Morning Worship

Three years ago, or so, wow it does not seem possible, I wrote a blog about worship in Tchad. Well it is time to write one now about worship in Sierra Leone. It is similar but also very, very different.

First the similarities, morning worship starts the day. Day shift and night shift are all expected to attend. The only staff exempted are those working the afternoon/evening shift. We sing, pray, a staff member gives a talk, and often we have “contributions”, comments about whatever the topic was.

We don’t do the handshake thing that was so big in Tchad, probably due to Ebola. That scared the Sierra Leoneans from any physical contact. And the singing here is much better. These guys can carry a tune, and harmonize. Then too, we have worship in the OPD (Out Patient Department) which has awesome acoustics. When the staff ramp it up on their favorite hymns it is positively heavenly.

The Staff doing morning stretches.

Led by JP

And worship time is very structured, Monday is administration day, so a staff member talks about their job, like say a cleaner (janitor), explaining what they do with their time, and often share some of their frustrations. There is usually then a long discussion where the most vocal staff voice their opinion on the topic, usually positive, but sometimes if it is perceived that the staff member is whining unnecessarily, they will be called on it.

Tuesday and Thursday are health talk days, so a clinical staff member will give a treatise on hypertension or diabetes or nutrition, or any health related topic. Lately the focus has been on waste management, and this morning our waste management officer (he is also our anesthetist, seems to me like a natural combination) talked again about proper waste disposal. You know like, putting sharps IN the sharps container, not on the lawn. And putting soiled bloody dressings in the proper dust bin (waste receptacle). Little thing like that. In fact, just last week the Waste Management Team did a skit for worship on that very topic, what waste goes where. This is a good thing to talk about in a country that seems to believe that any public place is a garbage repository, and that the entire country is one giant urinal.

Our Waste Management Team doing their best to get the staff to put the medical waste not only in the trash, but in the right trash.

Wednesday and Friday are reserved for more traditional worship talks, which are often very thought provoking, others, well, not so much. But by and large, morning worship is a great time of fellowship and comradeship.
After worship we have the all important announcements, what committee is meeting that morning in my office, or what our upcoming schedule is. And after worship time is when we celebrate staff birthdays, births, and provide support to those who have lost loved ones. It is the time when we welcome new volunteers, or new staff with our “Welcome, Welcome” song, and it is the time when we say good-by to those who are leaving us. It is the time that the staff receive their certificates for attending and completing educational classes taught by our volunteers.

Nurse Karin giving Mr. Conteh his Certificate of Achievement.

The Loma Linda University Pharmacy Team with their Sierra Leone plaques, signed by the staff.

It is the time when we bless new additions to the hospital, from little things like dressing supplies and point of care hemoglobin monitors to larger items like physio beds, cars and even autoclaves. I have come to love this AHS tradition. It emphasizes the fact that everything we have here, everything we do here is for the glory of God, it is by His hand that we survive and function, and we owe it all to Him. So everything large or small is dedicated to be used to His honor and glory and in His service.

Blessing our new Physio table from the UK.

A particularly difficult farewell as the Peter Turay gives a heartfelt testimony about his brother Douglassss Turay at Douglasssss’s farewell.

Morning worship is held, as I mentioned, in the OPD, so it is not uncommon to have patients and families attend worship with us. What is unusual is what happened last week. Two patients wanted to share their testimonies with the staff after the announcements.

The first was Omo. She is a very brave woman who first came to us with a diabetic foot. It was really bad looking, but seemed to be viable and she was walking on it, so I did my best to save her foot. Sadly, the infection got out of control and started to spread up her leg. By the time we got her to surgery we had to do a high calf amputation and leave it open to let the infection drain out. It made me regret my earlier decision to not push for the amputation sooner. Anyway, when it came time to close the wound I had to explain to her that I could not save the knee. A below knee amputation would not leave enough length of bone below the knee to support a prosthesis, or be anything but in the way. Understandably, she was pretty upset. But she pulled it together and we got the job done, and her wound closed.

Omo

That morning she stood there on one leg, supporting herself with the walker and led the staff in singing “To God Be the Glory.” She then proceeded to praise God for His mercy, love and grace. I was so moved. Here was this woman who had just lost her leg, praising God in spite of it all. We are pretty good at praising God when He heals us, saves us or delivers us, but after losing a leg in a place that does not make it easy for the handicapped. Never saw that in America.

