A CULTURAL AWAKENING

One day last month I realized I was homesick. Now I have been in West Africa for four years, you would think I would be over homesickness by now. But nonetheless I realized I really missed America. What made it even more bizarre is why. I missed Christmas. I missed the lights, the store displays, the music, the movies, the programs, the concerts and even the parties. This is the original Grinch talking here, just ask Bekki. It bugged her to no end as I would bah-humbug my way through the holidays, until the last week when suddenly I went all in.

Julian putting our up our 32 year old Christmas tree.

But Christmas, even though it is a national holiday, does not exist here, not really. I did see some lights on a partly constructed building coming back from the airport the week before Christmas, but that is it. We have done our best to overcome this deficit, we had the volunteers up and had a Christmas tree decorating party, I have tried to play Christmas music when I could get the electronics to work, we hung the stockings with care, even on the elephant’s trunk. But, alas, it is just not the same when you are all alone in your festive spirit.

Even the Elephant head has it’s own stocking.

The gang at the Christmas Tree Party, Bekki, Ian and Heather, Julian, Eric, JP, and Dr. Donn Gaede.

The Adventists here don’t do Christmas, I was told. The other Christians do, just not the Adventists. The Muslims are obviously not really into it either. But for us Adventists it means no Christmas carols at church, minimal if any decorations, and certainly no mention of it. (On the Sabbath before Christmas I did preach on the Magi, however.) It all added up to a homesick missionary longing for Bing Crosby and Danny Kaye, dreaming of a White Christmas.

Finding myself in a bit of a snit, I decided to find out why Adventists don’t celebrate Christmas. The answer was not what I expected. It is simply that we don’t know that Jesus was born on December 25 so why should we celebrate Christmas? I also heard that Christmas is too materialistic and commercialized as the other reason. But the main one is that Jesus was almost certainly not born on December 25.

As I pondered this I became more and more annoyed. First, I don’t like the logic. I will grant you Jesus was almost certainly not born on December 25, truth is we don’t know when. So, the logic here is, if we don’t know the date, let’s throw the whole thing out and ignore it. My logic says that since we don’t know the date, pick one, and December 25 happens to be very convenient because literally the whole world is celebrating and talking about the birth of our Savior. So what if you don’t like the commercialism, then don’t do the gift exchange thing, but what an evangelism opportunity. Everyone is at least thinking a little about Jesus, between eggnog and wrapping presents, so capitalize on it. Don’t just ignore it. Everyone already thinks we are practically Jews because we go to church on Saturday, this is not helping convince them we are Christians too.

That was my logic and my rather convincing argument, or so I thought. I tried it out on a few of my Sierra Leonean SDA friends. I didn’t get very far. They thought my logic was senseless. I thought their logic was senseless. We are still friends because we could agree to disagree.

To my credit, even though I was annoyed, I dropped it. When in Sierra Leone do as the Sierra Leoneans do, the Adventists at least, that’s my motto.

Two nights ago I was leaving the hospital to head home and a short, well dressed older man stopped me asking for Dr. Koroma. I told him Dr. Koroma was on leave until February, could I help him? We were in the back so he asked about the lab/pharmacy building. I explained what it was and then pointed out the chapel currently under construction, surreptitiously patting myself on the back as I am rather proud of our construction projects.

“The chapel is just for Seventh-day Adventists?” he asked.

“No, it is for all faiths, even Muslims”, was my reply.

He then proceeded to quote scripture to me, “Remember the seventh-day Sabbath of the Lord your God.” I was pretty impressed. This man was obviously well educated, or at least well read. I didn’t recognize him, so I asked if he was Christian. No, he is Muslim he told my quite proudly.

It was at this point that he dropped the bombshell.

“Why do Christians celebrate Christmas when they know that is not Jesus birthday?” he asked. Going on he pointed out that at least Muslims know Mohamed’s birthday.

I was ready, had my argument all primed and loaded.

“Well, since we don’t know the exact day He was born on, what difference does it make then which day we choose to celebrate His birth? The alternative is not celebrating His birth at all?”

Had him. There is just no beating that kind of logic.

Unless you are West African.

“If you don’t know the day, you should not celebrate any day.”

