Autoclave

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

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

Bekki showing just how big this sucker is.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For those of you who are new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

KABIA – PART II

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

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

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

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

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

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

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

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

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

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

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

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

For those of you who are new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

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

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

THE ACCIDENT

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

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

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

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

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

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

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

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

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

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

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

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

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

For those of you who are new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

Eid al-Adha

For those of you who may have missed it, last Monday, September 12 was one of two main Islamic holidays, Eid al-Adha, or Feast of the Sacrifice. You guessed it, it commemorates the willingness of Ibrahim to sacrifice his first born son Ishmael. It also marks the end of the annual Hajj to Mecca.

We live in a predominantly Muslim country (60%), so as soon as the Supreme Court in Saudi Arabia set the date officially as September 12, it became a national holiday. So Mobile Clinic was cancelled, but things were pretty much as usual at the hospital. A hospital, like Las Vegas, never sleeps you know, or takes vacation.

That being said it was pretty much an uneventful quiet day until about 4:30 in the afternoon. Mr. Fobbie came to my office as I was starting to pack things up to go home.

“Mr. Abu is going to Mamamah to attend to Mr. Augustine Conteh”, he told me.

“Oh, why is that? What happened?”

“He was on his way home and was in an accident.”

“Is it serious?”

“I think so, they took him to his house.”

I am a surgeon after all, and so I thought I should go along and check it out for myself, plus I figured it would be a morale booster for Mr. Conteh, who is our head nurse.

Mr. Abu and I quickly got together a few supplies, not having a clue what we would find. Afterwards I realized we left the BP cuff and IV supplies behind. Next time we will try to have an emergency kit prepared.

Pa Sanko, our intrepid driver, the man who has no fear, holding Augustine's older girl, Rachel.

Pa Sanko, our intrepid driver, the man who has no fear, holding Augustine’s older girl, Rachel.

We hopped in the van with Pa Sanko and Mr. Abu had prayer. We desperately needed that prayer. I have spent many hours in the van with Pa Sanko at the wheel. He is a pretty aggressive driver. This time it was the Indy 500 and we were making up for too much time lost in the pits. I buckled in tight, and tried to concentrate on my solitaire game and not count the times we passed one or two cars going our direction while being passed by cars going in the opposite direction. These guys have incredible depth perception, they miss each other by millimeters, or sometimes not.
The vambulance

The vambulance

20 minutes later (of the usual 30 minute trip) we pulled into Augustine’s front yard. Abu and I hopped out and followed the sounds of wailing to the little carport behind the house, where they had held the naming ceremony for Augustine’s baby girl, Sarah.

Mr. Conteh was laid out on the cement on a pink lacy sheet. He was surrounded by probably 50 friends and relatives, many of whom were wailing and wringing their hands. One woman was standing over him pointing to a mass protruding from his bare abdomen. At first I thought he was dead, but then I noticed he was breathing. We did a quick primary survey and found nothing imminently life threatening, other than all the noise and commotion. His pulse was full and strong and didn’t feel too fast. I breathed a sigh of relief as we began the secondary survey.
The mass in his abdomen turned out to be an old hernia, apparently this woman had not seen him before without his shirt, so she thought it was new. He was able to talk fairly normally and answer questions. They said his left leg was broken and it had a traditional splint in place. Abdomen was soft and non tender, chest was normal. Glasgow Coma Scale was 15.

OK, this is good. I really didn’t want my head nurse dying on me in front of all these people, actually I didn’t want him dying on me at all. But I did want him back at the hospital where we could watch him in case something did show up.

I suggested we get him moved to the van, so 5 guys got on the right side of the sheet leaving me and one other skinny Sierra Leonean for the left side. I had visions of this not going well, but it was still better than the Tchadien method of transport; 4 men, each one holding a different limb with the head flopping around loose. We got him in the van without incident and tried to reassure the weeping crowd that he was going to be alright. Unfortunately, it is a van, so he had to sit semi-upright on the seat so we could fit all of him inside.

As we headed out I told Sankoh that Augustine was OK and we could go a little slower. I have always been opposed to accidents involving rescue vehicles, especially if I am inside.

I was now able to talk with Augustine and find out what had happened. He had been on his moto and was turning left onto the road going to Mamamah and failed to see the other motorcycle trying to pass him on his left (very common practice). So the left side of his body took all the force.

As we drove along I reflected on all the people weeping and wailing as they gathered around Augustine as he lay there. I realized that they had seen this before and knew that he was badly injured and for all they knew he was going to die. Augustine is the one who has the good job, so he supports a large part of the family. Their future lay on that sheet. What would happen to them if he died, or was no longer able to work? So it was truly a cry of frightened desperate people who had no control over the situation or the future.

When we got to Waterloo his brother-in law, who had come with us, said he was hungry so we stopped at a favorite cafe and picked up some food. At that point Augustine still looked pretty good, but then he commented that he was tired. I was really hoping that it was all the excitement and the broken leg talking…

At the hospital he was loaded up on a gurney and quickly moved to the private room that had already been prepared for him. I found out later that while we were gone the whole staff had gathered together and prayed for Augustine and for our safety as well. God answers prayer is all I can say.

