

Just as quickly came the answers (in order).

By plane.

I don’t know and I don’t care.

I don’t know and I don’t care.

Me. No. Yes

So I hemmed and hawed with Pastor Sandy, wanting to make sure I would not be raining on his parade, asking if, well what would he think, would it be OK if I went with him. He looked at me for the longest time. I thought, “Great, he is trying to figure out a polite way of telling me to stay home.”

But instead he said that sure, I would be welcome. Wow, OK now I had kind of committed myself. But I gave myself an out. I told him I would have to run it by Donn Gaede our board chair and my administrative team here at the hospital. (Read: I am going to sleep on this and see if I still feel the same way in the morning, if not I will save face by having them tell me no. Smart, huh?)

But by morning the impression and desire to go was just as strong. I got the green light from Gaede, Fobbie and Koroma, and started looking at airline tickets. It was definitely a bit more than I wanted to spend, but I was committed now. Besides the conviction was growing that I needed to be there. To be honest, I really didn’t know why. I mean, beyond the dates I knew nothing about this “campmeeting”. I didn’t even have a speaking appointment.

More questions without answers:

Who would be there?

How many?

Would they resent my being there? You know the American white guy showing up uninvited, unannounced.

Would I be able to overcome my natural shyness and be able to smile and not look grumpy all the time?

And so on.

As the time got closer those questions got bigger, especially since I didn’t get a copy of the schedule until 5 days before I was scheduled to leave. When I looked at the schedule my heart sank a bit. I had thought Pastor Sandy was the featured speaker, being the SLM President and all, and I was hoping that since he knew me he would at least introduce me and give me 5 minutes or so to say something about AHS Waterloo. But he was on the program only Sabbath afternoon, doing a Marriage/Family breakout session. I consoled myself that at least one of his daughters would be there and I really wanted to meet one or both as the oldest Jewel is an ophthalmologist and the younger one Jenny, is a CRNA (Anesthetist). Hannah, his wife would be there and I knew her, and so I was looking forward to seeing her. And I would have a bit of time to spend with Ronnie and Kermit Netteburg, so there were good things. And lastly I had gone into this fully informed that it was a $2500 gamble, but one I felt convicted to take.

The Sabbath before we left was the Thanksgiving service I wrote about. It was during Pastor Sandy’s sermon that I began to get an idea of what I was in for. I found out the reason behind the long pause when I first suggested the idea that I would accompany him. He was not trying to figure out a way to say no, he was trying to get his head around the idea that I would be willing to go. I kind of blind-sided him, in a good way. I also found out who was putting on the campmeeting. TAASLA, The American Association of Sierra Leonean Adventists. There would be folks there from all over the US. And Pastor Sandy was excited I was going to join him. OK, so now I had to go. I was pumped. Until…

The devil is always there to throw curve balls isn’t he? Sunday I got an e-mail from Air France. Seems their Cabin Attendants (Stewards and Stewardesses) were on strike July 27 through August 2, and so a lot of international flights were being cancelled. If I wanted to re-book I could do it for free, or even cancel and bank the fare for use within a year.

I was scheduled to leave August 2, on a flight from Freetown to Paris. It seems like African flights are always the ones cut, you know the old thing, “no one cares about Africa.” Seriously if you have a choice of cutting a flight between JFK and Paris or Freetown and Paris, which do you think Air France will choose to cut. And it is not like there are flights out of Sierra Leone every few hours. Not even every day. By now the conviction that I needed to be there was overwhelming, and so we prayed. Bekki got her prayer warriors praying. In worship the next morning, Monday, James Abu led us in a special prayer that my flight would depart as scheduled. I went to the Air France office on Monday to talk with them. They assured me the flight was a go. Although that was better than, “No it is cancelled,” I was still nervous. We kept praying. Tuesday morning I finally got the e-mail that I could check in for my flight, I began to relax. God intervened and Air France cancelled lots of other flights but mine was on time. Praise the Lord.

With the Sandy Family, Pastor Daniel on the Left, then Jewel, Jenny and Hannah.

Pastor Sandy and I went to the airport together. We had two hours to talk and share visions and dreams that we had for Sierra Leone, and just to get to know each other better. The respect I already had for this man just exploded.

The trip across the pond was uneventful, I had a great time with Ronnie and Kermit, enjoyed an Olive Garden Salad, listened to the Marine Band on the Capital Steps, and made a needed trip to the General Conference to deal with some matters.

The weekend song leaders.

Thursday afternoon I drove up to Hagerstown to Highland View Academy. Registration was from 1-5 pm, I got there a few minutes after 5. No signs, in fact the place seemed deserted. I went to administration and they directed me to the Boys dorm. I went there. Someone was putting a sign up on the door. I went inside. No registration desk, no one in the lobby, but I heard voices down the hall. And there I found Mr and Mrs. Kamara talking with the boys dean. Now one advantage I had the whole weekend is that I kind of stood out, if you get my drift. And my AHS Waterloo Hospital shirt didn’t hurt either. Since it was obvious I didn’t work at the school, and was here for the campmeeting introductions were soon made. When Kamara found out who I was he wrapped me in the biggest bear hug and with tears in his voice welcomed me to campmeeting. That set the stage for the entire weekend.

Mr. Kamara, my first greeter

Jenny Sandy with Mr. Kamara and Jacob Conteh.

I don’t think I have ever been so completely and unconditionally adopted by any group of people like I was by TAASLA. I was immediately an honorary Sierra Leonean. Most of them had grown up in SL and had gone to school together. This was the first campmeeting they had had in 4 years, and they did indeed come from all parts of the country, even one family from Mexico. So it was a homecoming of sorts. Pastor and I were accorded all the time we needed to share about the gospel and health ministry that is happening at home. We emphasized the close relationship the SLM (Serra Leone Mission), AHS (Adventist Health System) and ADRA (Adventist Development and Relief Association) have in SL. We shared our vision for higher education, ie a university in SL, we shared our vision for the health work, and for the ultimate spread of the gospel.

Pastor Sesay, the new TAASLA President and our weekend chairman.

