Good morning Shanksteps (of faith) followers. It’s 4AM and I have jetlag so can’t sleep anymore. I got about 6 hours last night so feel pretty good. Fortunately it cooled off to around 65 this night, so I slept. The heat is coming more and more, was about 95 during the day Im told.
So as you know from the last email, we are at Bere Adventist Hospital. It has been a surprisingly uneventful trip. Cant say that often when traveling in Africa. We flew from Portland to Seattle, Seattle to Paris, and Paris to Ndjamena, Chad. We had 4-8 hours at each layover. We left our home Thursday morning and arrived in Bere Sunday late afternoon. The Trecartins, missionaries here, had all the other missionaries over last evening for a going away party for the Netteburgs, who have been here ?11 years. It was nice to meet everyone.
So you may wonder, what does a surgeon take on a mission trip to Africa? What’s important to take in our luggage? There are a few things always at the top of my list. First is suture! I cant do my job without it. MAP international is the way to get Ethicon suture for mission work. So a few months ago I made an order with them, as did Audrey. I want suture to sew up incisions and cuts. I want suture to close abdomen- thick strong suture that lasts a long time. I want absorbable suture to sew up a uterus after a C-section… Next on my list is a headlamp. That way wether there is power or not, I can see what Im working on. Then there is scrubs, masks, surgical caps, OR shoes, stethoscope, small books on tropical medicine, water bottles to keep hydrated in this heat, OR towels of two styles. Then there are the other things of this trip- an AED, gluten free food for one of the missionary families, Pizza cutters ground in a way to use as skin graft meshing devices, bug barrier spray and spray bottle, ink for another missionary, a suitcase of breast pumps for another… 5 plastic boxes of stuff as luggage. We’ve found the plastic boxes aren’t to expensive and there are always people in Bere that want the boxes when we leave.
We landed in Ndjamena and were picked up by Laurant the taxi guy. He got a guy to come to the car to exchange money for us, then took us to the TEAM mission where we slept a few hours. Then up in the morning to catch the 8AM bus. We get our luggage put into the luggage compartment underneath and then pick out seats inside. We want to be near the front- because thats less bumpy, but not at the front, in case of a crash. We chose a spot about midway back. We sit down and realize that one chair doesn’t seem to have the back of the seat locked so it immediately reclines to almost lying down. So we choose a different spot. Gradually the bus fills and then starts honking, and we leave. It is a very bumpy, dusty ride as we go about 8 hours with two stops. One on the side of the road, in the middle of no where, for us to all get out and go out in the field to pee/poo. Men and women get off the bus and go into the field to stand and pee or squat to do #2. Then a second stop at the town of Bongor to change some passengers. At that stop there are venders of food and stuff all around. You can get beef, lamb, chicken, apples, sugar sweets, fried crickets, carrots, lettuce, bananas, few mangos, a watermelon, and other veggies I don’t recognize. Of course there are always the men walking around selling pairs of shoes, market bags, sun glasses, Kleenex, medicines, shirts. Women usually sell food items. The driver starts honking the horn and everyone loads back up and we continue on. In Kelo, Dr. Stacy and Sarah come to get us and all our stuff- and we are greatful to be picked up and not go motorcycle for the last two hours- though that’s not a bad way to go- with our luggage, we are more certain of it’s arrival, than just sending it off on motorcycle to arrive at the hospital.
Apparently there are many patients >60 waiting for an operation. Andrew is operating each day but there are more people waiting than can be kept up with. So it appears it will be a busy month 🙂
Please pray that we will be Gods love and compassion to all we meet and take care of.
Chad 2022 #0
It has been a couple years since we were able to do volunteer work. We are happy and nervous to do it again. We will leave soon for Bere Adventist hospital. If I can get out emails while I am there, you will hear more from us. I pray God‘s blessing on each of you as you serve Him in your own ways. Please pray for us in our travels and our ministry, that we will portray Jesus and His love to all those around us!
Thank you,
Greg
Disaster Response B #13 last one of Bahamas Disaster Relief
This was a hard day! One of children with medial problems. My last day in the Bahamas hurricane disaster relief.
I hear them calling for help in the ER as I’m in the step-down tent. They have a 8 year old school girl who has had a seizure and is in status epelecticus- a continuous seizure. She has been seizing for 30 minutes before getting to the hospital. The ER has given her a dose of medicine to stop it, and it continues. She is being bagged, and lays there in her cute school uniform. It consists of black round tipped shoes, black socks, a dark blue skirt, and a white button up shirt. Her hair is in woven brads. She is intubated by the anesthetist and bagged. She is put on a drip of sedation and meds to stop the seizure. Later she is flown to Nassau for a pediatric ICU.
