PROJECTS 3

In April of last year we held a two day strategic planning meeting. We came out of it with a bold, and to many minds, ridiculous, vision and plan. I of course was one of those who thought, “It can’t be done,” at least not anytime soon. Well, I thought I would just let you know what has happened to that Strategic Plan and how God apparently views it. And all that I am going to tell you is His doing, not ours. This is Part 3 of a Three Part Series.

Chapel: Our mission is to demonstrate the healthcare ministry of Jesus. But Jesus did more than just heal people’s bodies, He healed their souls. In fact, that really is what it is all about. It is nice to help someone feel better for a time, but we all die eventually don’t we? So then what happens? If we have done nothing for their eternity, we have failed them. That is why we have put a strong emphasis on our spiritual ministries department, and that is why we have made construction of a chapel on the campus a high priority.

The AHS church plant currently meets in one of the school rooms across from the hospital. It works OK, but it is too far for staff on duty to attend services, and too far for families and patients to join us. Furthermore, the outpatient department where we hold our morning worship is packed each morning with just the staff. It was clear we need our own chapel, as part of the hospital complex.

The Chapel waiting for the roof, which will come after the Physio Building is done.

A site was chosen and a 40X48 foot chapel floor has been poured. We also have a 20X20 foot room attached to the chapel that will service as patient and staff library and conference room. Very soon, by the grace of God, the walls will begin to rise and hopefully by the end of 2017 we will be in our new chapel.

The AHS church members are working hard to furnish the new chapel. The first model pew has been constructed, and they currently have funds for another 15 pews. A new pulpit and desk have already been fabricated and are in use now. Much work remains, but soon there will be a house of prayer for all, that will be open any time during the day that people need a place for meditation and prayer.

Vehicles: O ye of little faith. How Jesus could have been saying that about me. A year ago when our strategic planning committee met we discussed the need for hospital vehicles. At the time we had a Toyota 12 passenger van which served us well, but we needed a 4WD vehicle, especially for our mobile clinics which reach village well off the main roads. But the committee did not stop there, oh no, they felt that as a hospital we needed an ambulance as well. I clearly remember thinking, “Where are we going to get a 4WD vehicle, let alone an ambulance too?”

In November, 2016 the women’s auxiliary from Loma Linda donated the money for the 4WD vehicle. It came at just the right time too, because not 2 weeks after we licensed that vehicle the van was involved in an accident that has knocked it out of commission for 4 months now. (Hopefully it is coming home the first week of April.) Our Nissan XTerra has been a little workhorse for us, taking our mobile clinic team to places no vehicle should go.

Blessing the new (to us) Nissan XTerra.

But the ambulance, where to get an ambulance? About the same time our friends from French speaking Europe, specifically AMALF which is the Adventist French speaking medical association found a Mitsubishi that, thanks to Remy Herschey from Geneva, was able to be retrofitted as an ambulance. It landed here in Salone the last week of March, so there you have it. Less than a year from the strategic planning and we have all the vehicles under our roof, so to speak.

Our Mitsubishi Ambulance,

Mobile Clinic/Community Outreach: Before Ebola AHS had an active mobile clinic program. They had a large ambulance that could serve as a small clinic, and the staff would take it on outreach missions. The ambulance had seen better days and was sold to a man who had plans for it, I guess. Really it was not in usable shape. But…we wanted to revive our mobile clinic program.

The elected head (Councilor) of a large area with many rural villages about 15 miles from here came to us, imploring us to come to his villages and do mobile clinics. If you could see the roads these people have to travel on you would understand how difficult it is to get to medical care unless it is in your village.

So, Mr. Abu, our Community Health Officer (CHO) and Erin Acosta, our Public Health volunteer, got to work and set up a mobile clinic program. It is quite a production with everything organized into tubs and boxes, complete with collapsible tables and chairs so all will fit in a vehicle. A pharmacy formulary was carefully chosen and then modified as we had needs and all the meds prepackaged in unit doses for easy and rapid dispensing. The mobile clinic goes out every week to a different site and usually sees around 30-40 patients, although some days as many as 120 have been seen. It should be noted though, that this is not a “screening clinic” as many mobile clinics are that see 200-300 patients in a few hours. This is a full clinic where we obtain demographic data, full vitals, consultation and dispensing of medications, dressings and injections as needed.

