Chad #2 2019

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Chad #2 2019

            It’s 92 degrees as I drip from my shower to my bed.  The fan is just outside the mosquito net pointed at me.  Totally wet, and the fan on me, I don’t feel hot for the first time! 

            At midnight I get a call from Dr. Sarah from the maternity ward that there is  a patient with a uterine rupture.  Apparently this patient is in her 3rd pregnancy and has been at a district health center clinic and has been in labor 5 days (way to loonnngggg)!  She had had a previous C-section so this was especially to long.  This mother was sent here after developing more intense abdominal pain.  There is no baby heart beat.  They are putting in the spinal.  As we start the surgery her blood pressure was 7/4.  Which in our usual terms is 70/40, low.  She’s lost a lot of blood and I hope that she got enough fluids before hand to not go lower.  People can die from a spinal that have lost to much blood or they haven’t gotten enough fluids before it’s placed.  As we get into the abdomen we get a lot of blood as expected and immediately see the back of the baby.  I see the umbilical cord and there is no normal blood flow palpable in the cord confirming that the baby is dead.  The baby, cord, and placenta are all free floating in the abdomen.  We pass all of this off to the nurse in the room and continue on to the uterus.  The mother wants more babies so we try our best to save the uterus.  It is torn across the front where she had a previous C-section and then down the front of the uterus towards the vagina.  The part down there was very thin and difficult to separate from the bladder.  Suturing the bladder into the uterine repair is a bad thing!  We put clamps on each side laterally on the uterus where the uterine arteries are bleeding.  We suture the large hole shut and reinforce it with more stitches.  Dabbing and looking, dabbing and looking…there is no more bleeding.  I massage the uterus to help it contract.  About this time we hear of another mom in labor that isn’t progressing, and we ask that she be given a good IV with IV fluids running.  We close the fascia and then as I close the skin, Sarah takes off to check out this other woman.  Within about 5 minutes Sarah is back and confirms that we need to do a C-section on her.  As we take off the drapes we see a “code brown”, with the relaxation of the spinal there is a huge pile of poo between the legs.  It takes a little while for the nurse and anesthetist to clean it up, before we can start the next case.  By now I am sweating more than ever.  The air conditioner in the OR, is the only one in the hospital, and it’s not working for 3-4 weeks now.  It was “fixed” last week only to fail after 30 min of use.  It is now 94 deg in the OR, as it appears to be warming up with the lights and machines on.

            The next girl is lying on her stretcher and is moaning and rocking back and forth saying, “I can’t do it”, in French!  She is taller than average and muscular and lays there naked with an IV and urinary catheter in place.  She holds out her hand in a pleading gesture of requesting help, reaching towards me.  I find out this is her first delivery and she’s not pushing any more even when contractions are coming.  She gets her IV fluids and spinal and she doesn’t drop her blood pressure to much.  Her baby had a good heartbeat on the maternity ward.   We do an incision across the lower abdomen in the “bikini” line.  Skin, tiny bit of fat, fascia, muscles are all opened to see the uterus.  We make an incision above the bladder and push it down with repeated motions to separate it off the front of the uterus.  Then we make an incision in the uterus and see a baby.  The head is really stuck in the pelvis.  Sarah asks the anesthetist to push up in the vagina to push on the baby’s head to dislodge it.  I’ve not ever done that before.  This help is successful and she pulls out a living, crying baby.  This is the only time I really appreciate a crying baby!  I really dislike pulling out a limp, non-breathing, baby in a C-section when we had thought the baby as alive at the start of the surgery.  This baby is crying and we pass him off to the nurse to dry him and tie his umbilical cord.  We close up the uterus and the subsequent layers as we work our way out.  It’s now 3 AM, I’ve lost a lot of sweat in the OR, and so I drink a lot when I get back to the room I’m staying in.  Next is the shower again, and off to bed dripping wet!

Chad #1 2019

administrator Greg No Comments

Chad #1 2019

Hello family and friends,

            I am doing a volunteer month in Chad and will be writing “shanksteps” emails again.  This originally started as our “shanks steps of faith”.  As I usually do, I will attempt to send out emails about what I’m doing and seeing.  This does two things:  First, it helps me process that things I’m seeing and going through, Second, I get to keep a connection to you and help you to see aspects of other cultures and environments that stretch you and me. 