Greetings from TAASLA!

I got to spend time with the Sandy girls. Jewel, the ophthalmologist, shared with me her vision for starting an eye clinic at Waterloo, and even developing a residency program there. Jenny would love to come and spend time in our OR, helping and doing education. I received invitations to speak at their churches, and may even get a chance to speak at the academy this fall. It was a blessed, inspiring, Spirit filled weekend, that gave me memories I will cherish forever. I count it a privilege and honor to work in Sierra Leone, and to be able to connect with this dear group of ex-pats. Next campmeeting I will be there, and by God’s grace Bekki will be there with me.

Epilogue: Sabbath morning while I was at Campmeeting, Bekki and Erin exited our front gate to find this little gift.

Happy Day

Meet Happy Day, or HD for short. Here when someone says “Happy Sabbath”, the response is “Happy Day”. Since HD was found Sabbath morning, she was named Happy Day. She was extremely malnourished, exhausted and covered with sores. She ate well Sabbath, like a starving little pup, then threw it all up. For two days she barely ate or drank. We started forcing water with coconut milk down her with a syringe and after 36 hours of that she decided enough already and began to eat. She is still skin and bones, but now acts like a puppy, hopping, jumping, playing, barking at the intruder dog in the oven door, and eating like a pig, even getting a bit choosy. You will most likely hear more about our new addition, and her brother who is currently in Erin’s generator shed with his brother and sisters. He will join us when he is weaned. It starts, ominously.

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

Rainy Season

The rains have come. We thought it rained in Tillamook, and then we thought we knew rain in Tchad. NOOOO…it really rains here, and this is just the beginning. Little trickles of creeks are now gushing rivers, drains overflow, it pours, takes a breather then pours some more. It seems that everything floods, then finally the rain stops and all the water disappears. That is one nice feature, apparently they have the drainage part figured out.

They have a thing here they call 7-day. That is when it rains for 7 days straight, usually in August. I am not sure I am ready for that. Plus, we will soon be in our house, God willing, but then it means a quarter mile walk through the rain to the hospital instead of a 50 foot walk. We will see how that goes.

The road from our house to the hospital, basically it is now a river bed .

Flooding in Freetown.

Every thirteenth Sabbath, the last Sabbath of each quarter the churches in each district have a combined service. Everyone gathers at one church and there is a big celebration. Actually most of it is Sabbath School. That (Sabbath School) lasted until noon. Well 10 days ago we had our combined service at the Salem Church in Waterloo. Unfortunately, they don’t have real church building. They did take up an offering to purchase land for a church, but for now they meet, well, kind of under the second floor of a partially finished building? I am really not sure how to describe it. Anyway with the addition of the members from the other churches there was not enough room, so they put up a nice blue tarp cover on the ubiquitous wood poles to keep us out of the sun.

Dr. Koroma giving his health talk

It worked great, it kept the sun off of us all through Sabbath School and into church. Each church choir performed a special number or two and Dr. Koroma gave a nice health talk on the benefits of ginger. Shortly after the pastor got up to speak we heard a little tap-tap on the tarp. Eyes widened, ears lost interest in the message from the front, but then the tapping stopped and there was a collective sigh of relief. However, all too soon the tapping started again and this time rapidly increased in speed and volume. Anxious eyes scanned the tarp looking at the many holes in them and gaps where they didn’t quite meet. Soon enough we were in a bona fide deluge. Those directly under the holes began to move their chairs, and interest in the ongoing sermon was rapidly lost. It did not take long for the tarps to sag under the weight of the water and people started for the front, under the unfinished second story. It was about then that some of the poles started to give way and gallons of water poured down on the now vacant chairs. Needless to say the sermon, church, the combined service was over.

It was pandelerium as the tarps gave up their load of water.

As we drove home in the van through the latest deluge I for one was checking out the exits on the van, and planning my escape route should we be swept away by one of the many rivers of water cascading across our path (it did not deserve the name “road”). I also remembered the advice to never venture across moving water in a flood when you don’t know the depth. Advice that obviously had never been heard before in Sierra Leone. But by God’s grace we made it home without being swept away.

Some other random news for those of you not on facebook, half our checked luggage decided to spend an extra few days in Brussels thanks to a wild-cat baggage handlers strike at the Brussels Airport. Probably asking for combat pay. Fortunately, as you can see they finally made it home. This was a huge blessing as those two pieces contained parts of the new Ultrasound machine, and my new surgical headlight, as well as the new HB201 hemoglobin machine and test strips.

Our box and trunk!!!!!!

It has been so great to have that headlight to use. I can actually see what I am doing when operating. I can’t begin to tell you how much easier it makes surgery. Again a huge thank you to the donors who made it possible.

My headlight, lightweight, bright and comfortable. And a six hour battery.

It is the custom here to ask God’s blessing on and dedicate everything. We had a special dedicatory prayer for the new curtain in the school classroom/sanctuary we use for church. So we had a special prayer with laying on of hands for our new Hemoglobin machine. For those of you medical types, our lab guys would take a small pipette of blood, let it settle and then hold it up to a chart to get the hematocrit. Divide by 3 and bam you have the hemoglobin. I didn’t even bother looking up the reported accuracy of this method, this is simply not appropriate if you want to be taken seriously as a lab or hospital. So again, thanks to our donor support we were able to purchase the HB201 Point of Care Hemoglobin machine and some test strips.

Dedicating the HB201. I know, I know, I had my eyes open during prayer.

Our well got finished and the electric pump installed, and our own water tower at the house is full. Of course we are not moved in yet. Allegedly our container is out of customs, so maybe we will have it in a few days (or weeks, or months…). But it is a blessing for Dr. Koroma and his family who live next door to us, as the well provides them with water now, so they do not have to send the teenage boys all the way to the hospital and carry back 20 liters each of water every day. Another blessing from donors who paid for the digging of the well and for the pump.

Our well being dug

The completed well!!!

I know I have mentioned a lot of donors, and we so appreciate all of you. But a sad reality is that we serve very poor people, and 60% of them cannot pay the minimal fees we charge for being in the hospital, for their lab tests and for their medications. A hernia surgery with meds, anesthesia, pre-op lab and the surgery is $100 for example. We have made a commitment to treat people regardless of ability to pay, so when 60% of our patients cannot pay their bill, or can only pay a portion of it, it makes it difficult for us to have funds to pay our staff, pay for the fuel for the generator etc. Let alone pay for extra things like lab equipment, headlights or wells. So your donations allow us to function. Thank you and God bless.

To follow us between blog posts on Facebook type “Waterloo Adventist Hospital” in the search line, then “like” us when the page comes up. There are two Facebook pages, one is Waterloo Adventist Hospital, run by us. The other is Adventist Health System – Waterloo Hospital and is run by our administrator, Mr. Joseph Fobbie, also a great page to follow.

To follow us on Instagram look for us as “scottnbekki” or “Scott N Bekki Gardner”

To follow us on Twitter we are @ahswaterloo60 or Scott Gardner.

If you like our posts, pictures, or stories, please repost, retweet, share with your friends. We want the world to know about Sierra Leone, and the remarkable people who live and work at the Adventist Health System in that beautiful tropical country.

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. On the “Videos” page watch a real Ebola survivor, Dalton Kabia, 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

Annual Leave

Our time in the United States is just about over. On Tuesday, June 14 we head back to Sierra Leone to again take up our work there. To be frank it has not been much of a vacation in the usual sense of the word, as we have crisscrossed the country doing presentations, meeting with potential donors and volunteers and doing everything we can to tell the incredible story of the Adventist Health System in Sierra Leone.

OK, please give a proud dad a little slack. We came back for Lindsay’s graduation from Southern Adventist University.

Jon and Lindsay love their mom.

And God has blessed our efforts. Thanks to Adventist Health International (AHI), Brothers Brother Foundation, and Healey Foundation we have a new OR table, suction machines and cautery on a container headed to Freetown. Thanks to donors we have not one, but two operating headlights to use until we get the overhead lights repaired or replaced. We have leads on a refurbished affordable autoclave, we have two anesthesia providers who have committed to coming in the next 8 months to do teaching, and a chaplain who is coming this winter as well. We have hospitals, clinics, and churches who are considering partnering (read adopting) us. I just heard that one of the medical school classes at Loma Linda University is considering taking us on a project.

So it has been busy, but there is still much to be done, please pray that God will give us grace, wisdom and strength to meet the challenges that lie ahead.

So Lindsay, at the last minute, got me to teach her classes for her. She learned how to put on PPE, from Sierra Leone.

Bekki and I in our Africa duds with Lindsay in her PPE.

On our blog page we added a “Projects” page to keep you updated on the status of the various projects we are working on at the hospital. We also added a “How to Donate” page to give simple, clear instructions on how followers can help out financially. We updated the pictures, and are currently sharing a series of posts sharing the story of Ebola and health care in Sierra Leone.

Bekki and I have been convinced of the new reality that is life in the digital age, and the age of social media. So in addition to our blog we have a Facebook page for Waterloo Adventist Hospital, you can follow us on twitter, and Instagram.

To follow us on Facebook type “Waterloo Adventist Hospital” in the search line, then “like” us when the page comes up. There are two Facebook pages, one is Waterloo Adventist Hospital, run by us. The other is Adventist Health System – Waterloo Hospital and it is run by our administrator, Mr. Joseph Fobbie, it is also a great page to follow.

To follow us on Instagram look for us as “scottnbekki” or “Scott N Bekki Gardner”

To follow us on Twitter we are @ahswaterloo60 or Scott Gardner.

If you like our posts, pictures, or stories, please repost, retweet, share with your friends. We want the world to know about Sierra Leone, and the remarkable people who live and work at the Adventist Health System in that beautiful tropical country.

Bekki and I in the Smokies outside of Asheville, North Carolina with the McDowells. Mason is coming, YEA, to teach anesthesia.

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. On the “Videos” page watch a real Ebola survivor, Dalton Kabia, 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

THE GOOD, THE BAD, THE UGLY

Our first 2 weeks in Sierra Leone (derived from Portuguese for “Lioness Mountain”) are in the books, and as you can suspect it has been quite a time. Before we arrived we enjoyed three months of fantasy, dreaming of Sierra Leone as some type of “Fantasy Island” for those of you old enough to remember the old TV show. A country in West Africa with streets paved of gold with endless white sand beaches, where the missionaries enjoyed a little R&R sipping virgin daiquiris. We refused to listen to anyone who would try to wake us from our dream world, knowing that the awakening would come soon enough, April Fools day to be precise.

And so the vision was snapped at 3:45 am, April 1 as our Air Maroc 737 touched down in Lungi, Sierra Leone. We had spent the last 3 hours listening to certifiably crazy woman on the plane, one who clearly forgot to take her medications the day or days before, and spent the whole flight shouting things that really can’t be put in a family blog such as this. She even rated her own personal security guard as the Sierra Leonean authorities attempted to get her through the airport as quickly as possible.

Really the trip between Tchad and Sierra Leone could not have gone smoother or been better. We were able to see many of the people we love in Geneva and Collonges, and spend quality time with our closest friends. We had amazing dinners together, we went to museums together and just spent time talking in the living room. Grand Merci to all of you who made our time in Geneva and Collonges so special.

But back to Sierra Leone, this may come as a surprise, but it really isn’t the paradise we had fantasized about. Reality is that we are still in West Africa, which is in Africa, which is in a sinful world, so that should explain a lot. But I thought I would borrow from an old movie title and write what we have found to be the good, the bad, and the ugly.

The Good

The reception we have received from everyone here. All the staff are so happy to have us here, the mission president and mission staff, patients. Our welcome could not have been warmer. We have felt loved and accepted from the get go. And everyone has done all they could to make us as comfortable and happy as possible.
The roads. Wow, the main routes are all paved, and really well, very few pot holes, and although still two lane, they have shoulders, they are a full two lanes, they have barricades on the sides of cliffs, they have pullouts with concrete picnic tables overlooking scenic spots.