The second one effects us all. Death is never easy! It’s a little easier for me, when expected- a very traumatized person that has life threatening injuries that can’t be repaired; the huge heart attack that kills suddenly; the person with very advanced cancer that withers away; or the person who has a massive pulmonary embolus. Those that I find harder, are the seemingly insignificant injuries that kill, or the asthma attack, or the mild symptoms that turn horrible and quickly the person decompensates. It is always hard for the loved ones of the person who dies. This death was hard for me today.
I’m in the ER evaluating an adult patient on the edge of the tent when I hear a nurse behind me scream out the name of the ER doctor. I had seen an x-ray on the monitor of a small person with a whited out left lung field. It is this child. I turn around and she is grabbing a 5 year old boy who is seizing. She flips him over on his stomach and some stomach contents come out his mouth. I race over and we grab a mask and bag to help him breath. The ER doc is helping him breath and we check for a pulse. There is none- so we start CPR. We suction and bag the boy. The ER doc tries to intubate and is unsuccessful. The family is standing by watching our CPR efforts. The anesthetist arrives and I help her get the suction ready again. The endotrachial tube ready, then she intubates. She holds the tube after taping it in place. The CPR is bouncing the boy all over the place and the tube seems like it’s dislodging. So she holds it and I bag. The lungs feel stiff and hard to expand. There are distended neck veins, so Dr. J places a needle on the left side, followed by a chest tube. No real air or fluid comes out. We are continuing to give the different drugs that may have an effect in a situation like this, but nothing seems to be changing. We are now about 30 minutes into the code. There were still distended neck veins so we place a chest tube on the left. Again no difference. We keep re-assessing the lung sounds on both sides. I keep bagging and chest compressions are continuing, with people switching off doing chest compressions, changing about every 2 minutes. Family is crying. Staff are crying. Staff are praying. CPR continues. Again, for the hundredth time, we check for heart beat, checking again with ultrasound for heart motion. Nothing. Eyes are fixed and dilated. We continue chest compressions and bagging difficult lungs. No one wants to give up. The ER doc running the code continues to order meds. At an hour in he surveys the physicians and nurses present- whether to continue or not. There seems to be a slow heart beat now, so we continue with chest compressions and breathing with the bag. He starts a pressor drip, and we decide if this doesn’t make a difference, then we will stop. We try for another 15 min or so after the pressor. No changes. So after 1.5 hours of bagging and chest compressions… we call an end. The mother has gone outside some time ago. The father sits there with his head in his hands. The end is called, and he goes out to join his family and friends outside. We were all exhausted, physically and mentally! The family wails outside and many staff are crying in different areas of the room, some are hugging each other.
I’m asked to see a patient in triage that they think has appendicitis. There is a 79 year old man that has the classical physical findings of appendicitis. He has pain in his right lower quadrant, exquisitely tender there. But instead of having an elevated WBC (white blood cell count), his is normal. I cant get a IV contrast abdominal CT at night so I decide Im convinced enough to take him directly to the OR. As I come out of triage back to the ER where the family and staff are gathered around the dead boy- I hear the family singing- It is well with my soul! Wow that hits me! That is an incredible hymn with and incredible story all of it’s own. It has huge meaning to me in that moment- especially with the family singing it.
That night I hear that someone found out that the child had a congenital condition that gave him only one ventricle in his heart. Something no one could change. I look forward to the day when Jesus comes again, and birth defects are corrected, and children don’t die any more!