We spent the next five minutes going back and forth, basically repeating our arguments, but getting nowhere. He had me, I had him, but we were playing in two different worlds.

But, I had an ace in the hole, if you don’t mind my mixed metaphors.

“Seventh-day Adventists don’t celebrate Christmas,” I told him triumphantly.

“What? That’s not true.”

I looked over at Pa Cole who was sitting there quietly, probably loving every bit of this interchange.

“Tell him”, I said.

“It’s true, we don’t celebrate Christmas for that very reason.” Pa Cole backed me up.

The man’s entire demeanor changed. These were Christians he could understand, Christians he could relate to. None of this crazy American idea of just pulling any date out of thin air to celebrate the birth of your sect’s prophet.

And the crazy American understood. It’s their culture, it’s their logic, and it gives us one more part of the bridge between Christianity and Islam.

I am still homesick for Christmas, and the first Christmas I am back home I am going to go nuts, we are going to drive around and look at the lights, we are going to watch Christmas movies, go to hear the Messiah, go to school programs, attend every Christmas party we get invited to. I told Bekki I am getting a 25 foot tree.

But now I see that for this culture where the logic is different (not wrong, just different) and there is such a strong Muslim influence, the Adventists here have a valid point.

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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Is A Human Life Worth $200?

I happened to glance out my office window yesterday to the front parking lot of the hospital. I watched bemusedly as a yellow cab pulled in, the front seat passenger got out and opened the right rear passenger door. My curiosity was piqued as I watched him pull out a young man by his arms. As if out of nowhere a crowd appeared and several pitched in to help carry the patient up the steps into the hospital.

It didn’t look good, but it also didn’t look surgical, I hoped. We had just cancelled my one case for the day because the young lady had eaten breakfast so I was looking forward to being able to get caught up on paperwork and other administrative stuff. Not long after I ventured out of my office and ran into Mr. James Abu, our CHO (Community Health Officer, basically a nurse practitioner).

“Doctor”, he said with his usual sly smile, “Doctor, I just admitted a patient with a bowel obstruction I would like you to see.”

“OK, no problem.” This is my usual response whether it is a problem or not, always hoping the lilt in my voice would put a smile on my otherwise sour face (those of you who know me will understand).

I asked if this was the young man they had just brought in. Sure enough it was. So much for being nonsurgical.

We went to the mens ward and found a young man, Sahr, in his early twenties laying on his side facing the wall. He had little ulcers on his right leg. I found out he had fallen from a mango tree some years back and has been paralyzed since.

The history was three days of abdominal pain, nausea and vomiting. Indeed, he looked like a bowel obstruction, distended abdomen, tight, tympanic (sounded like a drum when I tapped), no evidence of an incarcerated hernia and no peritonitis.

Here, our only non-invasive diagnostic is an ultrasound done by a rank amateur (me), so the only real decision is does this patient need an operation and if so, when? Well, he needed an operation, and since the crew was there and anesthesia was present, now was good.

As I walked back to the OR, Mr. Abu stopped me and said, “Doctor, his family has not paid anything yet. What should we do, who will pay the 1.5 million leones ($200) for the surgery?”
My response was simple, “He needs surgery and he needs it now, we will worry about the money later.”

I am done with not treating someone with a life threatening or emergency condition simply because they cannot pay. We will get what payment we can from them later. But as a hospital it is our creed to treat everyone regardless of ability to pay. God will either make up the difference, which so far He has, or we will go under. But I am going home if I have to turn someone out because they don’t have money.

Back to the story. In the OR, I was explaining the necessity of being careful when opening the abdomen on cases like this to the surgical team. Because the abdominal wall is stretched thin and the dilated bowel will be just underneath it is easy to slice into the intestine. (Most teaching of this nature is from personal experience, this was no different). This time though, as I gently opened the peritoneum there was a rush of odorless air. It was followed by thick yellow fluid, 5 liters of it. The surgery people among you know exactly where I am going with this. No bowel obstruction, but instead a 1 centimeter (1/2 inch) hole in the duodenum, just below the stomach. Diagnosis, perforated ulcer.

As I repaired the hole and cleaned him up, I marveled at how far God had brought us in such a short time. A month ago I would never have dreamed we would be ready to do a case like this, but with our new suction and cautery and OR Table and the reorganization of the OR, we were ready. The case went well, and I am happy to say that today he looked as good as anyone can look with an NG tube hanging out their nose. He has a long way to go, and many bad things can happen, but so far a life has been saved by God’s grace.

Sahr the morning after surgery.

Sahr the morning after surgery.

After surgery I met with the family and explained what we found and what we had done. I also shared with them that Sahr was still very ill and needed lots of prayer, and that God is the One that would need to heal him.

In worship this morning Mr. Abu shared the “rest of the story”. In the days since he became ill the family had taken him to traditional healers and other clinics and hospitals. Sahr had been treated with herbs and other local remedies, which I can attest to as I suctioned out a number of pieces of leaves from his abdomen. The family had spent all its money before coming to AHS. They had only enough to pay the 30,000 leones ($5) for the consultation.

Sahr and his nurse.

Sahr and his nurse.

If we had insisted on some payment yesterday before treatment they likely would have put him back in the taxi and driven off, and he would be dead today, instead of being on the mend. And we would never have had the opportunity to point them to Jesus as the Source of healing.

Will Sahr fully recover? Remains to be seen.

Will the family pay? Probably something, although not likely the entire amount.

Will it hurt us financially? Maybe.

Is a human life worth $200? Definitely.

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

FROM NAMING CEREMONY TO MOBILE CLINICS

Mother and baby

Mother and baby

About 6 weeks ago the wife of our head nurse, Augustin Conteh, had a baby, a little girl to be exact. Since we don’t do OB, yet, she had the baby at a nearby health center. Apparently it was a bit rough, but, praise God, mom and baby came through in fine shape.

Here, moms go home as soon as possible after the delivery, but always without giving the new born a name. Maybe the custom has its roots in the high infant mortality, or maybe that is just the way it has always been done. Whatever the reason, the babies are nameless for 10-14 days until the naming ceremony.

Samuel Danqua giving the charge to the family and church to help bring up the child in the Lord.

Samuel Danqua giving the charge to the family and church to help bring up the child in the Lord.

The naming ceremony is a big, huge deal here. And so it was that on a Sunday afternoon we loaded up the hospital van and Fobbie’s car and headed the 18 miles to Augustin’s home for the above noted naming ceremony.
The home where this was held was out in one of the villages, fortunately not too far off the main road as once again we were offroading it and avoiding sinkholes (too big to be called pot holes) in what was left of the pavement to keep the vehicles from being swallowed whole. I kind of understood how Korah, Dathan, and Abiram felt (see Numbers 16), only we had a better outcome than they did. But I digress. We all gathered behind the house under a shelter from the rain and/or sun. Finally after much waiting mom and baby appeared. As is typical around the world baby was passed from woman to woman, finally stopping with Fatmata, one of our nurses who pretty much kept the baby to herself the rest of the program. It would soon be evident why.

With the announcement of each name guests would bring up an offering of money to give the baby or the mother.

With the announcement of each name guests would bring up an offering of money to give the baby or the mother.

The program consisted of prayers and talks by various dignitaries, much like an expanded child dedication service held in Adventist churches. Finally the big moment arrived, the unveiling of the name of the baby, or in this case, names. She was given 3 names, (4 if you include her last name, Conteh):

Sarah-named after the wife of Abraham and mother of nations

Millicent-named after our nurse who died in the Ebola plague

Fatmata-named after one of Conteh’s favorite nurses, and the one who kept the baby with her during the ceremony.

It is actually pretty cool, much thought is put into each name, and each name is special. Unlike “Scott” which really has no meaning to me, other than that is what I answer to. I really have no idea why my parents named me that. I think I asked once but obviously did not get a memorable answer. I think they just like it. Frankly that is why we named Jon and Lindsay, Jonathan and Lindsay, we liked the names. In Jonathan’s case so did half the other parents in our generation, a fact which he reminds us of every time he can.

