MABINTY

The RAC Mobile Clinic Team, Sanko, Paul, Kadiatu, Mr. Abu, and Shawn Hannah, KCMA PA Student

The Restore a Child Mobile Clinic team heads out from the Adventists Health System-Sierra Leone, Waterloo Hospital each Tuesday and Wednesday, taking medicines to children in villages with no access to health care. The following story is told in the words of James Abu, our beloved CHO (Community Health Officer) and head of our mobile clinic program.

Mr. James B. Abu, CHO, Director of the Mobile Clinic Program.

This child, Mabinty Kanu, age 3, was seen during one of our mobile clinic sessions in a village called Masentigie. According to the mother, the child had been having a fever on and off for one week, which became continuous over the last two days before we were there. In addition, she was coughing and vomiting after every meal. Her abdomen was distended and she was obviously seriously anemic. She was so helpless that she could not stand without support.

Mabinty Kanu, sitting on her mother’s lap with an IV hanging from a Mango Tree.

I asked the mother, “Why have you kept this child at home until now?”

The mother’s reply was, “I had no money to take her to the hospital. To get even what we eat is a problem. I have been giving her some native treatment, but it does not help.”

I asked about the father and she told me he ahs separated from her and does not even visit to know how Mabinty is doing.

Mabinty was quickly examined by another PA student from Kettering, Olivia Kwiatkowski, and given emergency treatment with IV fluids and antibiotics. A motorbike was hired and she was transported to the Adventist Health System—Waterloo Hospital, where Mabinty was admitted and laboratory investigation confirmed the severe malaria and anemia. Treatment that had begun in the field was continued and she was transfused with whole blood.

Mabinty on the road to recovery, sitting up on her hospital bed.

By God’s grace she responded well to treatment and 2 days later she was discharged to home with oral medication. The mother was so happy and was crying as they left, saying, “Thank you for saving my child’s life. I pray that God will continue to bless you.”

Ready to go home!! Praise God!!

We shall be making a follow-up visit on her after one week to see how she is doing. But she would not be alive today with the Restore a Child Mobile Clinic Program.

James B. Abu, Community Health Officer
Restore a Child Mobile Clinic Supervisor

Truly this child would not be alive today if it were not for the mobile clinic program. And the mobile clinic program only functions because of donations given through Restore a Child and our other faithful supporters. Thank you and God bless each of you.

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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Un Jour Férié (A Holiday)

Today we celebrated Tchad’s Independence. I was told there was a big festival downtown in Independence Square, but no fireworks. It was a three day weekend, which frankly doesn’t mean much unless you work for the government or a bank. Here it was a day just like any other except I told the OR crew to knock off early, they really worked hard last week.

But in the midst of all the death and suffering was one really bright spot, a miracle of life, a regeneration, almost a resurrection. Saturday afternoon a man about 30 years old was brought in, comatose, with decorticate posturing. He had been sick about 5 days and had worsened during the last 36 hours, and had been unresponsive for most of the last 24 hours.

I figured it most likely was cerebral malaria, a lethal complication. Indeed the parasite count in his blood was 15-20%, pretty high. So we started through all the motions, IV fluids because he was almost certainly dehydrated since he couldn’t drink or eat, catheter in his bladder, IV quinine for the malaria, IV glucose for the hypoglycemia that comes with malaria, broad spectrum antibiotics in case it was something else like a bacterial meningititis, and something for the fever. All pretty much futile, but you try to let the family know you are doing everything possible, which we were.

He was in the Salle de Reveille, our ICU and recovery room. He was in the bed right next to the door to my office. I was pretty impressed with the dedication of his family, they stayed right with him, fanning him to keep the flies off, keeping him covered, watching the IV to let us know when it was empty.

Sunday morning when I came in for worship I was surprised to see him still alive, albeit still comatose. All day I waited for the familiar wale from the female family members that signaled a death. I wrote for another day of IV medications, not wanting to write for more as I still didn’t expect him to live.

In the late morning I saw an handsome young 8 year old boy. He didn’t look so good either, distended abdomen, grunting respirations, sick for a week, but worse the last 48 hours. We got things going on him, IV fluids, blood tests for malaria and typhoid, empiric antibiotics and quinine. I was worried about his abdomen, but he was in no shape for surgery at this point so I figured I would check on him in a few hours after we got him hydrated and meds started.

About three hours later Abba the nurse came by the house and told me the boy had died. What? He was sick, but I didn’t think death was that imminent. Abba told me the boy had been talking with his father and Abba went to do something else and when he came back the boy was dead. I have seen that so many times here, they compensate to a point then fall off a cliff and are gone.