Disaster response B #12
Disaster response B #12
So I wake up a bit late, nearly time for worship. But I want to check on my patient from last night. So I get on my scrubs and walk to the hospital tent where my patient is. We operated on him many hours last night. I walked in and as expected he is in the ICU (the left side of the main tent as I walk in). There are 4 ICU beds with monitors and 2 ventilators. He is getting ready to go the CT scanner across the street for a head CT ordered by the ER doc last night. So they get two nurses along with the ambulance crew to take him over across the street to the RAND hospital for the CT. Eventually we get the monitors on to battery power, the ventilator unplugged and hand carried, the IV drips on pumps that are battery powered and the nurses want me to go. I think that’s quite reasonable so I go. He’s moved to an ambulance gurney and we roll out the door to the waiting ambulance. I realize that the oxygen tank I’m carrying is empty about half way out to the ambulance. The ambulance personnel said it was full… So we rush out and attach the bag that I’m bagging him on- to the ambulance oxygen. We drive across the street and unload. And roll down the halls, that the nurses know, to the CT scanner. After placing him on the CT scanner with all the machines hooked back up, the ambulance people leave. They say they are going to get another patient from our ER to take to the scanner too. They will be back! I’m immediately skeptical and try to convince them to stay. Unsuccessful! Guess I didn’t think about them not staying with us and bringing us back. There is a lot of fussing about by the radiology tech and eventually he gets the scan done. I’m watching vitals and tubes and thinking about things and not watching what the tech is doing. The ambulance people aren’t back yet so we call to our own ER and try to get the doc there to get the ambulance people back. As I look through the pictures I realize that none of them were done with IV contrast like I asked. So I have to tell the guy to re-scan with IV contrast. The radiologist eventually arrives and there is lots of discussion between them and clicking of buttons. In about 20 minutes they start the scan. I hear that the ambulance has brought the other child from our ER for a scan. They say their ambulance is to small to carry our patient, and the other one went out on a call. I do my best to convince them to stay and take us. As we are finishing the contrast scans. They are in the room. Just as we are finishing they get a call from their dispatch of a code ?? some number. They say they have to leave urgently and will be back later to get us. What am I to do???? When will the other ambulance be free? They didn’t know. I do not want to stay in the CT scanner with a sick ICU patient, so I call my own ER and ask them to send someone with a stretcher. Eventually one of the ER docs comes over pushing a stretcher. I’m VERY happy to see him. WE get loaded up and we walk out of the one hospital and across the parking lot. The two SWAT guards trailing us all the way. At the road, they walk out to the middle to ensure traffic stops and we roll across. Then on to “our” parking lot and then to our tent hospital. Through the ER and down to the ICU tent. Whew, “home” at last, 2.5 hours later!!
The night before I had just returned from playing a tennis match at the local YMCA that our tent hospital had just arranged for us to be able to go to. Getting back to the hospital I was told there were some trauma patients coming. I changed and ran in. We heard there was a stabbed woman and then a man. Then we heard that one had jumped from a balcony and ambulance personnel couldn’t get to them, it was apparently a hostage situation. The patients in the triage area knew all about what had happened, and were able to tell us even before the ambulance had arrived. Apparently part of the event was streamed live online.
Eventually we got a patient who was in his 30’s and had blood and cuts all over and 4 stab wounds with omentum hanging out of one. He apparently had jumped or fallen 3 stories to the ground after an altercation above, in which a girl had died. He arrived with police and SWAT members. As you know, we don’t have CT scans, it’s across the road. He was unconscious and we intubated him. Then full exam and a chest x-ray and pelvic x-ray. His pelvis was an open book fracture- splitting wide open in the front. Blood kept bubbling from the chest wounds. On ultrasound, he didn’t appear to have blood around his heart, but it sure seemed likely that his heart was stabbed. Dr. J and I took him to the operating room. We started in his abdomen and would extend to the chest as needed. As I entered the abdomen there was only a small amount of blood. We packed off all four quadrants. There seemed to be more blood in the pelvis. I ran the small bowel (looked at all of it), and then the large bowel. There was a small hematoma on the colon at the area the omentum was hanging out of the abdomen. After opening this area, I identified a small serosal injury and repaired it. Then unpacking the rest of the abdomen, there was a retroperitoneal hematoma and blood oozing from that.
Next we explored retro-sternal (behind the breast bone) to the anterior surface of the heart. No blood was seen in the pericardium (heart sac). I was grateful for the man, that his heart was not punctured. We got control of the oozing from that area. Then we closed up his abdomen. Now to stabilize his pelvis. As Dr. F (the orthopedic surgeon) and I worked on his pelvis, Dr. J went to sewing up the many lacerations on his arms and neck. Dr F directed how to put in the two screw tipped posts into each side of his pelvic bone. Then we used the carbon fiber tubes and clamps to create a rectangular structure that connected the two sides of the pelvis together clamping to the two posts on either side. (For a detailed example of something similar see https://www2.aofoundation.org/wps/portal/!ut/p/a1/04_Sj9CPykssy0xPLMnMz0vMAfGjzOKN_A0M3D2DDbz9_UMMDRyDXQ3dw9wMDAzMjYEKIvEocDQnTr8BDuBoQEh_QW5oKAD4ENaS/dl5/d5/L2dJQSEvUUt3QS80SmlFL1o2XzJPMDBHSVMwS09PVDEwQVNFMUdWRjAwMDcz/?bone=Pelvis&classification=61-AT&method=External%20fixation&segment=Ring&showPage=redfix&treatment=Operative ) After we were finished with the pelvic fixation we finished the skin closures and took him to the ICU. We finished about 2 or 3AM. It takes me a while to wind down and go to sleep, but when sleep comes, I am deeply asleep._______________________________________________
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Disaster Response B #11