Then a couple of days later, an old Muslim man wanted to share his testimony. He is recovering from a stroke and is still very weak, but he managed to walk a few steps and he too started to sing,, “Tell Papa God Tenki (thank you)”. It is a Sierra Leonean favorite, but I didn’t realize the Muslims sang it too. The staff joined in lustfully as they say here. It is a praise chorus, “Tell God thank you for what He does for us, He saved us, He does everything for us.”

Our Muslim brother leads us in singing, bring those hands together.

Paul tells us in everything to be content and to give thanks for all things and in all circumstances. I would do well to learn from a woman with one leg and an old Muslim man.

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 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

You Might Be In Tchad If…

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

YOU MIGHT BE IN TCHAD IF…

You might be driving in Tchad if…

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

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

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

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

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

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

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

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

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

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

You might be a surgeon working in Tchad if…

You have ever used sterilized fishing line as suture.

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

You routinely operate with bare feet in flip flops.

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

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

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

You do all your CT Scans with a scalpel

You daily do cases you have no training for.

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

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

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

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

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

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

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

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

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

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

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

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

You might be in a hospital in Tchad if…

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

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

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

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

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

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

You realize there are many things here worse than death.

You start everyday really really praying to your God.

You might be a missionary in Tchad if…

You have your own personal set of malaria symptoms

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

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

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

You get to have your faith tried every day.

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

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

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

For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. You will also find links to other missionary blogs such as Olen and Danae Netteburg and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

SYLVAIN

« Oooh-Ohh!! Ça fait mal, ça fait très mal !! » Sylvain screamed in pain as he lay on the soccer pitch holding his left leg.

Sylvain is a normal 11 year old boy, in the third grade, the third of 6 children. His family is very poor, although he is lucky enough to still have both parents. They live in the village of Bembaida which is 117 km (70 miles) from Moundou. Sylvain’s family are farmers, and their little field only produces 2-3 sacs of grain a year. Now granted each sac weighs at least 100 kg (220 pounds), but for the whole year that is not a lot.

As I noted, Sylvain is a normal boy, and like all little and big boys here in Tchad, he loves to play football (soccer). On this particular day last September he was playing with his friends. It is not clear what happened, but he fell to the ground screaming in pain. He had broken his left femur (the main bone between hip and knee).

Now in every village you will find a traditional healer. A man or woman who has learned how to use natural products to heal the various maladies Tchadiens come down with. These traditional healers are also the local orthopedists. They set and splint broken bones, and often do a pretty good job, as long as there is no wound. If it is an open fracture, the standard of care is to go to the local health center where the nurse will carefully and beautifully sew up the wound, making sure that all the grass, dirt, mud, and seeds are kept in the wound so they can’t get out of the wound and cause problems. Seriously, last week a lady came in with a nasty cut on the top of her foot. It had been sewn up at the regional hospital. The nurses had carefully cleansed the skin with betadine before closing the wound. We took her back to the OR and under spinal anesthesia opened up the wound. We found a bunch of what looked like hard little larvae. I asked her what was in the truck she had been riding on. It was full of millet, which is a grain. The Central Hospital staff had carefully closed her wound leaving enough millet seeds in her foot to grown a small garden.

A well padded splint

A well padded splint

A bark splint

A bark splint

So back to Sylvain, his family called the local traditional healer who came four times and manipulated the fracture to get it set correctly, massage it, and do who knows what else. After the fourth attempt he admitted that this case was beyond his ability. Now that is a pretty impressive admission, as usually they just keep treating and accepting money until the patient gets better, dies, or the family fires them.
A mud plaster splint

A mud plaster splint

When you don't have string or rope, strips of bark and branches will do.

When you don’t have string or rope, strips of bark and branches will do.

Well the next step was to call the local “voyants traditionelles”. These are the “clairvoyants”, the witch doctors of the village. These individuals are also an important staple of each village. And everyone, Christian, Muslim, animist, all seek them out if all else fails. Well the local clairvoyants came and examined Sylvain. Their diagnosis was that one of the local sorcerers had trapped Sylvain’s soul and was holding it under a special Spirit Tree in the bush. Now these sorcerers, or evil clairvoyants are also a staple in the villages, and are used, again, by Christians, Muslims and animists (the traditional religion). If you have an enemy, or someone offends you, seek one out and they will, for a fee, cast a spell on the person, or somehow cause some evil to befall them. You may laugh, but it is real and it is true. And the spells work, people are killed or badly injured or fall terribly ill because of these spells. And it is not just a psychological thing. Bad things happen that shouldn’t when the cursed individual doesn’t even know he is cursed until after the fact.