After the ceremony we were all served refreshments, fried rice with chicken or fish, complete with soda. It was during this time that I was approached by a dignified looking man I would come to know as Ahmad Bangura. Turns out that Mr. Bangura is one of the counselors for the district. He has over 7 wards, each one containing thousands of villagers. He approached me with a request, “Would we please come to this ward, Mamamaw, and establish a mobile clinic?” He explained that the people in only one of his seven wards has access to health care, without having to travel a significant (for them) distance. He told me he had been constructing an administrative building that he felt would be useful for a clinic as well.

He took me to see the building. It looked nice. It was locked and the contractor had the key so we just looked through the windows. I told him I would take it back to the administrative team and the community outreach team at the hospital and get back to him. I have learned not to make promises until I find out the “rest of the story”. This sounded like one of those things with a hidden agenda.

Counselor Ahmad Bangura in front of the building to be used for our mobile clinic.

Counselor Ahmad Bangura in front of the building to be used for our mobile clinic.

On the way back to the hospital I discussed it with Mr. Fobbie, then ran it by James Abu, our director of community outreach, and the one who is in charge of the mobile clinic program. Turns out there really was no hidden agenda. He really wants us to come once a week and see his people. He won’t even charge us rent for using the building. He told me he has pleaded with the government for more health centers or clinics in his wards, but to no avail. They just don’t have the money, or the people to man (or woman) them. So he was told to go find his own source of health care. Thanks to the fact that Augustin Conteh lives there, and thanks to the fact that Mr. Bangura went to SDA schools he knew about our hospital, and so he approached us.

A couple of weeks later we went back for a formal meeting to discuss the possibility further. I expected a small meeting with Fobbie, Abu, me and Erin Acosta, our MPH who is helping establish the community outreach programs with a Bangura, and a couple of the village elders. We (Erin and Mr. Abu) worked furiously to establish a budget and figure how this mobile clinic thing would work without costing us money that we don’t have. The problem is of course we are going to villagers who need health care and medications, but they haven’t got much money to pay for these things.

The appointed day came. Mr. Bangura had called me three times that week to make sure we would be there, and on time. It turned out to be a real all-village meeting. The village leadership was there to be sure, but so were many of the villagers. We all gathered in the Palava Hut, which is exactly what it is for. The Palava huts are basically city hall for the villages. It is where the chief or counselor or village elders meet and discuss issues, they resolve disputes, and carry on the village business. Kind of reminds me of the story of Ruth when Boaz went to the gate of the city to meet with the elders to work things out with Ruth’s nearest kinsman.

The meeting started late of course, as everyone gathered, but it was very serious, there was an agenda, and protocol and everything followed in strict order, making sure that everyone had their opportunity to speak. The first item on the agenda was prayer. Now remember that this was not an AHS led meeting. We start every meeting with prayer, but we are a religious based organization, we are supposed to do that (and we believe in it). This was actually a government led meeting. What took me off guard even more is that there were two prayers. The first by a Muslim representative and the second by a Christian. So we had a Muslim and a Christian prayer. Now I have been told that Sierra Leone is very proud of the fact that the Muslims and Christians here co-exist side by side with no religious discrimination or acrimony. This was, to me, a confirmation of that fact. There was peaceful, happy acknowledgement of the beliefs and ceremonies of both religions, with no attempt to place one above the other. It was really a cool thing to witness.

The village meeting under the Palava Hut.

The village meeting under the Palava Hut.

The meeting went well, other than being long, and pretty much the message was the same, we need you to come have a clinic here, we will support it, and we need it yesterday. As many as possible (which is a surprisingly large number crammed into the new building to look at it and see how we could make it work for a clinic. Abu was happy with it, which is what counts, he is the one who has to run it.

So it looks like we have our first mobile clinic. All because of a discussion after a naming ceremony. There is another meeting with the local district health team, but that should just be a formality. There is no reason for them to nix the plan of their own counselor. We have a few details yet to work out as to inventory of supplies we need to take, and meds we will take and how the pricing structure will work, but the ground work for those is done, so it shouldn’t be too hard. Hopefully we can hold the first clinic by the end of August. And it is not too far off the road so hopefully the van will hold out until we can find the money to purchase a 4WD Pathfinder or 4Runner, God willing.

On the way to the airport (I am attending a Sierra Leone Campmeeting in Maryland this weekend) I spent a good two hours talking with Pastor Daniel Sandy, our new Mission President. He told me of a new SDA clinic in diamond country that would like to be under the AHS umbrella. Hmmm, didn’t know about this one, but that is what we are about, that is our Vision:

To transform the physical, social, spiritual and mental well-being of people in Sierra Leone through the Adventist Health System, as we accomplish our Mission, which is to demonstrate the healthcare ministry of Jesus Christ.

So bring it on, let’s get out of Waterloo, we have got a whole country to reach!!

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

A Different Kind of Church Service

Church yesterday was a bit different, it was let by the Vacation Bible School students. You see they had VBS this last week, so today was a celebration of that fact. Now most churches when the young people have led out in the church service and Sabbath School it has been the teens and young adults. Not here, they really take this, “a little child shall lead them” thing to heart.

The male quartet singing while the platform participants look on.

The male quartet singing while the platform participants look on.

The kids did it all, they led the song service, they made announcements and called for different ones to have prayer. They even had the mission story. Actually it was the first mission story I have seen here. I have to admit having a mission story in what I consider the mission field, after all I am a missionary here, caused me to pause and consider. It made me realize that no matter where you are, no matter who you are, you can always be a missionary, there is always somewhere else that is worse off than you are, someone else who is worse off than you. So yes it is good for there to be mission stories in the mission field.

Between Sabbath School and Church the kids did a play about a problem the church here is currently facing. It seems they have lost control of their secondary school. It happens because there are often not enough Adventist teachers for the school so they hire non-Adventist teachers. Now there are a lot of great non-Adventist Christian teachers, but the problem is that here in Sierra Leone the standard is to hold classes on Saturdays. The teachers are insisting on having school on Saturdays and insisting that all the students, including the Adventist students, attend classes. So they are in the middle of a power struggle. And you have to understand that the future of these young people depends on their finishing secondary school and getting a good mark on their final examinations. Those test results determine what kind of career they can pursue, what kind of school they can go to. Just shutting down the school won’t solve the problem as then the students will then be forced to go to the government schools and still have to go to school on Saturday. So please pray for this situation, it is a sticky wicket.

A VBS graduate getting his certificate

A VBS graduate getting his certificate

Back to church, the kids called for the offering and even had the sermon. And after church the kids all got their certificates and the audience got food and drink. Other than communion we had never been to a church service where they fed you tuna fish sandwiches and ginger tea. I found a way to return my sandwich without being obvious and insulting anyone. Bekki and Erin drank the ginger tea and paid for it. Apparently it is very strong and burns all the way down, then burns in the stomach for awhile after.

It was all in all a fun interesting Sabbath morning, and good experience for the kids.

The graduates showing off their certificates as parents snap pictures with cell phones.

The graduates showing off their certificates as parents snap pictures with cell phones.

Sabbath afternoon Bekki did her skype thing with the Junior Sabbath School class in Kansas City. She has been doing this for several months now, usually one Sabbath a month, so the kids have been able to see Tchad and now Sierra Leone. It has been pouring buckets so the connection was a challenge. She wanted to show them the choir that was practicing for next weeks Thanksgiving service. But the calls kept getting dropped. The choir was singing a praise song called “One More Time”, so Bekki kept praying and finally tried one more time. This time it worked and she was able to show the kids the choir practice. It truly has been a great experience for the juniors, and for us. If there are any others of you who have Sabbath School classes and would like to skype with us, please let us know. We would be happy to work with you.

First look inside our container.  Everything came through great.

First look inside our container. Everything came through great.

The living room became the recipient of the goods.

The living room became the recipient of the goods.

Last Sunday was a big day, we moved into our house! Hee-haw. It is great, roomy, cooler, and great sleeping in our own bed, with air-conditioning. Then on Thursday we got our first house guests. Our good friends, Suzi and Remy, from Geneva, came to spend a few days with us before flying back to Switzerland. They have been working up at our sister Adventist Hospital, Magbenteh Hospital in McKenni, and came to look us over so they can take a report back to AMALF (French Adventist Medical Association, of which we are members).
Moving day fatigue.

Moving day fatigue.

First meal in the new digs.  Notice the corn chips, America to Tchad to Sierra Leone.

