Be’re’ Chad 2024 #8

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8 Bere 2024

It’s sabbath and we woke up before dawn to go on a moto hippo run.  Gary was here and had large motorcycles and he wanted to go out early to see if we could see the hippos.  That sounded like a great idea to us.  So Gary, Cherise, Audrey and i went out on motos at 5 AM.  We drove in the dark as the sky started to lighten.  We went in the direction of Kelo to the area of the lake.  After about ?20 minutes of riding we arrived at the lake.  They weren’t visible so we rode along the side of the lake through dry grass and over animal paths to the water.  The grass was about 2 feet tall.  After about 5 minutes by the lake we stopped to stand at the edge and see the sun come up.  It was a pretty sunrise, not the bright orange ball that sometimes comes up but was beautiful anyway.  Various birds were flying by in formation.  Others as individuals.  Swallows swooped down skimming along the surface and drinking the water as they flew.   A king fisher dove in and came up with a fish.  After watching the sun come up and seeing the reflection on the water we continued on further along the lake.  Finally we came to an area that couldn’t be crossed easily.  So we decided to turn around.  We notice that the moto that Gary is driving has a flat tire.  So he limps home and Cherise gets on with us.  We make it back and have some breakfast.  Then we go and join Gary and other at church in Bendele.  We sit through a hot sabbath school and then just as church is starting Im called to the hospital for a C-section.  

This lady presented this morning with a few contractions.  She was given Cytotec by the nurse and then her contractions started in earnest.   About mid morning she was fully dilated and she continued with hard contractions.  Then she had more abdominal pain and the uterus changed and became disfigured.  The nurse was worried about uterine rupture and so called us.  Audrey agreed and we took her to the OR.  She was in a fair amount of pain.  Phillipe the anesthetist got blood warming to give her.  He preloaded her with IV fluids and we started.  On ruptured uteruses I make a vertical incision.  As i got into the abdomen there was a lot of blood.  I saw a large hematoma on the left of the uterus.  As I felt higher I felt an arm or leg.  I pulled on the appendage and found it to be a leg.  The whole baby and placenta were outside the uterus, obviously dead.  I took them out as one unit and then pulled up the uterus to explore where the rupture was.  It was all along the left side of the uterus.  This was an odd location, as usually I see it low and in front.  I put clamps along the opening and reached for the bottom and started suturing.  I found a couple different areas where the uterine artery or its branches were bleeding.  After tying off a number of areas, the bleeding finally stopped.  Phillipe had kept up with the blood loss and she received a total of 4 units blood.  So the patient did well in the end and will need to have a planned C-section at each subsequent delivery.                                                                             

It’s about 111 deg today and i finally get to demonstrate the misting system to the missionaries in the public area where we eat lunch.  It works quite well.  The pump gets real hot so I only run it in about 1/2 hour segments.  But it works and I’m glad to have brought all the stuff for it.  Later in the evening we have everyone over to our place and we have a game night.  It is fun and we learn a new game as well.  it’s 97 in our house as we go to sleep- tough to sleep…

Be’re’ Chad 2024 #7

Greg Audrey, Greg, Shanks No Comments

7 bere 2024

When is it unwise to do an operation.  If I do a challenging one and succeed am I good, or lucky, or blessed by God.   If I do a challenging operation and hurt someone am I bad, unlucky, cursed, negligent…

I saw a woman in the last few days that was having a lot of abdominal pain.  She had some varices (enlarged serpigenous veins) on her abdomen from an inch above her umbilicus up to nearly her zyphoid.  She said these were very painful.  In the bottom area I had the feel that there may be a small hernia and she definitely was more tender there.  I got a small fluid wave on tapping so I think she has ascites too.  So by deduction she also has cirrhosis.  This can cause a back up of the usual venous drainage and make other veins, like the abdominal wall, dilate and take up extra flow.  So this becomes a high risk person to operate on and a risk of getting into bleeding that is difficult to stop and ultimately could kill her.  I’m hesitant.  But if she is having pain primarily at a small hernia I can fix that and try to take out these veins too.  So through translation of a student nurse I tell her about all this and that she could die from the operation.  She wants to proceed, that’s why she came to the hospital.  I think i can safely take it out so I book her.  