So Sylvain’s soul was trapped by a sorcerer under a spirit tree. Not a good diagnosis, but it obviously explained the reason the traditional healer failed. Immediately after that Sylvain’s leg began putrefy. It became more painful, swollen and started to smell as the muscle began to die.

By now it was the end of October and Sylvain was dying. Fortunately for him, his parents were not about to give up, and they called the only person they thought could help, a friend in Moundou. On October 29 Jean-Paul went to the village and picked Sylvain up and brought him to our Center. He was, by this time, a very sick little boy. His hemoglobin was 3 (normal 12-15). He was given 4 units of blood and had his leg amputated, which by now was dead.
Sylvain spent over 6 weeks with us as he healed. Despite the fact that he lost his leg above his knee, he kept his life. We were able to share with him and his family the story of Jesus. And Bekki was able to arrange with our local Handicap Center for Sylvain to receive a new artificial leg.

Sylvain

Sylvain


For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. You will also find links to other missionary blogs such as Olen and Danae Netteburg and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

MY BIRTHDAY

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

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

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

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

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

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

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

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

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

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

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

Solange is in between Bekki and I.

Solange is in between Bekki and I.

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

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

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

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

For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. You will also find links to other missionary blogs such as Olen and Danae Netteburg and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

A NEW BIRTH

Rebecca and I were privileged today to witness a new birth of sorts. Those of you who have been with us from the beginning can be fairly certain this is not speaking of traditional obstetrics as you know that that sort of thing is forbidden in our center. We DO NOT do OB here. Just wanted to make that clear, there is a perfectly good obstetrician at the central Hospital just a kilometer away.

No, it wasn’t a new baby human, we got to witness the birth of a new Seventh-day Adventist Church. About 15 kilometers southeast of Moundou is the village of Koutou-bete. Koutou-bete is one of our Pastor’s four churches and has a very active young peoples group, AYA in English, and J-A in French (Jeunesse Adventiste). They also have a pathfinder group with uniforms, although they need the patches, so if anyone wants to donate some either from France or the US they would be very happy to receive them.

Apparently the young people in Koutou-bete were restless and looking for a project, something they could do for Jesus. They found a little village 9 kilometers away (5 miles) and began going there on Sabbath mornings and started a branch Sabbath School. To put this in perspective, they walk the 5 miles each way on a little dirt path through the brush, and they carry their instruments with them. Now granted they aren’t much, a large yellow water container for a bass drum, another drum/stringed instrument and their maracas, but still that is dedication.

The young peoples group from Koutou-bete

The young peoples group from Koutou-bete

The Band with their maracas, and drum set, including the yellow bass drum.  Notice the overflow, late seating, the pole just above the ground in the foreground is really a bench.   I bet if our churches used these for overflow and late seating pews more people would be on time and sit up front.

The Band with their maracas, and drum set, including the yellow bass drum. Notice the overflow, late seating, the pole just above the ground in the foreground is really a bench. I bet if our churches used these for overflow and late seating pews more people would be on time and sit up front.

They have been doing this for some weeks and Rebecca and I were invited to go there today and see what they had been doing, also I am sure in the hopes that we would be impressed to help them financially. So this morning at 0830 Rebecca and I got on the moto and headed off for the village of Betkrim following behind Pastor Dieudonne and Roger our Chaplain who is the head elder in the church at Koutou-bete.

Roger with his three oldest daughters, out of 10 kids.

Roger with his three oldest daughters, out of 10 kids.

The first 7 kilometers were fine, good paved road, no problems at the check point, but then we headed onto the dirt and sand. Now this is rainy season and so there were large puddles to skirt around and much of the sand had been compacted down, but there were still plenty of places where the bike was really hard to control.

Rebecca and I on our moto.

Rebecca and I on our moto.

I was proud of Rebecca, like a good Tchadien she hung onto the moto, not to me. And she has become a very good passenger, knowing how not to upset the apple cart, or moto in this case. I also figured out why most of our fractures are left tib-fib fractures. When the bike starts to go over it is your left foot you naturally put down first, if you are right footed I guess. Well I could easily see that if that foot catches on something, and there are a lot of somethings to catch it on, the lower leg is going to snap like a twig. Anyway, just an aside.

Typical hut in the middle of the field.

Typical hut in the middle of the field.