            I am really excited this time to be bringing an X-ray machine with me to Bere Hospital.  I first came to this hospital around 15 years ago when Dr.  James and Sarah Appel were here.  From that time till now there has been no  X-ray.  Ultrasound has been available that last number of times I’ve come.  So I’m excited to get this functional here.

            As I packed for this trip, I was concerned about how to get the digital Xray plate safely to the hospital.  It takes about 3 days of travel (I left home Tuesday evening and arrived here Friday evening) and includes multiple long flights (Portland, Chicago, Addis, Ndjamena), then a 8 hour bus ride, then a 2 hour truck ride (or motorcycle) to reach here. 

            I’m often concerned about how my luggage will be treated or searched and what big commotion will be made in the airport of entry.  Will anything be confiscated or taxed excessively?  As I descend to the final airport I feel a bit apprehensive.  I walk out into the 110 degree heat of the Chadian hot season, then down the stairs to the waiting bus that will take all the passengers to the terminal.  We all got off the bus and walked into the terminal, through passport checking police, the health guy, looking for our yellow fever vaccination cards, and then to our baggage.  A porter walks up to me and offers his services.  I want a porter, it seems easier to get through the customs area with a porter and I have three 70lb bags plus my carry on to transport.  All my pieces arrive and I’m grateful!  Next we go through customs and my bags are all x-rayed.  They pull the one with the digital plate aside for inspection.  I explain that I’m a physician going to Bere Hospital and I have donated equipment to help the people there.  They seem unimpressed.  I pull out my donation paperwork and hand it to them.  I’m pretty sure that they the guy taking the papers cant read English but he glances them over and demands that case be opened.  I stall some more and tell them what I’m doing and how important my luggage is to the hospital.  Eventually I’ve stalled all I can and open the case.  They immediately point to the digital plate and want to know what it is.  I’m fortunate at this time that Sarah Appel has made it into this area of the airport and says some things in Arabic and French about how I need it to work at the hospital and they let me close the case and move on.  I’m relieved and walk out with the porter.  I sweat profusely just walking outside on the black top getting to the RAV 4 she and James are driving.  We cram all my bags and us inside and head to where they are staying as they are leaving the country the next day- for good.  Chad will not be the same without them.  They have done a lot and spent many years serving here.  We spend the evening talking with some other people we are staying with and to sleep I do my usual “ritual” in the hot season.  I brush my teeth, then jump in the “cold” shower.  The water isn’t at all cold, but is likely about 90 degrees.  I get cleaned up after my long trip and don’t dry at all, and drip to bed.  I lay there not touching any body part to another.  Fortunately I fall asleep before I evaporate.  I wake up about 4 hours later, wide awake.  Jet lag!  I’m tired, but cant sleep anymore.  I lay there till 4:30 AM and then get up to get ready to go to the bus station.  A doc at the hospital we stayed at, picks me up and takes me to the bus station at 5.  There are buses loading, honking, and people milling about.  I get my luggage in the compartment down below, with the porters and then get my ticket and sit and wait till the bus is full, then we leave.  It’s an 8 hour bus ride to Kelo.  At one stop in Bongor, our bus is leaking diesel at the engine and it takes them about an hour to find a used piece of tubing in the town to make a solution.  We stop about 4 times after that to re-arrange the repair.  Though the bus is air-conditioned, as the heat of the day progresses, I just sit there sweating, as the AC cannot keep up with the outside temperatures.  I’d guess it got up to 110 – 115 deg.  Either way, for a coastal Oregonian, it is unbearably hot.  

            I arrive at the bus station in Kelo and a truck and driver is there to get me, I’m grateful to no have to take motos to Bere with all my X-ray luggage.  After arriving in Bere, I meet missionary friends and meet a number of new people as well.  After supper the missionaries gather together for a  worship on Friday nights.  We sang songs and read a story of answered prayer.  Then I go to the room they have arranged for me, do my ritual brush teeth and shower- then to bed dripping wet.  I brought a thermometer out of interest, and it’s 92deg in my room as I hit the sack, under the mosquito net, and with a fan on me.

PS: If I’ve sent this while in Africa, that means that I’ve gone out during the afternoon (which I’m almost always in the OR), to that special tree between Bere and Lai where one can get a 3G signal.  Then if all airwaves line up correctly, things will go out.  Otherwise my phone says 3G and nothing happens.