So today Im looking at her on the OR table and thinking, what was I thinking the other day.  My courage is smaller today.  I tell Phillipe the anesthetist to warm up blood to give her if we get into a lot of bleeding.  I choose an assistant who is very good at assisting and will be a great help if I get into lots of bleeding.  I scrub at the OR sink with the bar of soap on the side counter and then put on my sterile cloth gown and sterile gloves.  I incise lower than all this mess and come up slowly underneath where I can see different structures bettter.  I slowly dissect around one side and see large vein after another.  There is slight bleeding but it is a small vein outside the vericosities.  As I slowly go up and peel this mass of veins up towards me, I find a small perforating vein from the inside.  I tie it three times and then divide it.  The whole rest of the veins go flat.  Wow, that was all fed by one smaller vessel!  Now I have more courage, I work faster now and find a second perforator near the top, likely the outfllow vessel.  I’m able to take off the whole thing and loose less than 1ml blood.  What do I feel- relief, gratitude to God for helping me not cause bleeding, and more relief!  Should I have done the surgery, I don’t know.  One day I had the courage, today i didn’t but did it anyway.  Thank you Lord God for helping me do it well without harming her.

This was Auds birthday too and she adds the following.

Thanks everyone for the wonderful birthday wishes. It was awesome to get them over here in hot, dusty Chad. 

My day ended up to be fantastic. I started off the day feeling just a tad sorry for myself but decided to have a good day anyway. People started wishing me a “Happy Birthday” right off. I rounded on the maternity ward and it went smoothly. I’m really enjoying the nurses that I’m working with which makes the mornings more fun. 

I came back to my place and had a bite to eat which was delicious local food. Several people stopped by to eat and chat. 

Be’re’ Chad 2024 #6

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6 bere 2024

It’s my least favorite thing here in Bere, neck abscesses from dental cavity infections.  I am sitting in the worship area which is a metal awning outside the ER.  Someone is giving a worship thought to the hospital workers in French and its translated into Nangere, the local language.  Im distracted by chickens walking by and pecking at something on the ground next to me.  There is a muslim man sitting in the front row waiting for the ER to open and just stayed there when worship started.  Another younger muslim guy walked up and starts talking to him, someone asks him to be quiet as we are having a meeting.  Then one of the nurses that asked me to help him with his schooling last week, walks up to me and says his uncle isn’t doing well and would i come see him.  I had admitted the uncle the day before.  He had swelling of his chin and neck and I did an ultrasound and didn’t see anything to be drained. It had be the rotten tooth cause.  He couldn’t open his mouth for me to see anything in it (trismus).  So I treated him with IV antibiotics.  I go over to where he is and his family is carrying him from under the tree to his bed.  He is sitting rocking back and forth and looking weaker and weaker.  They get a sat monitor and his sat is 47.  He is dying… I tell them to carry him to the OR NOW.  they grab him and I run for the OR.  I get the stuff and as soon as he’s on the table I try to intubate him.  I don’t expect to be able to open his mouth at all and also think of an emergency trach.  But I try, and it opens some.  My mac intubation blade is to small.  I find another and try again.  I intubate him and we start CPR.  The nursing student stays in the room and the other family members leave.  I pray for God to save him as I do chest compressions once the anesthetist is there to bag him.  I switch off with Audrey and a couple of OR guys.  We do chest compressions and bag him for more than 30minutes.  His pupils are fixed and dilated.  We stop.  He is still dead..

Another of my least favorite is a similar issue of a woman who was admitted over the weekend.  I found her on rounds Sunday morning.  She had an ace bandage around her neck that was wet with pus and her whole upper chest area was red and was like a big fluid pocket- pus!  So I told her to not eat or drink anything and she needed to go to the OR.  I wanted to sedate her but when in the OR i realized she couldn’t open her mouth but about a quarter of an inch.  So I cant sedate her and she will have to be done with local anesthetic.   This never works well, but is what is necessary.  The OR staff doesn’t want her in the OR because she smells awful, like dead flesh. (Think decaying animal).  So we do it on a bed in the consultation room.  She is sitting leaning against another woman.  I put betadine on, I know is useless, and then inject lidocaine in a few areas.  This is painful and she pushes me away.  She says she is going to die.  I think to myself that she probably will.  I incise the different areas that I injected and cups of pus flow out.  There is a dead patch of skin on her neck and I cut that off with scissors.  I realize that when she coughs a well of pus flows up from behind her sternum.  I see dark black tissue bubble up too.  I grab it with a forcep and pull up a huge piece of dead tissue from behind the sternum.  I grab the Dakins bottle (dilute bleach) and drown the area with it.  More pus flows up and out from behind the sternum.  The guy standing by helping hold her and the woman holding her, both nearly pass out.  The stench is awful.  im glad we are not in the confined room of the OR.  After there is pus everywhere and I cant smell anything but dead smell, im done.  I’ve pack everything I can and I go to wash off all my exposed skin I can.  I don’t think i got it on my skin, but I feel very dirty…