First meal in the new digs. Notice the corn chips, America to Tchad to Sierra Leone.

Suzi working on translating the Dalton Ebola survivor video into French.

Suzi working on translating the Dalton Ebola survivor video into French.

I will never forget the first time we met Suzi and Remy at the AMALF meetings in Valence in 2013. Suzi came up and started talking to us like we had been friends for years, although we had never met before. Little did we know at that moment what a blessing and support they would be through these last few years. Their support and help continued yesterday as Remy, a mechanic extraordinaire, repaired one of our malfunctioning autoclaves and gave us invaluable advice regarding our generators and some vehicles we need to sell. It has been such a delight to spend some time with them. It makes us anticipate even more the AMALF Congress coming up in November when we will be able to share with the other members about what is happening here in Waterloo and spend time with them.
Remy with the autoclave that now works, thanks to his skill.

Remy with the autoclave that now works, thanks to his skill.

Suzi, Erin, Remy and us.

Suzi, Erin, Remy and us.

Blessing the new sign advertising our free BP clinic.

Blessing the new sign advertising our free BP clinic.

This last two weeks have been ones of blessing as we received word that our application for a grant with the Winifred Stevens Foundation had been accepted, we received a major donation from the Buford SDA church which has allowed us to rescue our supplies from the rain and make our outpatient department more usable. And certainly not least God laid a burden on the heart of a young man in Columbia who is coming to spend a year with us to help us with our materials management, inventory and our administration. He has not only his bachelors degree, but his masters as well. Wow, far more than we asked for, and now Erin has someone her own age, rather than just us old geezers. There were tears in my eyes when I read the letter from Teen at the GC telling me about him. God has been good to us and continues to lead us as we slowly move forward.
The river we cross getting to and from the gate to our house.

The river we cross getting to and from the gate to our house.

Bekki crossing the chasm getting to our gate.

Bekki crossing the chasm getting to our gate.


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

You Might Be In Tchad If…

As we bid our final farewells to Tchad I thought I would just put down on paper some of the unusual things we learned about our life there. It is mostly tongue in cheek and much of it is applicable to all of Africa, but Tchad has some unique things as well. Some will make sense only to medical providers, but many things everyone will understand. Hope you get a chuckle out of it. The next blog will be our first from Sierra Leone.

YOU MIGHT BE IN TCHAD IF…

You might be driving in Tchad if…

Left on red is legal, what am I saying? Anything on red is legal.

You realize there are no traffic laws, only traffic suggestions.

You have ever passed a moto who was passing a bicycle, who was passing another bicycle, on a 2 lane major highway.

The potholes are so big and numerous as to be considered sink holes anywhere else.

You have ever played “Spot the Pedestrian” with your front seat passengers as you careened down the highway in the dark at a
breath taking speed of 40 mph (60 kph).

You have to share the major super highway in the country, with buses, trucks, cars, as well as pedestrians, wheel barrows, ox carts, motos, cows, camels, donkeys, dogs, children and anything else that walks, crawls or rolls.

The speed bumps are big enough to catch air at any speed over 5 mph (8 kph)

You realize that everyone else believes that lights on vehicles at night, and reflector strips on people and carts are way overrated, and you are just being whiny when you complain that no one has them.

Driving is truly like being in your very own video game, but without do-overs.

You start every trip with a really really sincere prayer for God’s protection.

You might be a surgeon working in Tchad if…

You have ever used sterilized fishing line as suture.

You have ever used sterilized mosquito net as mesh for a hernia repair.

You routinely operate with bare feet in flip flops.

You consider it normal to operate on plastic cases with the orthopedic instruments, and orthopedic cases with the plastic instruments.

In the box of instruments sent to you from America you find an arterial clamp labeled, “Broken, send to Africa”.

In a container shipped to Africa in 2012 you find foley catheters manufactured in 1981.

You do all your CT Scans with a scalpel

You daily do cases you have no training for.

Your operative field moves more than a fishing boat in a typhoon.

You start every case knowing that something will break, be missing, or quit working during the operation, you just don’t know what combination of the above.

You think electrolytes are lighter than air flying machines that runs on electricity

You realize that lab tests are way overrated, just let the kidneys sort it all out.