Bere 2018 #23- Last one

admin Audrey, Greg, Shanks No Comments

Bere 2018 #23- Last

My alarm goes off at 4:30. I’ve had about 2 hours of sleep since the C-section I described in the last post. I’m tired and could immediately go back to sleep. But we have motos to catch to get out to Kelo to get the bus by 7:30. Our moto driver, Abba, is suppose to be at the gate at 5 to get us along with another driver. The water is suppose to be high and he told us last night that we would need canoes to cross the widest area. So instead of the usual 3500 CFA he wants 5000 ($10) each. I’m skeptical but agree, saying that if canoes are not needed than Ill pay the 3500 CFA in stead. We had packed the night before so we basically get dressed and grab our bags and head to the guard’s gate to wait. At 5 AM I call him and apparently wake him up. About 15 min later he gets there and at 20 min later the other moto arrives. They strap our bags to the back and we sit down behind them. The sun is just coming up and it’s a beautiful ride. We are going around large puddles that could swallow a car easily and some areas are under water for 50 feet. It is beautiful as the sun rises. Eventually we get to the area of the lake, and the canoes want 500CFA to carry us. They decide it’s not that deep after all and drive on through with water up to Audrey’s knees. The motos keep going and we make it. She is with Abba on a decent moto, and I’m on a moto that doesn’t have a right passenger foot peg. I look down mid-way through the ride and realize my foot is resting on the exhaust. Since my shoe isn’t sticking to it and melting, I leave it there as there is no where else. Eventually we make it to Kelo after hitting a duck and a chicken- both appeared to survive the incident. I give Abba 10,000 and expect the change. He says no, that we had agreed to 5000. I’m tired and in no condition to be taken advantage of. I raise my voice and start telling him that he knows that’s not right and to give me change. He and the other guy chime in that this is what was agreed to. I’m too tired to fight for long, so I walk away and tell him he won’t have my business ever again. (Not that that matters to him, as I’m leaving and he knows it) I board the bus, and sit next to Audrey and we head the 9 hours north. We stop a number of times for pee breaks, out beside the road and make it by evening. Sarah A picks us up and we are grateful to stay with her and her kids. As we are falling to sleep we hear her dogs barking, and cats making terrible noises.

This morning I awaken at 6AM after some good sleep, but with a bursting bladder. I drank a lot after getting off the bus as I hadn’t peed all day. After breakfast of oatmeal and bread with peanutbutter, she had asked me to help her with a tubal ligation on two young german shepherds that she wants to sell. I’ve not done them in dogs, but she has and I have in humans. So we grab a puppy and put her on the table. Sarah gives her ketamine and soon the puppy is out. We prop her up with towels laying on her back. Her paws are tied back on each side. I prep with betadine and cut along the midline. I get to small intestines. I fish my sterile gloved finger around and find a fallopian tube and the ovary. I tie and take off the ovary. Then do the same on the other side. Down below where they come together, I tie off what I suspect is the uterus, and excise the whole thing. I close the muscles like I would a person and the skin. We do another puppy the same way. Later on I hear both are doing well, eating and playing again. I’m glad to hear that! I don’t want to hurt animals either.

Now we are on flights back. The whole trip takes 3 days to go and the same to come back. I’m finally cool and it feels great!

There is an ongoing need for surgeons and other help in Bere. If you are flexible, like adventure, and have your own funding to make a trip like this, please contact me or the doctors in Bere. You are needed! If any of you are interested in funding anything in Bere please contact me and I’ll figure out how this is best done. If you want to fund any assistance for the Koza hospital we used to work at, it can be done at the website below. Thank you for your interest in areas that are truly in need of your help. Sincerely, Greg and Audrey

for more mission stories visit our mission website www.missiondocs.org

for information on our missionary and pastors oasis visit www.lifeimpactministries.net and click on Safe Haven Oasis

Bere 2018 #22

admin Greg No Comments

Bere 2018 #22

I’m on the plane from NDJ to Addis Ababa.  It is just sundown and two seats behind me and to the other side, a Muslim man starts what to me sounds like the Islamic call to prayer.  He sings the song for a number of minutes.  Maybe its more than the call to prayer maybe it is the service that they normally attend.  As a non-Muslim, I’ve never been inside a mosque at the call to prayer, though it does interest me.