As we moved Augustine onto the bed I noticed his skin, previously dry and warm was now cool and clammy. Oh boy, direct left side hit, hard enough to break a leg. Hard enough to break a spleen, too? His pulse, once full, regular and slow was now fast and thready. While the staff got things together for starting an IV I got my ultrasound to do a quick scan of his abdomen. I really am not very experienced at these, and frankly not very good, but by God’s grace I quickly found his spleen and it looked pretty good. I didn’t like the black at the end of it though. I looked in the pelvis, a little black around the outside of the bladder. Then I looked at the left abdomen, black in the gutter, and I could see the bowels floating in a black sea. Black on normal mode ultrasound is liquid. In this case blood. Great.

My head nurse has a ruptured spleen. I have no night time OR, yet. I hope and pray he is not one of the few that don’t stop bleeding on their own. Mr. Abu got two IV’s going. I noted that we would need to be talking about the concept of “LARGE” bore IV’s for trauma. But the 22 gauges worked. 500 cc of fluid later he started to look around again and he quit sweating. After a liter he was talking normally and his skin started to warm up. Adequate blood pressure for brain perfusion has always been a favorite of mine.

Augustine feeling much better.

Augustine feeling much better.

I examined his leg and decided he just had a broken fibula, the little bone on the outside of the leg. The main bone, the tibia, was fine. I put a splint on it and then had prayer with him and told him I would be back in a couple hours to check on him.

At home I filled Bekki in and confessed my worries about what I was going to do if he didn’t stop bleeding like the book said he was supposed to. Patients have a nasty habit of not reading the books before coming into the hospital. We are not really set up yet to do surgery outside of regular hours. We are working on it, but it will take some time yet. So she called on her prayer team through e-mail and face book.

About 9:00 pm we went down the hospital and checked in on him. He looked pretty good, awake, alert, pulse good, abdomen soft, no pain except in the leg. I gave the nurses their final instructions and told them to call if he got sweaty again.

I have to confess I did not sleep well that night, waiting for my phone to ring. Praise God my phone stayed silent all night. I hurried down to the hospital early so I could check on him before worship, and was greatly relieved to see him holding court in his room very awake and alert and already busy disobeying doctor’s orders.

The big grin is because he had been eating against my orders.

The big grin is because he had been eating against my orders.

At worship that morning I noticed that Augustine was the scheduled speaker. I told him later that if he really didn’t want to do worship all he needed to do was talk with someone, having an accident was really not necessary. He got a good laugh out of that.

A very relieved Mrs. Conteh holding the baby Sarah, and a shy Rachel standing next to the bed.

A very relieved Mrs. Conteh holding the baby Sarah, and a shy Rachel standing next to the bed.

By Friday he was well enough to go home. Sunday morning at 6:30 my phone rang. Augustine called to thank me for taking good care of him, and to assure me that he was doing OK. I thanked him for calling, but have to confess that my thoughts were more of, “If you really want to thank me, don’t call me at 6:30 on Sunday morning:)”

Intercessory prayer works, it kept us alive during Sankoh’s mad dash to Mamamah, it stopped the bleeding in Augustine’s spleen, it helped us get the IV’s going in time. I cannot praise God enough that I was not faced with doing a splenectomy on him at 2 in the morning. We are not set up to deal with major trauma’s, but by God’s grace our head nurse will be back at work in early October.

It also showed me that we really do need an ambulance. Lights and siren would have been nice. A real ambulance gurney in the back of an ambulance that was already stocked with the supplies we needed would be nicer. As we grow, these kind of emergencies are going to be more common, we need to be ready to meet them. When we do the best we can with what we have, God makes up the difference. When we are just lazy and don’t plan ahead, and don’t work to remedy our deficiencies and ask God for help, it is presumption.

Despite the fact that Bekki did not serve mutton for supper that Monday night, it was an Eid al-Adha I won’t soon forget.

Paul checking Augustine's BP at his home today.

Paul checking Augustine’s BP at his home today.

Epilogue: We visited Augustine today as he lives just a couple hundred yards from our Mobile Clinic in Mamamah. He is doing well. Hemoglobin is stable, he is eating, no dizziness, minimal pain. We praise God for His mercies and healing. sg

A very happy Mr. Conteh on his bed at home, showing off his fancy cast-boot, and sitting up with no dizzyness.

A very happy Mr. Conteh on his bed at home, showing off his fancy cast-boot, and sitting up with no dizzyness.

For those of you who are new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

TAASLA

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

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

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

How are you getting there?

How are you paying for this?

Why are you going? You weren’t invited.

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

Just as quickly came the answers (in order).

By plane.

I don’t know and I don’t care.

I don’t know and I don’t care.

Me. No. Yes

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

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

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

More questions without answers:

Who would be there?

How many?

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

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

And so on.

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

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

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

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

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

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

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

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

The weekend song leaders.

The weekend song leaders.

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

Mr. Kamara, my first greeter

Jenny Sandy with Mr. Kamara and Jacob Conteh.

Jenny Sandy with Mr. Kamara and Jacob Conteh.

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

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

Greetings from TAASLA!

Greetings from TAASLA!

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

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

Happy Day

Happy Day


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

For those of you who are new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner