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Bere 2018 #13

“Quesque tu fait ?” I am trying to figure out what’s happening as the anesthetist and the student nurse get the very old blind man off the OR table and he starts to squat to the floor. They kick a bedpan underneath him. At first I think that he needs to pee, then I hear it’s to poop. NO NO! Go outside. They stand him up and slowly go out to the preop area to have him poop in the bedpan. I don’t want to stand in that smell for the next couple hours as I fix his strangulated inguinal hernia and his accompanying hydrocele. I also don’t want that contamination in the OR. Though it seems that frequently when someone gets their spinal, at the end of surgery there is poo between their legs. Finally he finishes and they get him back on the OR table for his spinal anesthetic. He has had an incarcerated hernia for about a week. His scrotum is nearly the size of a US football. The cautery grounding pad doesn’t seem to be working so I disassemble the connections and recreate the metal grounding pad. It works. He is prepped and draped with cloth drapes. This pack they had resterilized paper gowns, so I feel like I’m in luxury with sleeves long enough for my arms. As I get down to his hernia and open it the identifiable structures are difficult to find. I identify the fascial layers and the nerves. But the cord structures with the hernia sack is really edematous and difficult to figure out. After dissecting around for about 15 min. I finally enter the sack. It seems to have intestine stuck to one wall. After about another 15 min, I figure out that it seems to be a piece of large intestine with the appendix on it. But the intestine occupies one wall of the hernia sac and I can’t separate it. I kind of close it back up and then am able to reduce it back in the abdomen. I compete the suture repair of the hernia and then look at the hydrocele. As I dissect around the testicle, there isn’t a hydrocele, just a lot of edema. So I put it back in the scrotum. I close up the various layers finishing the surgery.

There was a lady that came in with a low hemoglobin 4 (normal >12), and received 4 units of blood last night. Today she is 6 (should be around 8). Her belly is distended and tender. I decide she needs an exploratory laparotomy. Eventually they get her form the ER to the OR and she is the first surgery of the day, well before the one noted above. Phillipe (anesthatist) gets her ready as I make rounds. I send home a number of people. Some of them just have dressing changes and have been here a long time. After she is ready, I call Dr. Sarah and she is done with rounds, so she joins me. Since her pain started all over her abdomen, Im not sure what I will find. So I make an incision in the middle of her abdomen. The blade seems dull for her tough skin. When I get into the abdomen yellow fluid comes out. There seem to be adhesions everywhere. They are fairly weak adhesions and most I can just divide with my fingers. I don’t see anything obvious for a while, so I keep looking. I don’t see any pus, no stool. Eventually I look around the stomach after extending the incision up as high as I can. Then I see some dark tissue on the anterior stomach. Eventually I see mucosa coming out a hole near the pyloris (exit of the stomach). She has a perforated stomach ulcer that is huge. I try to decide wether to close it or just cover it with omentum. I do both. Freshen up the edges. Reapproximate the edges and then suture up some omentum over the area. I have the anesthatist put in an NG tube and I leave a drain through the abdominal wall to the area as well. She will need antacids too!

I’m sound asleep. I hear tapping, and eventually am conscious enough to realize it’s someone at the door. I look at the phone and see I’ve been asleep about 45 min. I get dressed and walk outside. The moon lights up the sky and ground. The maternity nurse says she has a woman in the delivery room that bled a LOT at home and continues to bleed here. She thinks she is near term pregnancy. She doesn’t hear the babies heart beat. She did a vaginal exam and felt what she thought was placenta. Diagnosis: placenta previa. This is where the placenta covers the birth canal and as the cervix dilates, the placenta starts detaching from the uterus and bleeding. This often kills the baby and can kill the mother as well. I am AWAKE NOW! I follow her in, and get the ultrasound on my way. The 25 year old girl is lying on the delivery room floor, having just vomited on the floor. She lays in a puddle of blood and blood is all over her wrapped skirt. I put the ultrasound machine on the floor and squat beside her and do the ultrasound. I find a baby that is alive but 32 weeks and has a heart rate of 71 (normal is 130-150). This baby is dying, and is to early to live here. No neonatal ICU here- just mom and grandma giving him breast milk. The girls hemoglobin is 6 and I think this is falsely high. Her eyes could not be any more pale than they are. I see NO vessels whatsoever! I call he anesthetist to come in and figure ill call Dr. Sarah too. Then one of the student missionaries, Diana, comes by and she says she can scrub with me. So I scrub with her, and let Dr. Sarah sleep. She is blood type A-, and I think, it’s unlikely we have any blood that may work for her. Fortunately the blood bank fridge is in the OR, so when we get her in there I check. Yesterday we had a woman who had an ectopic pregnancy and we gave 4 units of blood to. Everyone the lab tested was A and the patient was O. They gave anyway, and we used O from our fridge. Now I see that God was working everything out YESTERDAY! As I look in the fridge, I find 5 units of A- blood. WOW!!! I hang one, and the anesthetist gets there soon after. We have a unit of blood going on each side, wide open. We do the usual prep and drape with cloth and I pray out loud and start. As I cut into the abdomen she bleeds, but I can tell it’s diluted blood. It almost seems see-through and doesn’t coagulate. I use cautery and clamps, and cause as little blood loss as I can. I cut into the uterus- and it always bleeds a lot. Then I pull out the baby. I strip the umbilical cord towards the baby to give it as much blood as I can. I hand him off after cutting the cord. He is trying to breath- Im not hopeful for him. As I close up the mother, I see the baby moving a little but no sounds. The nurse says he’s breathing. I ask God to save the baby again. I finish up and the mother is doing well. The baby has been taken out to the family and I head to bed.

