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Shanksteps Bere 2017 #4

Today we wake up early and our plan is to head to Bere.  James and Sarah get up early and feed us breakfast (Thank you!)  We then head to the bus station with all our plastic boxes of medical luggage in the back of the RAV4.  It’s dark and we are turning on one path then another, and if James weren’t driving, I’d be totally lost.  But I do see a little glow on the horizon so that can give some orientation.  We arrive at the bus station while it’s still dark.  James gets our tickets and then we realize the bus is on the other side of the road and there’s a concrete barrier between sides. So we go down about a half mile and turn around.  Arriving at the bus, there are crowds of people milling about.  There is a large bus that is air-conditioned, YEAH!  We get our things put underneath and then board.  The pungent smell of urine greets us.  There are decorative drapes on the windows and all around.  Reminds me of what I’ve seen in pictures of busses in India.  We find seats free near the back door and Allah sits behind us.  About a half hour later the horn is blowing and we are moving forward slowly, kind of waiting for the last people to get on.  We take off with a few empty seats.  These are gradually filled along the way by people standing on the sides of the road waiving us down.  As we leave town we are stopped at a number of police barriers.   We stop at some and others drive right through.  It’s getting a little lighter, and I can see temporary shelters and a section with many camels.  I guess this is the area where the nomads are.  They are often the ones with camels and herds of goats, sheep and cows.  A few horses may be seen too.  All the animals are very thin with all their ribs showing.  We also pass a few heavily laden two wheeled trailers that are being pulled by a long horned cow.  About an hour out of Ndjamena we are stopped at a police barrier.  A policeman gets on at the front and slowly asks people for their identity cards or me for my passport.  He is asking men, the women and young he doesn’t ask.  He asks for my identity card and I give him my passport, he asks for Audreys too.  He looks behind us and then gets off the bus with my documents and others cards.  Allah tells me I need to get off and talk to him.  I think that if I wait he will bring it back.  Allah says that the bus will leave either way.  So I get off with him to go talk to the policeman.  He says something to Allah who translates to me that he “wants a drink”.  I understand this immediately to mean he wants some money.  Rather than striking up a conversation like I should, I get angry.  I raise my voice and say I’ve come to help the Chadian people and all my documents are in order.  I demand my passport to show him, and surprisingly he gives me one.  I show him my visa…  I put out my hand for the other, and again, surprisingly he gives it to me.  I walk back to the bus.  As we leave, Audrey reminds me that I need to talk with the policeman on the bus before he takes my documents.  I had forgotten that this helps a lot!  One thing about the culture here is that relationships are very important.   And so if you are friendly and make conversation, this avoids many troubles.  I think they are spot on here, and I (and many in the US) could learn a lot from 3^rd world countries in this regard.

We continue down the road.  There are little villages here and there, and many miles of open areas with few trees, shrubs, and dried grasses.  It’s the dry season and things are dying.  The hamartan winds are blowing so there is a lot of dust in the air, as it comes off the Sahara.  Northern Chad is in the Sahara, and so we are still very sandy and dry here as well.

A while later we get stopped at another barrier and a military guy gets on in the front and another at the back door near me.  He walks straight up to me and with a stern face asks for my documents.  I start talking as Audrey takes her time rummaging around in the backpack for the passports.  I say hello and that we are doctors traveling to help the people of Bere.  That we will be there about a month and that we have just arrived.  I tell him we have brought medical supplies to bring to the hospital as well and that we are tired from our long trip that had started 2 days before.  He then says he just saw Olen from Bere come by there the day before.  I tell him that I was suppose to be with Olen but that my travels had been delayed.  He notes that he is coming to Bere next week, and I volunteer that he should say hello when he comes.  He smiles, and I show him the covers of the passports, he waves them away and continues down the line.  Others behind me are not as fortunate and as I see others get off after him when he descends down the stairs.  Eventually they get back on and we continue on our journey.  About 3 hours into our voyage we stop for a 15 min stop in a little town and back into a bus station.  We all pile out and they lock the doors so our things don’t disappear.  We go and pay the guy at the toilet the 50CFA (about $0.15) and walk in to the pit toilet.  It is full and the stench is overwhelming.  I am very happy to just need to pee.  I then walk around and look at the people selling various foods.  The one that catches my eye most are the fried grasshoppers.  There is large pile of them and a person is buying a small bag full.  I ask if they are good and I am assured they are and am offered one to try.  I can’t do it- so thank them and decline.  There are also piles of fried doe like donut holes.  Meat grilling on a fire, lemons, oranges, a few apples, peanuts, watermelon, papayas, taro, and a few other vegetables I don’t recognize.  I guess as we are after the rainy season, there is still a variety available.  They honk the horn and we all load again for the 4 hours that remain.  We continued on the paved road all the way.  There were many many large holes in the pavement all the way down.  So there was a lot of slowing down and swerving to hit a shallower area of holes.  If the road were good, we could’ve made it in half the time.  We don’t get stopped anymore and arrive in Kilo that afternoon.  We unload our boxes and luggage and wait for Dr. Bland.  We load up our stuff and head to Bere with him.  Before we leave town we look for gasoline.  Both stations in “town” are out of gas, and we have enough to make it to Bere so we head out.  We pass some girls selling bottles of roasted peanuts, so stop to get some.  As soon as I roll my window down and call them over, there is a mass of people wanting to sell theirs.  About 10 bottles are shoved through the window and dropped in my lap.  I try and tell them to stop and it’s mass confusion.  I finally roll up my window, I try to stop with it a little down- but it is automatic and continues all the way up.  Fortunately no ones fingers were in it when it closed.  I eventually get it a little down and get the excess bottles out.  I then pass out he money and wait for change.  About 3 minutes later the one woman I gave it to, gave me the change back.  Everyone else was unhappy that I didn’t take their nuts and waved them at me to take more.  We drove down the dirt road and into Bere Hospital.  It was dark when we arrived and we were happy to be off the road and take cold showers and get to bed.  Mrs. Bland had made some food and left it in our kitchen.  How nice to have that when we arrived!  It felt very good to get the dust off our bodies and as I usually do in sub-Saharan Africa- I went to bed dripping wet.  I hoped to fall to sleep before I evaporated.  And sleep I did- till the bat noises woke me up at 3 AM as my jet lag kicked in.  9 hours different is difficult for a number of days.