After 9 kilometers on the path we arrived at the village. People had gathered and the young people from Koutou-bete were there leading the singing. They were easy to spot as they had black pants or skirts and white t-shirts with J-A on the front and “Eglise Adventiste du Septieme Jour” (Seventh-day Adventist Church) on the back. It was what I expected, very bush. We were outside under a giant tree, with roosters crowing and oxen lowing in the background. Lots of little kids sitting on the mats, literally dressed in rags.
Little kids dressed in rags

Little kids dressed in rags

In fact I don’t remember ever seeing, even around Bere, so many kids in such tattered, torn clothes. We were surrounded by the fields of the villagers mingled in with their mud brick, thatched roof huts. Very different from what we are used to here in Moundou. It was a pretty simple service, the choir led the singing for a while, the pastor asked me to have the opening prayer, and then he gave the lesson study, followed by more singing and closing prayer.
VIP seating

VIP seating

There were several things that really impressed me though. One was the Pastor. Dieudonne is an evangelist at heart, on Thanksgiving at morning worship at the hospital he somehow tied the American Thanksgiving in with the seven trumpets of Revelation, and when he gets going, man, Dwight L. Moody would be proud. And when he gets wound up, his poor translator (he is speaking in French and someone is translating into Ngombaye), gets left in the dust. He will talk for literally two minutes, give his translator 5-10 seconds and then just get going again. His whole body shakes in anticipation of what he is going to say next. But today he gave Roger the time he needed to translate, and he kept it simple. The lesson was on the mission of Jesus which he beautifully wove into a message of the love of God, of salvation for all, and the call of all Christians to be missionaries for God.

At the end he invited one of the village elders to ask questions or make comments. We learned that although there is a school they never are able to finish the school year, so education is lacking. They would love to have a church to worship in. During rainy season worshiping outside is always dicey. They asked us to come hold a medical clinic for them. They have no bibles in Ngombaye or hymnals for that matter. Dieudonne impressed me again as he told them he couldn’t promise anything, except that if they were faithful in worshiping together each Sabbath and learning the Bible truths we would back in two to three months and hold a grand baptism at the river which is quite close to the village (meaning within 20 kilometers (12 miles)).

So where is the new birth in all this? The pastor gave the village elder a notebook and pen and asked him to go around and record the names of those wishing to become Seventh-day Adventist Christians. It is the first record of a church in this village. We look forward to the next step when we return for the grand baptism at the river.

The whole group from both villages in front of their "tree church".

The whole group from both villages in front of their “tree church”.

We are pretty pumped, this week Nick Buchholz our physical therapist comes. He is the final member of our team for the rest of 2015 which includes Rebecca and Diana Hernandez and our SM/Nurse from Southern University, Danny Alvarez. With this team we are hoping to get a mobile clinic program going and get some public health outreach started. We don’t even have to totally re-invent the wheel as they are already doing that up in and around Bere. But today as we bumped along on the moto looking at the road (read 4-6 foot wide dirt path), with low hanging mango tree branches we wondered how we are ever going to get our ambulance to these villages. We have got to start thinking about getting some other wheels for the hospital, something meant to go off road, like a used land rover or Toyota Hilux. I have no idea how we are going to acquire something like that. Which is a good thing, because it means I get to once again see a miracle from God.

Pastor Dieudonne on his moto

Pastor Dieudonne on his moto


For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. You will also find links to other missionary blogs such as Olen and Danae Netteburg and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

Our Staff

La Saison des Pluie (the rainy season) is upon us. This morning it started to rain about 6:15, and it poured. When it is raining like that in the morning no one makes it to work on time, so I didn’t hurry over to the hospital until almost 7:30. It was still sprinkling on the new lake between our house and the hospital. I took the dry route and only waded through water ankle deep. Fortunately, we had some foresight and had already contracted with Frederic, our contractor, to build us a sidewalk from the house to the hospital gate. And also fortunately he can do it in rainy season, and even more fortunate his crew started today!! Talk about timing. It doesn’t take much to get us excited here.

Putting in the  sidewalk through our sometime lake.

Putting in the sidewalk through our sometime lake.

Speaking of excited, we are thrilled that Nick and Kelsey Ewing are here. They are our new AHI volunteers who will be with us for a year. Both are nurses who just finished at Southern. They will provide some stability as our shorter term volunteers (who are also loved and appreciated) come and go. They have already been a huge help and along with Ellen are filling the holes left by Johnny and Brandon. Lindsay fills an entirely different hole in our hearts that only she and Jonathan can fill.