Bekki doing blood pressure checks at the Evangelistic Crusade just outside Waterloo.

The hospital physical plant. It is really nice, painted, all tiled, matching beds with mattresses and sheets, a mosquito net to each bed, a real scrub sink in the OR. There are real offices with computers, air conditioners and fans. My office has it’s own AC and a fan and a sink and a nice exam table with a curtain for privacy. It is pretty fancy and upscale for what I am used to.

The Food. The vegetable and fruit markets are full, with great produce. And this is the end of dry season, so it is the worst time of year to get veggies. They have peanuts, and although not on par with Tchadien peanuts they are still pretty good. But the cashews, oh my, they are everywhere, bags of roasted cashews that are so very good. There is also this bread, topaloppa, that is also available everywhere that tastes like the breadsticks in Bongor, only better. And popcorn is everywhere, both savory and sweet. Yesterday in Freetown we tried out several items from street vendors, sweet breads, popcorn, nuts. All good.

The Shopping. Just 25 minutes from us is a modern air conditioned supermarket that has just about everything we will need. Bekki was busy marking off item after item of “things I need to bring back from the US”. No need now because it is here. Freetown is only 75 minutes away and has pretty much anything we would need. And of course there is always the crazy, crowded, wild, dizzying, street markets.

Bekki and Erin Acosta heading into the chaos of the Waterloo vegetable market.

The Climate. It is hot season, so if you stand out in the full sun you will sweat. But there is often a gentle cool ocean breeze, even here in Waterloo. And it is very comfortable in the shade. Toward evening it cools down and is very pleasant outside. It reminds me very much of Hawaii.

The Beaches. Yea, you knew that was coming, especially those of you who are facebook friends. The beaches did not disappoint. They are only 20 minutes away, and are awesome. Clean, gorgeous sand with palm trees, and warm ocean water, waves to body surf on and pools to soak in. The terrain on the peninsula where we are is hilly, so very pleasant to look at, with green all around.

I could live here. Oh, wait, I do!

Current Housing. We are in a guest house with two small studio apartments. Erin Acosta a MPH student from Loma Linda University is in one, we are in another. It is small, but very functional and comfortable. It is air conditioned during the day, and cool enough at night to be comfortable. We have a stove and fridge, so I am able to enjoy Bekki’s home cooking. As good as Dina was, I still would take Bekki’s food any day of the week, except pizza day.

Front of our new house.

Future Housing. Too bad the movie wasn’t The Amazing, The Good, Bad and Ugly. The house they are preparing for us just may convince us to stay for a very long time. It is beautiful, big, with lots of windows, airy. I can’t wait to see how Bekki gets it fixed up. There are three bedrooms so lots of room for visitors (hint, hint).

The Bad.

The Roads. Once you get off the paved roads, oh my. Other than the width of the road, I have been on advanced dirt bike trails that were better than these. Sierra Leone is blessed with lots of rock, which is why their paved roads are so good and the dirt roads are…well they stink.

The Traffic in Freetown. It will be some time before I have the nerve to drive in the nightmare they call Freetown. There is nothing “free” about it. Traffic there is best described as one big traffic jam. Not even cities in India come anywhere close. It must be experienced to be believed and understood. The only good news is that no one is moving fast enough to have anything more serious than a fender bender.

The Electricity. Now that we have learned to deal with it, it could go into the “Not good, but not too bad” category (same with water, see below). State power (NP) is about like it was in Moundou, a few hours a week, and very sporadic, no schedule. The hospital has some big (150 KVA) generators, which they run during the day for about 6-7 hours. And during that time we have AC in the apartment, and really good power. In the evening Erin and we have to share a 5 KVA generator. At night we have no power outside our small goal zero battery. But we have learned to adapt and it is going OK.

The Water. So this is the end of dry season, which means the water table is at it’s lowest. We have a solar pump which is supposed to fill the water tanks during the day. But reality is we have water that trickles out every other day. Whether the solar pump is really too weak, or the water table is just too low, we will find out when the rains come. For now we have learned to conserve. Fortunately not too far away is another well with a hand pump, and I now have a key. So we have 20 gallons of water sitting in our bathroom in various containers. We are ready for Sabbath, it was just like picking up the manna for the Children of Israel, on Friday you get a double portion. As I was pumping the water out and hauling buckets I was thinking I could even have put water in the good section as I am finally getting some exercise.

Clothes. I have to wear them. Yep, my days of scrubs and flip-flops are over. They wear real clothes here, shirts, pants, shoes and socks. The first day on rounds, I was pretty under-dressed, kind of like your worst fashion nightmare. So now I dress appropriately. Fortunately it is cool enough here that it is bearable.

The Language. Yea they speak in English, but I understand African French as well as I understand their English. (European French is much easier to speak and understand.) They actually speak a combination of English and Krio, which is to English what Creole is to French in Haiti. So we will work on learning Krio, and already we are understanding the English here much better.

The theatre, or Operating Room, or Bloc Operatoire, pretty bare, lights don’t work, table doesn’t work, no suction, no cautery. But by God’s grace we do surgery anyway.

The Theatre. For those of you not familiar with British terms, you will learn, as Sierra Leone was a British Colony. The theatre is the OR, or Bloc in French. The theatre here is exactly what I expected, functional, but barely. They have 5 autoclaves, 2 are broken, 2 are 110 with no transformer, and they do all the sterilizing in one small dental desktop autoclave. Which means it is in constant use. The OR lights that work all need new bulbs, the suction is very weak, and there is no cautery. The instruments are all very old, worn out and used up. And yet they keep plugging away doing cases, mostly hernias and appendectomies, but still operating. It is going to take a lot of work and a lot of prayer.

The Ugly

I can’t come up with anything for this category. The people here are too beautiful, the scenery, the countryside, it is really a great place to live. Even after the devastation of the civil war, followed by Ebola they are so optimistic. And the leadership here thinks into the future, they have plans, they have dreams and they do what they can to fulfill them. They have an incredible faith in God and His power, even after all they have suffered.