Mobile Clinic Team packed up and ready to go.

Early on it was clear that the population most in need of care was the children, it also became clear that the people in these small villages are desperately poor and are often faced with the choice of food or medications, and even $2 or $3 is too much. Thanks to a grant from Restore a Child we were able to develop a charity mobile children’s clinic. For 3000 leones ($0.40) each children are evaluated and treated and given a 1 kilogram bag of rice. Restore a Child underwrites the expenses with a grant (gift) for which we and the people in rural Sierra Leone are grateful. The program is wildly popular as now mothers and fathers can bring their sick children to the mobile clinic knowing that they will be able to get care.

Little one getting checked in

This year we expanded the mobile clinic to a more traditional screening clinic, for hypertension. Hypertension is a huge problem for Africa, and as the “silent killer” most people have no idea they have it. Once a week the mobile clinic team goes out (now in the ambulance) to one of the markets or some other well populated, busy place and sets up their free Blood Pressure Clinic. They will usually screen 140 to 180 people and find about 20 to 30 people with high BP, sometimes very high. The staff carry BP meds with them which is then dispensed for those willing to start treatment. Thanks to the generosity of some of our supporters we also have funds to assist those who need the medications but can’t afford them. The staff then do lifestyle teaching and encourage the folks to follow up, either at the hospital or at least at the next BP screening.

A little guy with his bag of rice on his head.

Remote Clinics: I have often repeated the story of my first day at Waterloo Hospital. Everywhere I saw ”AHS”, which I learned stood for “Adventist Health System”. I tried to find out where the other facilities were located, since “System” implies more than one hospital or clinic. I was told, with a smile, that there aren’t any, yet. But since 2000 when AHS was created, they have been praying, planning and hoping that someday they would be a system. And in fact, the vision statement of AHS gives us a clear mandate to provide care to all people in Sierra Leone, not just those around Waterloo.

It was not long after we arrived that the first call came in. The Adventist Church in Bo, in central SL, wanted to re-open their clinic. It had closed down during Ebola and they felt the time had come to try it again, this time under the AHS umbrella.

About that time we were approached by an NGO out of the UK, Home Leone, which is in the process of building a 380 unit village for inhabitants of the slums in Freetown. Part of the village plan is a clinic, and they wanted to know if AHS would manage it.

Then a couple of months later we received word that the Adventists in Kono District, better known as the site of the “Blood Diamonds” story, were asking if we would consider opening an AHS clinic in their town of Kimbadu, on the outskirts of Koidu.

Three potential new clinics was a bit overwhelming, but AHS had learned to keep moving as long as God seemed to be leading, and see where He would take us. We had no idea where we would get the money for the necessary capital expenditures in Bo and Kimbadu, but as we spread the news, the SDA elementary school in Simi Valley was touched by the story of Bo and took it on as their mission project. Then the Loma Linda University School of Medicine Class of 2019 adopted AHS as their class mission project, specifically raising money for the Kimbadu clinic. Finally, our relationship with Home Leone has continued to grow, as we are sharing resources to benefit both organizations in our mutual quest to help the people here.

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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Projects-Chapter 1

Last Sabbath, April 1, marked the one year anniversary for Bekki and I to be in Sierra Leone. The experience here has been very different than our experience in Tchad, but one thing hasn’t changed, God’s providence. As we reflect over all that God has done at the Adventist Health System in Sierra Leone we are humbled and privileged to be a small part of it. This is the first in a multi part series detailing how God has blessed in the last year.

The Strategic Plan Team from April, 2016

In April of last year we held a two day strategic planning meeting. We came out of it with a bold, and to many minds, ridiculous, vision and plan. And I of course was one of those who thought, “It can’t be done,” at least not anytime soon. Well, I thought I would just let you know what has happened to that Strategic Plan and how God apparently views it. As all that I am going to tell you is His doing, not ours.

Doing our SWOT (Strengths, Weakness, Opportunities, Threats) Analysis led by Master of Public Health, Erin Acosta

OR Upgrade

You may recall that when we arrived I found Dr. Koroma doing amazing operations under very adverse conditions. Inadequate light, no cautery, no suction, an OR table that was frozen in one position, an untrained anesthetist who did not know the most basic airway maneuvers, just to name a few. Oh yea, a super tiny table-top dental autoclave that barely worked, and four other autoclaves that did not work at all. The OR area was packed with outdated (I mean 25 years outdated) items, including suture, and other materials. The minor room was home to four nonworking typewriters, and most rooms were so full of junk it was difficult to open the door.