The next morning as I get to the hospital I ask about that baby. I am told that he is doing well and has breast-fed already! PRAISE GOD!!!! A miracle!! I couldn’t have imagined he would ever make it.

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Bere 2018 #12

Malaria is a killer! I’ve been seeing adults with malaria that have low hemoglobins of 7 from malaria. Others have scleral icteris (yellow eyes) from blood breakdown from malaria. Some have large spleens from malaria. About 445,000 people die of malaria each year. More than half of those are children

I finish rounds on the surgical ward and the medical wards. I head over to pediatrics to see what Dr. Sarah wants me to do next. She has one more patient to see. As I talk to her, that last patient dies of malaria. The mother is crying and runs out of the building. The aunt that was holding the baby continues to hold it and shut it’s eyes. The nurse takes the IV out. It is pointless to do CPR. We are sad at loss of another life. With the quantity of child death in Chad, it remains one of the major health issues in the country. Each mother when you ask them about children, they cay how many they’ve had and how many are living. I was doing an ultrasound on a lady the other day, and asked that question. She said she had had 8 children and 3 were living. Others have more living children than dead. Most seem to have at least one child gone.

I continue to pray for each of the wards of patients, that God would continue to heal them and that they would know Him. He is the only one that can give you peace in this world of turmoil.

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 #11

There’s a knock at my door. Avava (a friend from Cameroon) and I have been sitting her talking. I open the door and its one of the student missionaries with the two AHI lab guys, Ben and Erik, that just arrived yesterday to set up lab equipment. They’ve come over for the Friday night singing and worship that the missionaries do every Friday. I didn’t know it was going to be here, but I’m happy it is. We have plenty of room in our place to host it. Eventually everyone show up and we sing hymns, in English. Then, as they’re used to doing, everyone goes around the circle and shares what they are thankful for this week. I mention that I’m thankful for the prompting of the Holy Spirit. He helped me decide to operate on the 17 year old kid that had vomiting without other signs of bowel obstruction. That he is doing well and I am glad that I operated on him. After out thanksgiving, we sang hymns. I really enjoyed as everyone sang and there was at times 2 or 3 part harmony. We than shared food. Some we had here and some they brought. We talked for a few more hours.

After everyone left I went to the hospital to pick up the ipad that I place orders on. I had left the ipad on the pediatric ward, where the only charging cord happens to be. A child of about 2 years old had just come into the hospital and the nurse wanted me to see him. He was eating a banyee (a small deep fried lump of bread, kind of like a doughnut without a toping). His abdomen is very distended and rock hard on the left side. His father says his abdomen is the reason he came. He eats fine, poops fine, and doesn’t vomit. Recently started to have a cough a couple days ago. He has an ultrasound report from another place. I can’t read all of it, but it seems to say he has something on his kidney. I wonder if this is a huge cystic kidney? Even though its 11pm I decide to do the ultrasound then, as the next day is Sabbath and I hope to go to church and not get stuck in the hospital. I take them to the ultrasound room, put ultrasound jelly on his abdomen and take a look. I see a huge solid tumor. This is cancer! I cannot get pathology here so there is no point in biopsying it. I also can’t treat whatever it is, even if I could biopsy it. I share the bad news with the father and they head back to the pediatric ward. The nurse doesn’t really speak his language so there isn’t great communication. I head to the other wards, to ask if they have any problems that I need to deal with before going to sleep.

As I lay in bed, I read my book and also think about that little boy. I look forward to Heaven, when we won’t have any more pain and these diseases will not affect people any more. And most of all we will be with Jesus.