Dr. Koroma and Mr. James Abu on rounds.

But we have our work cut out for us. As do you, dear readers, we need equipment, funds, and volunteers. As God opens doors and windows and opportunities we (the whole team here) are going to, by His grace, get this hospital fully functional and providing a full service for the people here in Waterloo, Sierra Leone.

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, and soon there will be a video of Waterloo. 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

Installation

I received some questions about the CPR course we were going to do, “Did it happen?” I am pleased to report that yes, Diana, Laure and Patricia were true to their word and did a quick 1 hour CPR course for our staff and students. It was of course very well received a lot of fun for all involved. On to the next post…

That is Laure doing chest compressions on Patricia, with Diana demonstrating the jaw thrust and airway management.

Now Laure is supervising Diana doing the Heimlich on Patricia, don’t know why Patricia was always the victim.

Ceremony is very important in Tchad, just like it is around the world. Holidays have traditions, ceremonies, parades, feasts. Here though instead of turkeys being slaughtered by the millions before a big event, it is goats and sheep. I will never forget driving by the market the day before a big Muslim holiday and seeing a goat or sheep (couldn’t see the tail) sitting up on the gas tank of a moto, with his front feet on the handlebars, wind blowing his ears, looking all around with the biggest grin you can imagine on his face. I could just imagine what he was saying to all his livestock buddies.

“Hey guys, guess who got asked to dinner, suckers!!”

But I digress, ceremony is very big here. And whenever there is a change in power or authority there is an official ceremony, the “Installation.” Pronounced the French way. And there have been a lot of them lately. Our Union committee, which oversees the work here just appointed three new officers for the Seventh-day Adventist work in Tchad. Well, it turns out he picked our Pastor, Dieudonne, from Moundou to be the new President. I think it was a very good choice. Dieudonne has a heart for evangelism. Only an evangelist would give the morning worship talk at the hospital on the seven trumpets of Revelation.

All the leaders of the churches and institutions in Tchad were of course invited to the high Sabbath in N’djamena for the big installation ceremony of the new officers. Unfortunately, I was invited as well, and since Dieudonne was our pastor here in Moundou, and since he was on our hospital board, and since he named his first born “Dr. Scott”, I really didn’t have much choice but to go.

I tried to get Bekki to come with me. I pointed out the long 8-9 hour drive over a road with potholes bigger than the car, sleeping on a lousy bed without our fans, attending a very long, hot crowded church service completely in French so she won’t get anything out of it. Then after another lousy night’s sleep, returning to Moundou the next day with another 8-9 hour ride over the same road. And since they use the entire road, without distinction to lanes, it really is the same road. That offer was opposed to staying in Moundou, where it is typically 5-10 degrees cooler, and have a girl’s weekend with the girl volunteers who were coming down from Bere. Despite my arguments she chose to stay in Moundou without me. That is what our marriage has come to after almost 34 years.

So I went by myself. She blew it, the temperature was relatively cool. I got to spend quality time with Olen Netteburg, who also was alone, and we sat on real plastic chairs instead of the backless wooden benches we have in Moundou. As I said, the change was a good thing in my opinion. It is a new opportunity for the church here in Tchad. The relations between missionaries and church administration have never been stronger. But the temptations for the new leaders are great, and they will need much prayer and support.

Tuesday evening, March 1, starting promptly at 4:00 pm (1600) we had our own installation ceremony here at CCAM. It was a very nice ceremony, with speeches by President Dieudonne, our administrator, David, and the administrator from the Hospital at Bere, who was there to represent Olen. The ceremony was to install a new Medical Director for the Center. Dr. Odei, a young Tchadien physician is taking my place as medical director here. We also installed Samedi, the nurse/surgeon, who has covered for me when I am absent the last two years, he will be the head nurse and surgeon for the Center.

For the month of March I will stay on a Director of the Center. The first of April, James Appel will resume his position as Director of the Center, although he will remain at his work in N’djamena and come down periodically to operate and direct the work here.

March 28, at 5 am (0500), Bekki and will be leaving Tchad and heading to Geneva, Switzerland where we will work on obtaining our visas for Sierra Leone. By God’s grace we will land in Freetown, Sierra Leone Friday morning April 1 at 4 am (0400) to begin our work at Waterloo Adventist Hospital as medical director and Surgeon of that facility.

In an interesting quirk of fate, last September at the AHI meetings in Abidjan, Ivory Coast, we met the leadership team from Waterloo. Bekki saw pictures of the hospital and the surroundings, and told them and me that she could be very happy there. They picked up on it and told us they had a place just waiting for us. It was all done in good fun, little knowing that in just a few short months we would be moving there for real.

The decision to leave Moundou and relocate to Sierra Leone has not been an easy one, and there are of course many reasons. Our decision was made after meeting with General Conference leadership in Washington, DC, and spending much time in prayer and reflection. We laid out the proverbial fleece, and received what we believe to be an irrefutable answer. Just as we were confident of God’s calling us to West Africa initially, we are equally confident that He is calling us to join the team in Waterloo.

As I told our team here in Moundou during my speech at the installation, this is the threshold of a new age for the Center, it is time for the Center to be led by Tchadiens, and for Tchadiens. They have been well trained, they have the tools, now they have the opportunity to run with it. Although CCAM, like every other health care institution in the world, has tremendous problems and challenges, if the staff here are faithful to their calling and purpose, if they hold firm to their belief in their God, if they rely on Him, if they follow His leading, all will be well.

We will miss our staff here terribly, we will worry about them, we will pray for them, but ultimately it is now up to them.

Dr. Odei, the new medical director giving his acceptance speech. David our administrator is behind and on the left, Masra the MC is on the right.

The Old and the New. Bekki and I on the left, Papa Samedi, our new head nurse and surgeon, Dr. Odei and family on the right, Rachelle, Abigail, and Baby Josephine (Jo-Jo).

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

Return

Dear Readers,

This will be a short post, just to let you know that we received the OK from the General Conference last week to return to our post in Moundou. We have tickets to start the journey back on Tuesday evening. We are scheduled to arrive in Moundou later this week.