Our very empty and bleak OR.

After many sweaty hours we were able to get the usable material separated from the unusable, the good from the bad if you will. (And we got the typewriters cleared out.) AHI, Brothers Brother Foundation and Healey Foundation helped us get a new OR table (that works!!!), suction and cautery.

Remy with the autoclave he repaired for us.

Remy Hirschy from Geneva got one of the other autoclaves working for us. Then a grant from the Winifred Stevens Foundation came through allowing us to put in windows that blocked the dust from coming inside, do some badly needed repairs, and I just ordered a new full sized steam autoclave, made specifically for use in mission hospitals, and a generator that will allow us to do surgery after hours.

The moving crew with the new OR Table.

And, last, but not least, Emanuel Soffa completed his anesthesia training course and is now serving as our permanent anesthetist. To help round out his education, Dr. Tim Mercer, Anesthesiologist, LLUSOM Class of ’85 (a great class) came over with his wife Connie, who is a PACU nurse, and did more education with him and set up a PACU protocol for our nurses. We had another team of CRNA’s from Asheville, NC led by Mason McDowell, of Bere Hospital fame, come in March to continue that training and the training of our nursing staff.

Team Tarheel (from Ashville, North Carolina) working with Soffa on spinal technique.


Stores

Bekki was overwhelmed when she was given the monumental task of organizing and inventorying the stores, or warehouse. It is a 40 X 48 foot structure made of termite eaten studs and tarpaulin, it is stuffed with supplies. Again, some useful, much of it not useful. Much of it from Ebola days. We have enough Ebola PPE (personal protective equipment) to last for 20 years.

The state of the stores (central supply), before Bekki took over.

But, in her usual quiet, organized way she started the job. She got several young men who came to be known as Mrs. Scott’s guys to help her as they sorted, cleaned and discarded. Doug Abbot, a nurse from California, came to us for a year, and he has cheerfully taken on the role as her assistant (read taken over the job). He has taken over the inventory process, and does his best to make sure we don’t run out of supplies. Buford SDA Church near Atlanta Georgia helped us with funds to convert an unused area into a mini-warehouse that we climate controlled to preserve the material.

Now in her air conditioned office, Bekki is surrounded by neatly stacked and organized supplies.

So now we have some idea of what we have, and things that have been donated are being used before they outdate, or go bad. Our next goal is to take the three 40 foot containers we have and use them as the walls of a permanent 40X48 warehouse, part of which will be climate controlled. We can then return the current storage space to it’s intended purpose of labor and delivery.

Stay tuned for Part 2.

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

A Plea

Warning: The following blog post contains graphic pictures that may be disturbing to some, and is likely to cause tears, and is also an unashamed plea for money.

One of the things they taught us in medical school and residency was to be somewhat disimpassioned. Don’t get too caught up with your patients, don’t get too personal, don’t empathize too much. I know that sounds heartless, but to do our job effectively, especially in surgery, we can’t identify too closely with our patients. If we did we would never be able to do our job. If we thought too much about the suffering of our patients it could easily get overwhelming and one loses ones objectivity, and then judgment is sacrificed and finally good patient care. That is why we are not supposed to treat family and close friends. That, and because they ALWAYS have the worst complications.

Here in Tchad it would be really easy to get overwhelmed by the suffering we see around us everyday, all day. It isn’t that there isn’t suffering in the developed world, or really wild bizarre pathology, it’s just that it isn’t normal to see it every day, all day. For instance today I had a lady with a huge, I mean huge, breast cancer, the whole lateral aspect of her breast is one big fungating, ulcerated mass. There is no way to get flaps to cover the defect if it is removed, she has an abdominal mass as well, probably a metastasis, and of course lymph nodes under her arm as well. Her hemoglobin is four. I can not remove this mass with killing her because she will bleed to death on the table. Friday I did a upper leg amputation for a young man who, a month ago, was in an accident and broke the end of his thigh bone (femur). The end of the bone came out through the skin behind his knee, taking with it the nerves and major blood supply to his lower leg and foot. So he has foot drop now. He also had 2 inches of dried rotten femur sticking out of the back of his knee, and a small opening on the front of his leg that literally squirted a fountain of pus 2 inches high each time we moved his leg. Thankfully I was able to convince his father that the leg was not worth saving, so we did an amputation and left the leg open.