Abba called me back in later that evening to attend a moto accident, with several lacerations and a fractured femur. While I was sewing up lacerations another man came in with a stab wound to his back. I quickly looked him over, 3 inch laceration mid right upper back, straight down to lung, but no respiratory distress, lungs clear and equal and no air bubbles from the wound, not even much bleeding. After I numbed him up I found out why. As I explored the wound I found it tracked forward along his ribs, all subcutaneous. Whether he appreciates it or not, his angel saved his life.

As I was finishing up Abba asked me if my unconscious patient could eat. “What? He’s awake?” I went over to check on him, and sure enough, eyes open, talking, wanting something to drink. So I told Abba he could start with Bouille, the local rice gruel everyone eats for breakfast.

By this morning he was still awake, more hungry and able to start on pills instead of IV meds. I told the family it was a miracle of God. We had seen a dead man brought back to life. It was a blessing for me too, as the day progressed and I had to tell a young woman that the 7 month old fetus she was carrying was dead, as I faced horrible orthopedic infections, and as I faced administrative head-ache after administrative head-ache, I could revel in the thought of a life saved.

Our miracle patient in front of my office door, he is alive!!

Our miracle patient in front of my office door, he is alive!!

Tonight the compound is quiet, no barking because Samson the dog is gone. Bekki, Nick and Kelsey took him to another mission station tonight, the first stop on his journey to Abeche to be reunited with James and Sarah Appel. We will see how our security plan of razor wire, and nighttime rounds by the guards works for keeping out thieves and robbers.

Tomorrow we face the challenges of a new day, trying to get our container out of customs, trying to get a package picked up from DHL, disciplining one my nurses, possibly firing another, trying to figure out how I am going to get all four fractures I now have sitting in the wards needing surgery, fixed in a timely manner. I am slowly learning to keep my expectations low, stay calm, roll with the punches, and let things play out. However, it is a tricky balance between having low expectations so you don’t go insane and feel like you are constantly beating your head on a brick wall, and having them so low that anything goes, which isn’t good either. I hope that by the time I leave here I will have figured it out, although that might be too high an expectation.

Thanks for listening, thanks for reading, thanks for supporting and loving us. We know that everyone has challenges and difficulties they face everyday, ours are no worse than anyone else’s, just different. Twenty-one days from now we start the journey home for a badly needed break. In the meantime, eat a Taco Bell bean burrito for us, s’il vous plait.

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, 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

Happy Birthday America

So it is Friday evening, almost sunset, I am listening to the music from the Clarkston Church and I thought I would write about the week. Nothing fancy, just what has happened. Bekki is currently laying down, she just took an anti nausea pill in preparation for taking 4 malarone tablets. When I came home this evening she was exhausted, more than she should be, achey, feverish, and the final straw, chilling. Not “chillin”, “chilling”, as in shivering. There is typically only one reason to chill in Africa, malaria. Our lab is closed, so she is just going to start on treatment based on the symptoms. I reassured her the second time is not as bad as the first.

Lindsay is also asleep, wiped out. I like to think that after all the stress she has been under the last several months, she is now home and finally relaxing. We were happier than words can tell to pick her up at the airport. She made it through with everything, including the fritos, except the permethrin. TSA nixed that in Chattanooga. Those of you who have gone without consistent American food for months can understand the importance a bag of fritos can have. Real haystacks, with real fritos. Oh the taste sensations, especially with the Taco Bell sauce Matt Tresenriter and Ellen Shin brought.

We had a good time in N’djamena, actually mostly at night, because the mission we stayed at had air conditioning in the bedroom. So it was just like old times. Lindsay slept on a mattress on the floor at the foot of our bed in a mosquito net tent. That way we all could enjoy the glorious cool air. Amazing how well you sleep with air conditioning. We also had a great time visiting with one of our Adventist Lay leaders who is very influential in the government, in fact I believe he has sworn in the President of the country. Anyway, we had supper with him and his wife Wednesday. It was good getting to know him. He is building a guest house and dental clinic on his property.

The other good thing in N’djamena was the mango ice cream, eating at Ali Baba with Matt and Brandon Tresenriter before they flew off, and getting our passports back with our new one year courtesy visas. Yea, we are official! And we bought a frying pan and cloth in the market. Cloth for clothes, frying pan for making toast as our container is still sitting in Duoala eating up someones budget.

Besides that N’djamena was hot, crowded and hot. We tried to buy medications for the hospital at the Central Government Pharmacy. Of the eleven meds we asked for, they had two. One of the meds we asked for was tylenol. We were told it was in the warehouse, and they didn’t know when it would be available. We could have 100 mg tablets, but not the 500 mg. So apparently for the entire country people will have to take 5-10 tablets three times a day for pain. Yea right. I am not sure if the bureaucrat was telling the truth or just letting us know that he controlled us, he could decide what we could and could not have. Whatever, I came back empty handed.