While we are pleased to be able to return and continue our work at the surgical center, we are mindful that the dangers that prompted the US State Department to issue the advisory have not changed. Tchad is frankly a difficult and dangerous place to work. However, it is also a place that desperately needs our help, frankly it needs all the help it can get.

The forced exit made our mission, our work, and the need all the more clear to us. If we are not there, who will do the surgeries, mend the broken limbs, make sure the sound system is charged, do the physical therapy, distribute the books and Godpods, and do the myriad other things that Rebecca and I and our volunteers do on a daily basis. Our presence makes a difference.

We have always felt very strongly that God called us to serve in Africa, and we prayed earnestly that if it was in His time for us to leave Moundou that God would make it as clear to us, as He made it clear that we were to go there. We still feel called to our work in Moundou, and we also believe that despite the challenges and dangers there, there is no safer or better place to be than where you believe God wants you to be.

We cannot begin to thank all of you enough who have prayed for us, encouraged us and worried about us. It means more to us than you can ever know. We are hopeful that by the weekend we will be reunited with Diana who has spend the last month working in Togo, and that Nick will be able to return in early November.

For us it will be a short time in Moundou to assess the situation and get things going again, then we will be heading to France for the annual AMALF meetings and also for the speaking engagements we have there with our “French Connection”. We will then be in the US for Thanksgiving with our family before returning to Tchad the first of December.

We had the privilege of sharing at four different churches during our time as refugees and the message we tried to emphasize is that we are all, as Christians, called by Jesus to be missionaries for Him. Some are cross-cultural missionaries who travel to distant lands, most are missionaries to their neighborhoods, their towns or cities, but all are missionaries. And so as we head back we ask for your prayers for our safety, courage and success all according to the will of our Lord and Master. At the same time we will continue to pray for you in your mission endeavors in and around your homes. God be with each of you. Maranatha.

Will To Live, Part I

We are still stuck in the US, in Tennessee actually, as we await word from the General Conference as to whether they will let us return to Moundou or not. We had a window of 4 days without any appointments and so decided to make the most of it and headed to the Smokies for a few days of just the two of us. It has been really nice, small, private cabin in the woods, long walks in the
National Park, sleeping in…

Bekki in front of our cabin. (just kidding, actually an old cabin in the NP)

Shortly after arriving however, we headed out for a walk on the road leading to our cabin. Bekki headed out first and I was right behind her. However, as I was trying to get out the door she was rather hurriedly coming back in. It took a few seconds to realize the source of her haste. Just outside our front door, not 15 feet away were bear cubs raiding the garbage can, which is inexplicably not well contained. Momma bear was not far behind and as we found out was rather protective of her 3 cubs. They finally ambled off and we commenced our walk. I carried a big stick, and reassured Bekki that I was not worried, I did not have to outrun the bear, only had to outrun her.

Our little bear friends

So we returned to our cabin in fine shape. Now it must be told that our cabin is at the end of a 100 foot long lane, and who should be between us and the cabin. Yep, Momma and the three bears. We made rather quick acquaintance with our neighbors at the head of the lane. They kindly drove us the 100 feet to the cabin door after the bears once again ambled off. Bekki promptly moved the refrigerator in front of the door for the night.

I wrote the following (it is Part I of a 2 part series) in Abidjan. I am hopeful we can take a full box of supplies back with us when we return.

WILL TO LIVE PART I

As a physician I have always been amazed at how powerful our mind is. The control our mind has over our bodies is incredible. It is emphasized by the well known “Placebo Effect”, but is also demonstrated by our “will to live”. It is that inner desire to stay alive that allows some people to stay alive well beyond their normal physiologic capabilities. It is also the lack of said will to live that causes people to die we before their time, without direct suicide or euthanasia.

Shortly after arriving in Tchad, James Appel told me that if you tell a Tchadien he or she is going to die, they will die, just like you said, sooner rather than later. I once had an older man, probably in his sixties (really old here) who had hepatitis. He came in with fairly vague nondescript symptoms, some abdominal pain, fatigue, and jaundice. I checked his gallbladder, no stones, and reconfirmed the hepatitis. With the jaundice it seemed clear that his hepatitis was active. We treated his malaria and typhoid and he just didn’t get better. Finally after 2-3 weeks he was demanded an explanation. I first talked with his son who is a nurse, and then with him, surrounded by his family. I explained that his hepatitis was active and there was nothing I could do to reverse that and that most likely he was going to die from this. All I could do was treat the symptoms. I had in mind that he would slowly dwindle away over the next several weeks. His vital signs were strong and other than feeling weak, no particularly alarming symptoms.

That was about 5 in the afternoon in the Salle de Reveil. Shortly after I went home for supper. I had to come back about 7 pm, two hours later to get something from my office which is just off the Salle de Reveil. I noticed his bed was empty, so I assumed the nurses had transferred him back to the general ward. The next morning on rounds he wasn’t in the ward so I asked the nurse where he was.

“He died last night, Docteur” she said, “About 6 pm, an hour after you talked with him.”

I was stunned. I said he was going to die, but I didn’t mean right this minute. Needless to say I try to be careful what I tell people around here.

This summer I have witnessed an extraordinary will to live in two patients, and I would like to share their stories with you.

CLEMENCE

Clemence, as she improved and got stronger.

Clemence came to us just a couple days after we got back from furlough. She had had a cesarean section in December to remove a late term fetal mortality. An all too often occurrence here. Since then (it is now late June), Clemence just didn’t feel well. Vague abdominal pain, a little nausea, fevers, and loss of appetite, followed by significant weight loss. On exam she had a small opening on the left abdomen over a firm area that had a small amount of pus draining from it. The center of her c-section wound was also slightly open with a drop of pus on the skin.