One evening last week the nurse comes to my door just as we were sitting down to dinner.

“Docteur, a patient is here with a dental abscess he has had for the last two weeks. He is in a lot of pain.”

“Ok, I will come after dinner.”

He had been sick for two weeks, how urgent could this be? So after a nice leisurely dinner I strolled over to the hospital. “OK, Rafine, where is the malade (read “patient”)?

“Oh, he died 5 minutes after I came to get you.”

HE DIED? What kind of dental abscess is that? Not one I want for sure. And this is just the last few days, pretty much every day has its own little surprise in store for me. Oh, I forgot about the guy with the hernia with quite literally half of his small intestine in his scrotum, been that way for a long time. And although this was the largest one so far, the hernias here are ginormous. I can’t imagine having that volleyball between my legs all the time. (For those pictures, visit the surgical pictures page, if you dare, followed by a deep guttural Vincent Price type laugh.)

But twice since I have been here I have been pushed to the edge. Two times I had to blink back the tears and try really hard not to think too much about what it is like for these patients. Both times were for little kids with Burkitt’s Lymphoma. I included pictures so you can share my pain and more importantly their pain. But I have to tell you, pictures do not come close to doing this disease justice. It is horrifically dreadful.

A little girl, horribly disfigured, she just cried and cried all day and night she was so miserable.

A little girl, horribly disfigured, she just cried and cried all day and night she was so miserable.

Burkitt’s Lymphoma is a type of lymphoma (cancer of the lymph system) that is endemic in high malaria areas. It manifests itself usually as a swelling in the face, and if untreated can cause gross malformation of the face and jaw and swelling around the eye. There can also be abdominal tumors. Usually these are in preschool age kids, little ones who can’t understand what is happening to them. They have a hard time eating and drinking because their jaws and mouth don’t work right. They can’t see out of one or both eyes, they constantly drool, they cry, the swelling is uncomfortable at best, painful at worst. They are sickening to look at, partly because of the grotesque deformity, and mostly because the suffering hits you right in the mouth.

I just treated this little guy for the first time this last week.  He too was just miserable.  He has a large abdominal mass and ascites as well, his chances at cure are not as good.

I just treated this little guy for the first time this last week. He too was just miserable. He has a large abdominal mass and ascites as well, his chances at cure are not as good.

But, and this is a big but, it is amazingly treatable, with single agent chemotherapy. Cyclophosphamide works wonders in these kids. It cures over half of them. They get a dose every three weeks until the tumor is clinically gone, then one final dose. The first kid I treated came back for his second dose. He looked normal. The next two, were the two worst ones I have seen. They haven’t come back yet, and they may not, they may not survive, or maybe their parents don’t have the money to pay for treatment, who knows. But it is their only hope, and only help.
Same little guy, side view.  The dark skin hides a lot of the deformity, but it is there.

Same little guy, side view. The dark skin hides a lot of the deformity, but it is there.

Now for big but number two. There is no cyclophosphamide in Tchad. In fact as far as I know, there are only two places in Tchad that kids can get treatment for Burkitts, Bere and Moundou, the two Adventist hospitals. And we have it only because we purchase it in the US and we or our volunteers bring it with us. The stuff, as you can imagine, is not cheap, over $100USD a gram. We usually treat the kids with between one and two grams depending on their weight. Since the medication is donated, we can’t charge for it, which is just as well since no one could afford it anyway.

I have one gram of cyclophosphamide left, Bekki is going to try to get more while she is in the US and bring it back with her. If your heart has been touched and you want to help financially please send your tax deductible contribution to The Clarkston SDA Church, PO Box 548, Asotin, WA 99402. Put on your check that it is for the Africa Mission Fund, for Burkitts Kids. And if you send me an e-mail, or a comment on the blog site that you have donated for a Burkitts Kid, I will do my best to send you a before and after picture of a kid you helped save. Thank you on behalf of all our Burkitts Kids.

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, where we initially were to be. Soon there will be a new video about 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, Jaime and Tammy Parker 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. For our Francophone friends there is a French translation of our blog that you can find at http://gardnersenafrique.wordpress.com.

We welcome volunteers.

-Scott Gardner