You have a vague memory that potassium has something to do with the heart, I think.

The heart? Oh yea the muscle that pumps quinine to all the other organs.

In your dreams you hear the dwindling beep beep of the O2 monitor as someone is dying outside your office door.

Best practice is what gets you and your patients through the day alive.

You watch reruns of MASH, not for diversion, but for medical education, we are about 1952 medicine, right?

Your patient is sweating and clenching their fists, but not making a sound and not moving as you rinse out their broken leg without anesthesia or narcotics.

There is a good chance your patient really might be devil possessed or cursed.

You start every case with a really really sincere prayer for God’s guidance.

You might be in a hospital in Tchad if…

The skilled nursing facility is a mat on a concrete floor.

You are a woman in the men’s ward, or a man in the women’s ward.

You got the good bed because it doesn’t collapse when someone sits on it.

You got the good mattress because the mattress cover has a ratio of material to holes greater than 1.

A “private room” means you pay 7 times the normal rate for an 8X8 foot cell with no ventilation.

If you want to eat, you had better bring someone along to cook for you.

You realize there are many things here worse than death.

You start everyday really really praying to your God.

You might be a missionary in Tchad if…

You have your own personal set of malaria symptoms

You have had less control over your intestinal function than a 6 month old.

You get to see miracles, just like in the Bible, every day.

You get to meet and work with other missionaries from all faiths, who are the greatest and coolest examples of real Christians you could imagine.

You get to have your faith tried every day.

You get to learn patience, and each day as you fail, God takes you over it again (day 796, still haven’t got it down)

You get to live more than you have ever lived in your life.

You really really start every day with prayer, like your life depended on it.

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

UNCOMFORTABLE

Uncomfortable – adj. A state of mental or physical discomfort, ill at ease, distress.

Or it may be illustrated by being the only two white Americans on a bus full of Arab Muslims as they show the movie “Delta Force” with Chuck Norris.

For those of you who may not be familiar with this particular film. Arab Muslim Jihadists hijack an American plane and take it to Beirut. Ultimately the Jews are separated from everyone else and the men are all held hostage somewhere in Beirut.

The Delta Force, led by Chuck Norris and Lee Marvin of course come in and save the day, wasting untold numbers of Arabs. The climax of the movie is when the liberated plane with the hostages lands in Israel and is greeted with a crowd waving hundreds of US flags and singing “God Bless America”.

Uncomfortable – adj. A state of mental or physical discomfort, ill at ease, distress.

We kept a low profile, didn’t join in the singing or stand up and cheer

Jack and Nancy Snyder with granddaughter Alyssa, Diana, Bekki and I.  Jack and Nancy have been in Tchad almost 30 years and have been some of our mentors.

Jack and Nancy Snyder with granddaughter Alyssa, Diana, Bekki and I. Jack and Nancy have been in Tchad almost 30 years and have been some of our mentors.

As we close out our ministry here in Tchad we have had a wonderful weekend of fellowship with the dear friends we have made here in Moundou and in N’djamena. Missionaries who truly humble me with their dedication, their love of Jesus, and their willingness like the Apostle Paul to suffer whatever hardships they are called to in order to tell the world of Jesus. Missionaries from all different Christian denominations, who have truly blessed us and honored us with their friendship and ministry. We pray that we will find more brothers and sisters in Christ like them in Sierra Leone.
Bekki and Diana with the Moundou ladies Bible study group.  What an inspiration and blessing these women are.

Bekki and Diana with the Moundou ladies Bible study group. What an inspiration and blessing these women are.

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

Staff Meeting

This is along the theme of a couple of posts ago, things are different here. A good case in point is our last staff meeting. Not like any I have ever attended in the US.

We had our first staff meeting last week in the pediatric ward, which is serving right now as the salle de reunion (meeting room) and storage room. Unfortunately the electricity is not hooked up there so it is a bit dark inside, lit only by the ambient light. Which also means that David and I, who sit in front facing the staff and students are looking toward the open door with bright sunshine pouring in. It gives everything a surreal unearthly glow, and if someone happens to be standing in the doorway it looks like either an angel or alien, depending on your current point of view.