So i hate that the people here have no available dental care or way of getting to it.  And even when they have rotten teeth they often want to keep them because they’re the only teeth they will ever have.  We, in the first world countries, are very blessed to have access to care many other people in the world have no access to at all.

God help me to demonstrate Your love to these suffering people!

Bere Chad. Miah Davis

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Dear reader,

My name is Miah Davis. I am 17 years old, and am graduating high school in June of 2024. I shall be attending Walla Walla University to take either medical or nursing prerequisites, and aspire to be either a CRNA or anesthesiologist someday. 

I was granted an opportunity to go to Bèrè, Chad as part of a medical mission trip team. I embarked on the journey with no expectations really, but I gradually became astonished by the rusticity of Bèrè Adventist Hospital. When I first walked into the various wards—maternity, pediatrics, adult, surgical—the simple spaces were not a surprise. It was not until I went on rounds and spent many hours in the operating room (OR) over the next few days that I realized two things: 1) how lucky I, as an American, am to live in a country with such advanced health care and 2) how great of a God I believe in. 

I have heard many people in the US complain about the cost of healthcare, whether that be the cost of birthing in a hospital, attaining cancer treatment, or getting insulin needed to survive with diabetes. I do agree that such things are dreadfully overpriced in the US, but I have now seen a place without them. In the US, there is consistent pre-natal care and multiple options for a safe birth, In Bèrè, birthing mothers can only be monitored, given epidurals, and taken in for c-sections. Sometimes the beds the women give birth on break during labor. Cancer treatment is surgery, and if surgery cannot get rid of it, there is nothing more the doctors can do. Diabetics are given a syringe and enough insulin to last a month. At the end of the month, the individual comes for a refill and a replacement of the now very dull syringe needle. Therefore, despite the hardships, I think that US residents should be more grateful for the medical technology it has. 

In the US, sanitation and privacy are highly valued. The Bèrè wards, excluding the OR, contain beds lining the walls, no privacy anywhere. There are curtains for doors, and concrete floors. Doctors and nurses do most of the physical exams without gloves to preserve the limited supply of gloves for the cases that truly require them. 

The Bèrè OR is the most basic an OR can be. Patients have consults in the OR waiting area, and do post-surgery stuff in a partially partitioned off space behind the waiting area. The two operating rooms are the two rooms in the entire hospital compound to have air conditioning despite the extreme heat (at least to us Americans). Unlike the US OR’s and their seamless floors and positive pressure, the OR floor not only has atmospheric pressure and seams, but there are also holes and bloodstains on the floor. The anesthesia machine only relays blood pressure and heart rate. It does not show the telemetry or the information from the cardiac monitor. There are often up to 10 aspiring nurses crowded into the room during an operation trying to learn. IV’s and syringes are reused, and fluid is often transferred from non-sanitary to sanitary syringes. Glove fingers are used as drainage capsules. Surgeons from the US will often ask for a certain tool only to be told that the hospital does not have one. Scrubbing down for surgeries is taken very seriously, but I am sure many US doctors would still gasp in horror. 

I have seen many patients here in Bèrè with afflictions—typhoid, abscesses from dental infections, malaria, etc—that are virtually non existent in the US. I have been able to observe, and assist in surgeries that teach me so much about the human anatomy. I have experienced what it is like to not have advanced medicine like the US does. Most of all, I have seen the human body and its interworking parts in ways that only further solidify my belief in God Our Creator. The body heals wounds, protects against internal foreign objects, and recovers from surgical procedures. In my mind, this can not be in accident. It is a beautiful masterpiece of God’s craftsmanship. 

This trip has been life changing. The people here—locals, missionaries, and OR staff—have found their way into my heart, and I am so grateful that I have the chance to spend two weeks in Bèrè, Chad. 

Sincerely,

Miah Davis