Even though the bus ride was long, and not terribly comfortable, it was all worth it to have Lindsay with us now. That being said it was bittersweet as Brandon left, and next week Nick and Kelsey come to start their year with us, but Johnny leaves. We get so close to our volunteers and when they leave there is a big hole in our hearts. The only saving grace is the new volunteers that come to take their place.

This morning at worship there were big smiles and lots of “Bon arrivé” from the staff. It was good to be missed and good to be welcomed back. Although the staff miss Brandon, they were glad to meet Lindsay (Linley, because they cannot say Lindsay). They greeted me with another open tibia and fibula fracture, which Abel had carefully washed out already. There was a man with a huge (15 centimeters) fungating skin cancer on his heel, full of maggots, and another man who was now ready to have his hernia fixed. There was rounds to catch up on and three days of consults and echoes to do. But I am slowly learning not to panic, it all seems to work out. We got the hernia fixed, amputated the cancerous leg, and got plates on the broken tibia and fibula. During the last case it poured rain, and most of my consults went home to come back another day.

One last little story. Abel does the dental extractions for us here. He is the head of the OR and our head nurse. He is very competent, but at times a bit of a bull in the china shop. Anyway, he knows how to pull teeth, and I don’t have the time, so that is his job. Today he did a dental extraction, but apparently used some ketamine as well as local anesthesia. Between cases I heard lots of yelling and screaming coming from the dental room. I really did not want to go in there, for fear of what I would find, but eventually my curiosity got the better of me and I entered the room which was already full of nurses, and family. The patient was sitting up on the gurney and then he spied me. He started shouting again and pointing in my general direction. He was speaking Arabic, so I did not understand it, but I figured it was an invitation for me to leave, so two other nurses and I exited the room. Later in the OR Daniel and Appo told me what the trouble was. Indeed I was the cause. Apparently, he believed that during the dental extraction of his molars I would also extract his intelligence and his wisdom and take it back to America with me. I am still trying to find out who gave away the secret as to what makes America great.

Speaking of America being great, Happy Birthday America! Hope you all have a great fourth of July. I miss watching the fireworks on the Snake River from the boat.

OK, this really is the last story for now, but last Friday night we showed a video again. We wanted to do something different so borrowed a Jaime Jorge DVD from the Blands in Bere and showed that. It is nature scenes with him playing the accompanying music, very calm and peaceful, and no words so translates easily. We did notice that most of the scenes were from the Pacific Northwest, not bragging, just sayin’. Anyway there are two tracks each about 45 minutes. The first track ends with the US flag waving, a bald eagle flying, and Jaime plays the National Anthem and God Bless America. I didn’t want to be the ugly American so I played the other track which ends with the Holy City. About 5 minutes into it the computer started to act up, so I hit a few key buttons and got it settled down. What I didn’t know was that somehow I made it jump the tracks and we were now on track one, at least I didn’t know until the US flag starts waving and Jaime is playing the Star Spangled Banner. Bekki hissed, “Scott stop it, this is embarrassing.”

So I went over to the computer, not sure which was worse, to obviously stop it, or let it keep going. Well the computer decided for me. I could not get it to stop, I pushed every button on the key board, I double and triple clicked, I even ejected the DVD, it just kept playing. I swear the computer was possessed. Finally after it was all over, I just shut it down and then thankfully it started to rain, so show over. The Tchadiens seemed to like it anyway. With that I will go give Bekki her 4 malarone pills, then rub her back in a couple of hours while she throws up.

Love you all and God Bless America, even if we only won one game in the World Cup.

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

Life and Death II

At 12:49 this morning another Tchadien baby died. Probably another at 12:48 and 12:50, because Tchadien babies die all the time. But I don’t know about them, I do know about this one. It is the same old story, little tiny baby, a few months old, shows up at the hospital, high fever, grunting respirations, dehydrated, pale conjunctiva. I can’t count the number of times I have seen it since I have been here, malaria with pulmonary complications. Despite all that, the nurses are usually able to get an IV in, and get fluids, dextrose and quinine going. The baby is put on oxygen and over the course of a few hours or at most a day or two deteriorates and finally dies. I think I have seen one baby leave the hospital alive after coming in with those symptoms and being treated like that. But that is all we have, it is all we can do.