I took her to surgery confident it was just a superficial post op infection we could get drained and cleaned up with minimal muss and fuss. She was very thin, but then so are most of our patients so I gave that little thought.
At surgery I found a superficial abscess cavity, but no explanation for it. After draining that, I looked at the wound, also expecting a superficial infection. I probed the wound with my finger, going deeper and deeper until finally I realized I was in her abdomen. OK, so it is not superficial, probably just an infection around the uterus. I opened up her abdomen big enough to get my hand in there and started feeling around. Actually it seemed pretty clean, not much infection to be found. But something was nagging at me, I couldn’t account for the swelling on the left side of her abdomen, it had not disappeared when I drained the abscess. So I kept working my hand over and over toward the left. Finally I found it, something that shouldn’t be there, so I pulled and tugged until a lap sponge came out. She had had this lap sponge in her abdomen for 6 months. No wonder she didn’t feel well. But as I looked at the sponge my stomach flip-flopped. It looked like stool (poop) on the sponge. Maybe it is just from old old infection, I vainly hoped, but as I explored further, it was clear there was more wrong than just a retained sponge.

I extended the incision again until I was able to see the problem. A good sized hole was in her left colon and the small intestine had tried to cover up the hole and so the two had grown together. I ended up having to remove parts of the large and small intestine and suture them back together. I checked for leaks before closing and then closed her up, hoping and praying she would heal the anastomoses. I knew I should put in a diverting ostomy, but ostomy care is so difficult here, I just dreaded that thought.

Clemence did well for about 8-10 days. One morning on rounds I took off her dressing to be greeted by pus from her incision. I didn’t even fiddle with it, she went straight to the OR where I found her small intestine anastomosis breaking down. I put a tube in it, in an attempt to create a controlled fistula. It didn’t work. Over the next three weeks there were several more operations as I did everything I could to avoid an ostomy.

During this time Clemence barely ate or drank. We kept her alive with IV fluids. She got thinner and thinner, until she was literally skin and bones. I left her abdomen open. Now it is not uncommon for me to leave the skin open, but I left her abdomen open so we could dress it and get the accumulating pus cleaned out. We usually gave her some sedation for the dressing changes, but she would still cry out during them. But never once did she try to fight us as we took her to the OR and started the dressing change. She just layed there and suffered day after day as we fought infection and nonhealing intestines. Every day when I came in I expected her bed to be empty. I just did not see how she could survive, or want to survive. I expected her to come down with malaria, but she never did. She would try to smile when I told her good morning on rounds. She refused to give up, and so we kept working with her, day after day.

Finally the day came when I ran out of options and I was forced to do a diverting ileostomy. It was a little over a month from her original operation. Up to this point the colon had not leaked, but now as I carefully inspected it, I found that the sutures were starting to deteriorate, and after a month there had been absolutely not one bit of healing at the tissue level. I re-did that anastomosis and made a makeshift loop ileostomy, wondering how I was ever going to close it.

Now as you are no doubt aware, an ostomy requires an appliance or bag to go over it to collect the product the body produces. One of the reasons I had put off the ostomy is that when I looked for the box of supplies I could not find them, anywhere. But the week before I did the ileostomy on Clemence the box of supplies showed up in my office. I had loaned them to another hospital in April and they finally returned them. I had totally forgotten about it, but God had not.

Any of you who have dealt with stomas, either your own, a family members or as a nurse, know that, especially with an ileostomy it is important to get and maintain a good seal around the stoma. Otherwise the bag leaks and the skin breaks down. It is always hard to achieve that, especially with someone really fat or someone really thin (read concentration camp emaciated). So we had every bit of difficulty I expected and over the last month have blown through our ostomy supplies. (Those of you who are into the gross pictures can find a picture of her wound and ostomy on the Surgical Pictures page.)

Diana told me when we were down to the last appliance. We don’t have a volunteer coming for two months. I didn’t have a clue what to do for this poor woman with the incredible will to live, who had proven that she deserves every possible chance.

Fortunately for Clemence I married an incredibly smart, resourceful, stubborn and pushy woman. The conversation went something like this.

“Scott, I just realized the team from AHI in California are going to meet us in Abidjan, Ivory Coast next week.”

“Yea, so what”

“Scott, they can bring ostomy supplies with them and we can bring them back to Tchad with us.”

“Rebecca,” I said in my usual patient, sunny, optimistic voice, “There is no cotton-picking way. First I am sure they are already full with things they need for the conference. Second they are no doubt already crazy busy trying to get last minute things done. They will not have the time to get supplies together, do not bother them.”

Now my wife has read Paul’s counsel to women on obeying their husbands, she just doesn’t very often buy into it.

As I write this I am sitting in our apartment in Abidjan next to a suitcase full of ostomy supplies brought over to the Global Health Conference by the team from Loma Linda. They busted their butts, along with everything else they had to do, to get supplies together for one little malnourished woman deep in the heart of Africa. A woman who just won’t give up.

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

MY BIRTHDAY

I hate my birthday. For one thing at my age it means I am a year older. It meant the same thing when I was younger, but then it was cool and great to be a year older. Now it just means, well I’m getting older. But really the biggest reason I have come to hate my birthday is that it is one of the two days of the year that will “Live in Infamy” in the American psyche. The other day is December 7. Now even those of you who don’t know me well can guess what my birthday is, yea, 9-11. September 11, now a national day of mourning. It is kind of hard to get worked up about your birthday when the entire country is remembering a horrid, dreadful, cowardly act of infamy.

So it was that nine days ago, on my birthday, I was not in a particularly good humor. Work that day didn’t help things much. The entire government was on strike, including the central pharmacy where we buy most of our medications, so we still were not able to restock on badly needed antibiotics. Then just the usual petty annoyances of trying to diagnose and treat patients without either proper diagnostics or medications. That and just the general misery that we are constantly surrounded by, the man with the necrotizing fasciitis (flesh-eating bacteria) on his neck and chest from his dental cavity, the old man in the coma, the patients without limbs and on and on. Most days I can push it aside and just get the work done, but that day it just kind of enveloped me.