The other big news is the loss of a cherished fantasy. You see for nearly seven months I have been telling myself and everyone else that there are no snakes in Moundou. In the villages yes, but not here, they have all been driven out. I had myself happily convinced of this fact, even to the point of going outside at night without a light, until Monday night. I went out to open our bedroom window (we close it during the day to keep the room cooler), and there under our window was a legless reptile, lazily moonbathing. He really had no interest in moving, even when encouraged to do so. He finally sauntered off so I could open the window. Then last night I found his home, right next to the foundation and wall of our bedroom. I do not know if he is venomous or not, I have had several suggestions to kill him, which will probably happen. But I can assure you the days of venturing outside at night without some kind of light are over, permanently. So much for fantasies.

On to the title, our staff. I just wanted to share a bit about our staff, who are by and large a great group of dedicated hard working, caring people. Before I came I had this picture of African nurses as lazy, incompetent, and pretty much useless. Was I ever wrong. I have found our nurses to be caring, hard working and a huge help. There are always variations and exceptions of course, but by and large this is true. And I have come to love them and enjoy working with them. They like to laugh, tease each other, and they love correcting my French, which thankfully they do at every opportunity. I have seen how much they care about the patients as well, and that has probably been the most humbling thing,

I will never forget Abel, our deaf head nurse, and how hard he worked to save a dying baby one night. (That story is in “Life and Death II”). He is so gruff and rough, but has such a tender heart toward the little ones especially.

The nurses will also come to us and let us know when a patient doesn’t have the money for food anymore. They know we have a bag of rice and a bag of beans just for that purpose. So they will take some from the shed and discretely give the patients some food.

Josué, a new nurse, is struggling with the fact that many people we can’t save, they come in too late, or have problems we just can’t fix. I hear it in his voice when he comes to the house in the late evening. He knows someone is slipping away, “Isn’t there something we can do?,” he asks me with his voice inflection and body language. He knows in his heart that there is nothing else that can be done, but he wants to fix it or have me come and work a miracle so badly. And I have to tell him, « Je suis desolé, mais il n’y a rien ce que je peux faire. « (I am sorry, but there is nothing I can do).

Then there is Solange, our chic lab tech. She is a snappy dresser in her skinny jeans and blouses. She is also a top notch lab tech and always looking for ways to help out when the lab is slow. But the story begins with Janvier, which means January, because he was the first baby born in that area in January.

Janvier

Janvier

Janvier (who is now an adult) came to us in early March after a moto accident (surprise, surprise) with a humerus fracture and an open fracture of his tibia, fibula and several bones in his foot, all on his left side. He was a mess, the end of the tibia was shattered, his left arm hanging useless and his left foot all swollen. We put him in a hanging arm cast, cleaned out his fractures and ultimately put a intramedullary nail in the tibia (I would not do that now). He was clearly dirt poor, and I could not tell if he had anyone taking care of him. And with those injuries there was not much he could do for himself. Everytime I came into the ward he was in the same position on the bare mattress, his face was expressionless and he rarely talked. We would change his dressings in silence, he never flinched, winced or complained. He was so quiet I thought he might have some mental deficiencies. With his whole left side banged up he couldn’t walk, could barely feed himself and certainly couldn’t cook for himself. It was often hard to reach his urinal which was under the bed, so he would urinate on himself. And of course bathing was out of the question. After a few weeks you can imagine how he smelled, it was so bad the other patients were complaining.

Solange

Solange

Enter Solange. Mind you, she is a lab tech, not a nurse, but one day she got Janvier in a wheel chair and took him out back to the shower area and gave him a bath, and helped him get his clothes washed. I can only imagine how bad it was, but talk about a sermon in shoes. Our administrator’s wife, Colette, cooked for him. People from the US had sent or left clothes which found themselves on Janvier. You know, after that Janvier started to perk up, he had a personality, he talked, we even found out that he speaks some English. Eventually his arm healed really well, and he got around in his wheelchair. He could bathe himself and wash his own clothes. Unfortunately, his leg has not faired so well, the rod got infected and the bone never healed, but he would not let me amputate his leg. He is now in his home village getting daily dressing changes at the local health center. I may see him again someday with pus dripping from his open leg wound, or maybe by the grace of God it will be healed.

“Then the King will say to those on His right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. For I was hungry and you gave Me something to eat, I was thirsty and you gave Me something to drink, I was a stranger and you invited Me in, I needed clothes and you clothed Me, I was sick and you looked after Me, I was in prison and you came to visit Me.’” Matthew 26:34-36 NIV

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