Usually I am on the periphery, there really is not much for me to do, it is mostly nursing care, and not even much of that once the IV is in, the oxygen is on and the meds are given. Tonight was different. Around midnight I heard Brandon call out for me. He is in the room at the end of the house and it seems the nurses have decided the best thing is to get him up, and have him call me. So Brandon told me that the nurses needed the keys to get the oxygen concentrator because another baby with fever and respiratory difficulties had arrived. I gave Larpur, the nurse, the keys and went back to bed, waiting. Sure enough 15 minutes later, “Doctor Scott, the nurses need you to come put in a central line.”

My first reaction was, ugh. I was pretty sure what I would find, and I was not disappointed. She was a little tiny baby girl, perfect, cute as can be with an oxygen mask on her delicate little face. She had the usual grunting respirations, her oxygen saturation was 90%, which is not bad, but soon started to fall, 80% then 70%, back to 75%, but steadily down, down, down. Brandon was right, the nurses wanted a central line so they could start fluids and quinine and dextrose (these kids are all hypoglycemic due to the malaria).

I had a dilemma, it was clear this little girl was going to die, and very soon, and an IV with fluids, quinine and dextrose was not going to save her. Her problem was her lungs, and I am not going to start intubating these kids, just not even going to go there. The last thing I wanted to do was to start poking her with a sharp needle, and making her last few minutes even worse. On the other hand my nurses are pulling out all the stops to save this little baby, and now was not the time for a discussion on the ethics of when it is time to stop treatment (read torture) and let someone die peacefully. Besides my French is not good enough to allow for that kind of discussion. So, right or wrong, I decided I had to let my nurses know I cared enough to help them try. Unfortunately, we have these little pediatric central line kits, and I knew where one was. So I used a little lidocaine and spend the next 15 minutes trying to get a femoral line in. All the while the grunting respirations worsen, the oxygen saturation drops to 60 then 50 then 40%, and finally the pulse ox quits working. But she is still breathing, and the nurses continue to look everywhere for a vein. I can hardly get more than a drop of blood from her groin, so I try for the internal jugular a couple of times, feeling guilty the whole time. What am I doing? We need to just let this poor little baby go. Finally, I felt like we had done enough and I told them to call the family, she is going to die, soon. So the grandma came in and was too upset to stay. I tried to get her to hold the little one, but either the message never got through or it is just not done that way in Tchad. It was time for Johnny, Brandon and I to go back to bed.

Usually as we walk back to the house after working together we talk about what happened and I try to do some teaching. Tonight I was too upset, and too conflicted. I had just tortured this little baby, and why? To show my nurses that I cared? How crazy is that? At the house I filled a water bottle and thought about what we could do different, what is the right way to care for these kids. All I could think of was the fact that when I left she was alone, putting all her energy into breathing, probably not really conscious, but still alone. And then I thought about Jon and Lindsay, how would I want them treated if they were babies again and were dying. And so I decided I was going back, that this baby was not going to die alone, not without a human touch, at least I could do that.

Back at the hospital I found that the baby was not alone, well sort of not alone, 2 nurses, 3 nursing students, and a grandma were all in the room. But no one was touching the baby. The nurses were still trying to figure out how to get quinine in her, Larpur was drawing some up in a syringe. I guess she was going to give it IM since there still was no IV. So I went over and laid my hand on her chest and abdomen and tried to gently stroke her. I tried to let her know that another human cared, I didn’t want her to die without feeling some kind of touch. It was probably just a couple of minutes and she breathed her last breath and was gone.

I don’t know for sure why I am even writing about this. It is not to diss my nurses, they really put their hearts into trying to save her. It is not because I did anything special, in fact most people probably would have stayed with her and not gone back to the house to begin with. And people die all the time, even in the first world. Most of you have been with someone when they died, so my story is not unique to Africa or Tchad or Moundou. I guess I am writing about it because it was a very unique experience for me, because it touched something inside me that doesn’t get touched very often. Even though I have had lots of patients die through the years, very rarely have I been with them as they breathed their last breath. And whenever I have been there it is always a very moving experience. But even deeper than that, tonight I put aside the doctor and became a human. I let myself feel something, it was good, a little painful, a little scary, but good. She wasn’t just another patient, she was a dark skinned Lindsay, or a dark skinned Jonathan, and I felt the grandmother’s pain. In a couple of hours I have to get up and catch the bus to N’djamena to meet Bekki, who is flying home as I write this. If I could I think I would cry myself to sleep tonight, but since I don’t cry, that probably won’t happen. I guess a virtual tribute to all who have ever lost someone they loved, which is all of us, will have to do. That and a prayer adapted from John the Revelator, “Even so, come quickly Lord Jesus, and put an end to all this sin and death, amen.”

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