When I started surgery it didn’t get better. I had a pediatric hernia to do, the surgery pack had no small delicate instruments in it, so I was trying to find and remove the hernia sac with adult sized forceps. The rest of the surgeries were more of the same, surgical packs with three pairs of needle drivers and no scissors, other packs with three pairs of scissors and no needle drivers. It seemed like the anesthesia didn’t work right on most of the cases, so there was a lot of moaning (both me and the patient), and movement during the operations. It really wasn’t significantly different than any other day, It is just that on this day the irritation was more acute.

And so it was that my thoughts turned sour, “God get me out of here.” Really how can I be expected to practice any kind of medicine, to do surgery, in this environment. I was surrounded by a lot of negative energy, much of which I was creating myself. The wishes of “Joyeux Anniversaire” (Happy Birthday), instead of brightening my mood only made it more dark. I made it through the day and that evening Bekki had planned a nice little birthday celebration. A couple of missionary friends came over and we had a nice dinner together followed by an evening of singing and fellowship as we welcomed the Sabbath together. I have to admit my spirits were lifted, my thoughts of wanting to quit and go home were washed away and when we went to bed that night all was well.

Sabbath morning September 12 our world was turned upside down. Top of the list of e-mails that had come in during the night was another travel advisory from the US State Department STEP program. Now we get these every 2-4 weeks, and they have not changed much in the last 2 years. In fact according to those in Tchad longer than us, they haven’t changed much in 10 years. This warning though started with, “It is recommended that all US citizens leave the country of Tchad as soon as is feasible.” What? Why? What happened? Bekki got on BBC and Al-Jezeera looking for news, nothing. I soon got a call from the missionaries in Bere, as we all were trying to make sense of what was going on and what we needed to do. Olen woke up John Thomas in the General Conference (GC) in Washington DC and the crisis management team there was activated. I went over to the hospital and talked with David my administrator, nothing, all was peaceful and quiet in Tchad.

At 9 am the five of us ex-pats met in our living room. We shared the e-mail with our volunteers. The only thing clear at that point was that Danny had to go home. I couldn’t take the responsibility of keeping a student missionary in Tchad with that kind of advisory. What was to happen to the rest of us was really up to the GC. In Bere they were going through the same process, with the same angst.

The e-mail from the State Department put us in a real pickle. It gave no reason for the sudden evacuation recommendation, and from what we could tell all was Tchad was internally peaceful. Did the State Department know something no one else knew? Was this our window of opportunity to leave (akin to the Chirstians in Jerusalem in AD 70)? If we waited till something did happen would it be too late? Decisions had to be made quickly without adequate information. Sometime early Sabbath afternoon we received word that the GC had decided to take us all out of Tchad.
The next 72 hours are a blur in my memory, a blur of e-mails going back and forth across the Atlantic, where are we going, when, how? The GC was making sure everyone was accounted for and taken of, we were trying to make sure everyone was taken care of as well. We packed, not knowing if or when we were coming back. So everything was sorted into the 200 pounds we could take with us on the plane and then the things that were boxed up to be shipped out later if we couldn’t go back, and finally everything else that would just be left. We got everything done with two hours to spare. The last box was taped shut and the last suitcase closed at 3 am Tuesday morning and we left the compound for the bus station at 5 am.

The rumors, this may be hard to believe, but rumors were everywhere and all over the map. The whole thing was an error and the State Department was going to issue a retraction. The State Department sticks by its recommendation and is not going to issue a retraction. This is all overkill, there is no good reason to leave. This is real, you need to get out now. The president of the country has cancer and is in a coma and dying. The president of the country has left the country. The president is in fine health and no problems.

Amidst all the confusion, all the rumors there was one thing that was crystal clear, on thing that was real, tangible. It was the tears, the looks of shock and horror when our staff found out we were being told we had to leave. I have never seen David so somber as when he realized the weight of the center would be on his shoulders alone. Not only that, the future of the center suddenly became uncertain. Solange came to our house to say good-bye to Diana, she thought Diana was the only one leaving. When she found out we all were leaving she covered her mouth turned and ran. She wouldn’t talk, wouldn’t even look at us. We were betraying them.

The Staff and Students at CCAM, Monday, September 14, 2015

Solange is in between Bekki and I.

Monday afternoon at 3:30 we had a staff meeting in our front yard. By then everyone knew we were leaving, but were not necessarily why. One advantage of all the rumors that were floating around is that I felt at liberty to choose the one I liked best and stick with it. Telling my staff that I had no idea if or when we were coming back, or what the future of the center looked like really did not seem like a good idea, so I went with the rumor that the recommendation was an error and that it would slowly be retracted over the next couple of weeks. Therefore I was able to confidently and with a clear conscience reassure our employees that we intended to be back in 3-4 weeks, and all would be good. It made what would otherwise have been a horrific staff meeting, into one that at least held out a ray of hope.

Bekki with Francis, the young man we are sending to the Adventist University in Cameroon.

Tuesday morning the five of us went to the bus station and had the least eventful trip to N’djamena we have had in months. We found a capitol city with no signs of disruption, no stress, it was quiet, calm and peaceful (at least as quiet, calm and peaceful as it ever is). Wednesday morning I woke up feeling like I had been hit by a truck, headache, and fever. Bekki immediately started me on anti-malarial medication. Thursday we flew out of Tchad. Friday afternoon Jon and Lindsay met us at the Chattanooga airport with an enormous group hug. It was hard to leave, it was good to be with our kids.

At this point our future is uncertain, despite my assurances to my staff. I am still an employee and to some degree have to do what my bosses tell me to do. Will the GC let us go back, if so, when? We don’t know.
But I do know one thing. Last Friday I was so frustrated and wanted to just go home. Sabbath God said, “OK, Scott, this is what you wanted, you have your ticket out, you can go home, in fact I am taking the choice away from you.” I had the next 72 hours to see the effect my leaving had on my staff. I had time to really think about all the people who wouldn’t be helped, who would continue to suffer, because we were gone, or even worse if the center closed. I had time to reflect on my petty selfishness and my perpetual pity parties. And I realized, I am not ready to leave, our work is not done here. Yea, OK I will go home for a bit. Lindsay’s birthday is tomorrow and so it will be nice to be with her to celebrate. But I don’t want to stay here. I want to go home.

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