The day before yesterday I did rounds with Dr. Sarah on maternity and told her about the patient with the tracheostomy and what I thought would be a reasonable timeframe to take it out.  I wanted to let her know what I was doing and had done for a few so she wouldn’t be in the dark after I left.  In the early afternoon I took a kid to the OR that had broken his leg in January.  It must have been an open fracture based on the fact that now, bone was sticking out.  He had been unable to walk for about 3 months, then was able to walk,   At this point he is walking and playing football (soccer).  He is about 8 years old, and has shorts on with a handkerchief wrapped around his mid-lower leg.  I unwrapped the handkerchief, and saw about 6 inches of tibia.  The upper end was sticking out a little, the rest was exposed with a bridge of skin about an inch wide in the middle.  It seemed firm, but I suspected that if  I took him to the OR, enough time had gone by that I’d be able to remove it.  I suspect a sequestrum.  That’s when your body takes an infected piece of bone and starts pushing it out over time.   The bone behind or the periosteum can create bone behind that allows the person to have an intact bone.  Healing behind the infected piece.  So in the OR, he was given ketamine, and the nurse prepped his leg with betadine.  After it was prepped and draped and he was asleep,  I cut the skin over the middle.  Then we grabbed the end that was out the most, and it seemed a little mobile.  I rocked it back and forth.  I realized that a spike of bone was still under the skin in the upper area, so I cut the skin above that spike.  After releasing the spike the rocking motion easily dislodged about a 6 inch piece of the anterior tibia.  Behind was all granulation tissue.  Dressing changes should help him heal this nicely.  A dakins dressing was placed and off he was to the preop/postop room to start to wake up.

Next was a 15 year old kid with a mass on his  foot that had been there about a year.  He said a piece of wood had stabbed him there before.  I suspected a reaction to retained wood pieces.  The mass was on the top of his foot and was about 1.25” across.  I expected to have to leave it open, but I was able to get the skin closed with some tension.  He was pleased that I was able to close it.

I thanked each of the OR staff members and thanked them for their work.  As I grabbed my bag and walked out suspecting this was my last surgery in Africa for this trip.  Then they said I was needed in the ultrasound room for a suspected ectopic pregnancy.  I put back my bag and head over there.  As I look at the ultrasound screen and run the probe over the woman’s belly, I realize it must be an ectopic (extrauterine pregnancy).  So I write orders and send the husband to the pharmacy to get medicines and send her to the OR to start getting her fluids so a spinal can be done.  After the spinal Dr. Sarah and I opened the lady’s abdomen, and as I described in previous posts, there was a lot of blood!  Three to four liters of blood came out in the suction canister, all over the drapes, and pudlded on the floor.  She was getting blood as we started, and I could see welts starting all over her.  She was having a transfusion reaction.  They haven’t really started crossmatching blood yet.  Though apparently the lab has just learned how to do it.  We gave her dexamethosone, gave her a benedryl tablet under her tongue and I wondered whether she would go into DIC (a bleeding disorder) from the transfusion.  Her hemoglobin was 5 before any dilutional effect.  At the end of the surgery Dr. Sarah tells me there is a woman in maternity that had a C-section before and is trialing for a vaginal birth.  If she stops progressing then she will need another C-section.

Back at home I sit in front of a fan and sweat!  It feels real hot tonight.  Finally with sitting and cold water I stop sweating.  I take a shower and head to bed wet, hoping to fall asleep before I evaporate.  I do fall asleep and about 1 hour later am awakened by a knock at the door.  Someone who has been stabbed in the back, is in the ER and I need to evaluate them.  I grab my headlamp and head in, expecting to need to operate, they don’t make short knives here.  So I anticipate internal injuries.  I see a young man writing around in pain with a crowd of about 20 onlookers.  He stops writhing as I examine him.  I see a small ½ inch hole just to the left of midline in his lower back.  I also see a ¼ inch hold that is in the midline.  Did it hit his spinal cord?  Either way I cant do anything about it, but I’m curious.  He seems to have normal sensation in his legs, but pain on one leg more than the other.  I prep both areas with betadine and grab a needle cover to probe the wounds.  The one in the middle goes straight in about ¼ inch.  The other one goes in about 3 inches but runs just under the skin.  I decide to leave both of them open with a sterile dressing.  Give him antibiotics and tetanus vaccination and expect him to get better.

I go to maternity to see how the woman is progressing with her delivery.  Dr Sarah is there and the patient isn’t progressing.  So to the OR we go.  We get a live, crying baby out with lots of meconium (baby poop, meaning fetal distress).  I head to bed about 2 AM after another shower to get the blood off me and cool down again.  We are scheduled to leave at 5 AM for our trip back HOME.  It was a short night!