After prayer, I as medical director and chief honcho have the floor. Sometimes I attempt to do some teaching, sometimes I say nothing, sometimes just a bit of counsel. Today I had more important things on my mind, shoes. Yes, shoes.

It is a requirement to remove your outdoor shoes before entering the main building where the consultation rooms are, and the Salle de Reveil (ICU, ER, PACU), and OR are all located. This is not cultural, it is about the nurses not wanting sand tracked in on the tile floor and having to clean it more than every other day. So everyone removes their sandals (and maybe a couple of tie up shoes) outside the door leaving them outside before entering. Those of us who spend a lot of time in the building have “indoor” shoes that we wear. I keep my indoor shoes locked up in my office as they have a way of disappearing if I don’t.

Now, apparently in Tchad sandals are common property. The unwritten code is you can take anyone’s sandals as long as you return them. I don’t buy into this code. I don’t want to wear anyone else’s sandals and I don’t want anyone else wearing mine. And it is not a racial or hygiene thing. It is a practical thing. When I need to leave the building, I want my sandals where I left them, so I can leave my indoor shoes in my office.

One time someone took only one sandal. I was not happy, but had no idea who to blame, so I kept my cool and kept my eyes open. Sure enough the next day the wandering sandal reappeared. I have no idea where it had been, I really wished it could talk. So in the past I have even kept my outdoor shoes in my office as well to protect them, and I have made enough of a fuss that no one takes my shoes anymore.

One of the reasons my sandals are protected is I have the only Wal-mart specials on the compound. No one else has sandals like them. I tested this theory the other day, I wore different sandals to the office. Sure enough, within two hours they were gone, only to reappear an hour later. So I went back to my Wal-mart specials which are more comfortable anyway and obviously more secure.

That is until Wednesday. I went to leave the building. No sandals. I was not happy. Fortunately, where I was going wasn’t urgent so I could occupy my time doing something else while I waited for the sandals to come home. I didn’t have to wait long. Some hapless new stagiere (nursing student) had chosen the wrong sandals to slip on. So I firmly told him it was not cool to wear the doctor’s sandals, and don’t ever do it again.

We have a new crop of students, so I figured staff meeting was a good time to give them the sandal lecture. First I made sure everyone had their own sandals. They did. Then I clearly, kindly, and firmly explained that they should wear their own sandals and not someone elses, and if I caught any of them wearing my sandals (and in fairness I held up my sandal and showed them my unique brand), they would regret it. In my attempt at French, I could have told them that if they took my bra I would snap them with it, which would also be true, by the way.

Following this important notification, we had a lively discussion on the subject of a previous blog. Patients who want their blood to take home with them. The staff had no more ideas on how to deal with it than I do, and it is their culture. All they could come up with is, “That is just the way they think”, duh.

We then moved to a request from the night nurses for winter coats because it is too cold. Now in their defense, it is cold at night. We are even using 2 blankets (granted they are thin), and I often wear my fleece in the mornings. It gets down to 70 degrees (19 centigrade) by early morning, darn cold. I have even been wearing socks to the office some days. The problem is if we buy a coat for one we have to buy a coat for all, that is just how it is done here. So for now we are ignoring the request, figuring they can buy their own. I thought about just buying one coat that they could share, but if we had one big enough for the two female nurses, pour little Service, the only male night nurse, would drown in the thing, we would have to send in a search party to find him in it.

Our final discussion revolved around Felix one of our housekeepers. Felix is a cute little guy, small by Tchadien standards, and usually pretty quiet, but he was really worked up that morning. He doesn’t know much French so he talked in Ngambay. The students and staff were laughing at what he was saying, but he was serious as a heart attack. He probably went on for 10 minutes. The problem-well, you see for many Tchadiens the whole world is their toilet, and they just don’t see the utility or purpose of a concrete room to potty in. There is lots of great sand just outside the wards and along the walls. So despite all the signs and threats of fines, patients and family members pee and poop wherever they want to. This is much to Felix’s dismay because he is supposed to keep the place picked up and tidy, and well, this adds layers of unnecessary difficulty to his job. But when all was said and done, and we have gone around this barn before, “It is just the way they think”, and we ain’t changin’ it.

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