Bere 2018 #10

I’m on the moto (motorcycle), riding along the mud road. Periodically children are yelling “Nasaraaaaaaaaaaaaaaaaa”. There are huge pot holes everywhere. An S pattern best describes my continuous way of going around them. There are tire tracks from the many motos that have traveled this road on the way to Lai. It’s the next biggest town to our east. I weave along the main road through Bere and continue towards Lai. Women are walking with a load of about 4 ft long grass in a bundle laying on their head, with little children strapped to their backs. Boys aged about 8-16 are naked on the side of the road and a few are still playing in the rice field. They must be laying down, as it seems that the water in a rice field cannot be very deep. Or maybe a little stream that I cannot see since the whole thing is flooded. Other little boys stand on the side of the road with about a 10 ft cane of some type, and with a string and whatever- are fishing in the rice field. Others are slowly moving along on their bicycles in groups of 1 or 2. I pass a group of about 8 guys that have been out working the fields as they have the curved cutting implements laid across their shoulders. The special tree comes in to view. I pull up near by and get out the computer. I get out my phone and I create the hotspot. After connecting my computer I send my emails. I try to contact my wife, but she is already at work, so we aren’t able to talk.

There ended up being no scheduled cases today but I found one and Dr. Sarah found another. I had done the rounds on the surgical ward and then went to the medical ward. There was a kid there who was about 16, and had been vomiting a week now. The last two days I thought he was improving. As I step up to his bed he grabs a bowl and pukes a huge amount of green stuff into it. Part of it hangs in a string from the side of his mouth, and the dad grabs the stringy saliva and drops it into the bowl. His belly is not really distended, but he’s been vomiting a week they say. When I re-ask about bowel movements, this time he says it’s been a week. But he passed some gas yesterday. I finally decide he must have a partial bowel obstruction that must be real close to the stomach, since he doesn’t appear distended. I tell the father that we need to operate on him and send him to the pharmacy to purchase supplies. The whole surgery with postop medicines comes to 65,000CFA ($130). They pay it right away. He is the first surgery, and we start about noon. Fluid and then a spinal anesthetic is given. I smile to myself again, as to why we are giving a spinal to a guy with upper abdominal surgery a spinal anesthetic. If it were to actually work, then he would stop breathing, then there would be many hours of bagging him with a mask. I’ve told the anesthetist that many times, and he does it anyway so I don’t say anything. Dr. Sarah joins me and we scrub. We put our cloth gowns on and sterile gloves. We put four drapes around the abdomen that has been prepped, then apply the clips in the four corners. The large cloth drape with a hold in the middle is placed last. Now only the abdomen with it’s vertical, near top to bottom, scar is visible. I expect this to be difficult so I do it and she helps me. I cut through old scar, and eventually get into the abdomen in an area there doesn’t seem to be any scar tissue on the inside. I am glad, as sometimes intestine is stuck there and it is possible to make a hole in the intestine as you enter, even if done cautiously. Once I can feel the inside, I extend the incision where I can. Other places I have to use scissors to take down the intestine from the abdominal wall. There are adhesions everywhere. I slowly dive in cutting them, in areas I can see. As I get about a quarter of the way down, I see a loop traversing underneath others. As I free this up, I realize that this was the point that was pinched and blocking the flow of intestinal contents. I am happy that I chose to operate on him as this will fix his problem. It takes another 45 min or so to take down the rest of the adhesions. I decide to do an incidental appendectomy (means the appendix is not inflamed but I take it anyway), as I’d hate to be in this abdomen again, though it does add a little risk of infection. Eventually we recheck everything, wash out his belly, and close him up. He immediately pulls out the nasogastric tube in the postop/preop area, when the nurses aren’t watching him closely. The nurse sent out his father then left him lying there by himself. I reprimand them gently and I reinsert it. Then I have one of the nursing students hold his hands so he can’t pull it out again. I seriously doubt it will even last a few hours, but I hope it does.

Next there is a 18 year old girl with a wound infection who was told not to eat about 9 this morning. Instead, she ate breakfast after that, and had a glass of water at about 1pm. The anesthetist wants to put her off till tomorrow, and it seems reasonable to me, so we get the next one.

Next is a 18 year old girl who just had a delivery and has some parts of the placenta retained. Dr. Sarah is doing rounds on peds and asks me to go ahead. So I do a curettage to get out the pieces of the retained placenta. Im done by about 3:30 so I head out on the moto to send emails. What a beautiful afternoon! The sun is out, frogs are croaking, birds are singing, children are yelling Nasarraaaaaaaaaa. It’s beautiful!