Shanksteps Bere 2017-3

I awake from a relative unrestful sleep- because of jet lag. It is 3:45 in the morning. There are dog barking, insects chirping. I lay there in the heat and toss and turn. I went to bed wet last night, and hoped to sleep before I evaporated. The desert cooled off and I felt cold in the middle of the night. At about 4:20 I hear the familiar Allahu akbar (God is greatest)x4

Ashhadu anna l ila ill Allah (I testify that there is no God but Allah)x2

Ashhadu anna Muhammadan rasul Allah (I testify that Mohammed is God’s Prophet)x2

Hayya alas salah (Come to prayer)x2

Hayya alai falah (Come to security/salvation)x2

Allahu akbar (God is greatest)x2

La ilah ill Allah (there is no God but Allah)

Assalatu khayrum minan naum (Prayer is better than sleep)

This intonation goes on for about 3 minutes (can be heard online if your interested). I feel at home in West Africa again. I lay awake unable to sleep and have my special time with God. I am also reading a book called “The Bondage Breaker”. Within an hour the sun is coming up and the sound of chickens and dogs increase. It is Friday. We have decided to halt our progress to Bere to stay with some friends in Ndjamena (the Appels).

We all eat an oatmeal breakfast and James and I head to the hospital. It is a mission hospital that James volunteers at here in Ndjamena. We go to see an old man who needs a debridement of his foot. It’s a holiday and the hospital has two nurses on and we can’t find either one. Finally we find one in the “ER” (two bed small room with a curtain in between them). We go to see the man with the foot that’s been infected and draining for many months. He is eating bouii (pourage), meat, and other things for breakfast while he was ordered NPO (nothing by mouth). So it is unsafe to give him sedation and do the debridement. So we tell him not to eat anymore and we will work on him in the afternoon.

We go and find the covering Chadian doctor and do rounds with him. During rounds we see a 10 year old girl that has been treated for myositis (muscle infection) of her upper leg. She lays on the bed very stoic. The antibiotics seem to not be working as her upper leg remains swollen and very tender to touch. There are little healed cut marks on the thigh, which I interpret as the place of most pain. (In Cameroon these cuts were made to let out he bad blood or pus by someone at home with a razor blade). She had an ultrasound 4 days ago and no abscess was seen. Her leg had been wrapped in a gauze and the nurses put alcohol on the gauze. The patient thinks that it may be a little better. We talk to her and her mom and grandma who are at the bedside. I wonder if there isn’t an abscess now, as it isn’t better. So we tell the family we will be doing another ultrasound. The mother wants to wait for the father to make the decision, and we convince them not to wait. She is taken to the ultrasound room. She is lifted onto the exam table with eyes ready to pour forth tears. She doesn’t know what we are doing. Her grandma is there encouraging her. As James looks around her thigh- we find what appears to be a pocket of fluid that seems to be lateral on the leg. After explaining to the mother and grandmother what we’ve found we convince them to let us take her to the operating room for sedation and to open her leg.

In the operating room she is given a shot of ketamine and we wait. She is eventually staring off into space with unconscious eyes. I incise the side of her leg and spread into the muscles. Spreading around I start to wonder if we really saw an abscess. James spreads around to and pus flows out. We put a finger in and break up the loculations all around the femur. We get about 300ml of pus, and the space is about half of her lower thigh. We wash it out with dakins solution and pack it with gauze. I am now content that she will get better.

We are called to the ER again to see a guy with a strangulated inguinal hernia. An old man lies on the bed. His hernia has hurt for 4 days. And yesterday he started to vomit and has been unable to pass stool since yesterday. His abdomen is very bloated. We ask for the operating room crew to be called in for an emergency hernia repair. In about an hour we are in the operating room.

He is given a spinal anesthetic and we start. I incise the skin and I think, either this skin is tough or this blade is dull. I make a number of passes with the knife and am finally through the skin. The hernia is large and firm all the way down to the bottom of the scrotum. Slowly we dissect out the hernia sac. We open the sac and find his colon and omentum(a fat layer it the abdomen) in it. The colon does not look good. I open the hernia site larger and with more space, blood starts to change the color of the colon back towards normal. I’m able then to reduce the colon and omentum back into the abdomen. Within minutes we hear diarrhea coming between his legs. The blockage has been relieved and the odor of success is permeating the room. We close up the hernia site and close the skin.

Later we debrede the infection off the foot of the old man.

After each operation the staff take whatever has been removed out to show the family and they nod and make comments about whatever they see. I’m often curious what they are saying. Especially about the pus from the girl, because there were a lot of facial expressions and talking.

We went back home and ate some rice and beans. It is 95 and dry. We spend the afternoon talking and swinging in hammocks. Night falls and it finally starts to cool off. I’m am very grateful for cooler nights. I’m also grateful for the ability to serve others with trips like this. Seeing other cultures always reminds me of the blessings I have that many others do not have, purely because I was born in a 1st world country.