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It is Saturday, Christmas Eve, and I was at church. I’m called out in the middle of it to see a patient that was in a moto accident. One of the health center workers was riding at a “slow speed” and hit a rock and fell over. He lay in the dirty suture and dressing change room moaning. I asked Bouba, the nurse to find a stethoscope. I had forgotten mine in the US. He ran to the ER and came back with one. The man complained of his shoulder only. I listened to his lungs checking for a pneumothroax that could kill him, and they sounded normal. So I examined the rest of him. I only found a broken clavicle. I put him in a figure-8 dressing to help put this in place. I checked on a couple others lab results then headed back to church. Right at the end of church they called me again.

There were three that had been on a moto. Two men and a teen girl. The girl had a fractured wrist, one man had a fractured wrist and a hematoma on his head. The third man had a fractured wrist, broken femur (upper leg bone) and a ankle fracture. They were laying in their hospital beds moaning. After checking each one out I asked whether they wanted to be treated here or by the traditional bone setter. Two wanted to leave and the one with multiple fractures wanted to be treated here. I have always had to fight with them before, so I knew what was coming. I decided since they were adults they could choose badly for themselves, and besides, though I have shamed many people in the past for not doing what the doctor ( me) wanted, they still wouldn’t let me do it. So when these decided to not do it, I wasn’t surprised. It ended up after the x-rays that even the lawan (the local low level chief of a certain area of the village) with three fractures, he decided not to do it either. So I left and went home.

We prepared a special evening meal. In the late afternoon our friends from Chad arrived on a surprise visit. And the power went out. So we filled up every available pot, jug, and glass with water before it ran out in the water tower. We had a wonderful candlelit meal. It consisted of home made everything; gluten, beef stew, stuffing, green beans, salad, potatoes with margarine, rice. Later we opened the few gifts we had brought for our guests and the student missionary here, while sitting in front of our decorated tree branch that we cut from a tree. Decorated with toilet paper streamers, paper figures, and cutouts from a magazine. We had a great time. We think we appreciate a simple Christmas, as theses have been our favorite. G

I sit against the operating room wall holding a small baby in my lap. He is wrapped in a dirty blue towel that has amniotic fluid and meconium all over it. He had come out of the cesearean section that I just performed with a big cry and apparently breathing well at the beginning. I was doing a surgery on a woman with a small pelvis that had been in labor for three days before making it to the hospital in the evening. I had done the same girls previous surgery a couple years ago. She says that her girl is still living. She wanted to have her tubes tied after this surgery. Her husband agreed. As we finished up the surgery, Yaouke was suctioning the baby, Dr. Solomon and I were closing the uterus, and abdomen. Yaouke said the baby wasn’t breathing well. At the end I checked the baby. If a black baby can be blue this one was, or at least his lips were! I put oxygen on him. He had small grunting sounds. I sat there against the operating room wall will the nurses cleaned the room. As I sit there I cradle this new life in my arms. I try to wipe meconium off my finger by wiping it on a “clean” area of the towel. I place the oxygen monitor on the baby’s finger. The whole hand fits inside, but eventually I get a reading. When the baby wiggles around and the oxygen comes off his nose, his saturation drops to 77% (normal >92). He desperately needs the oxygen. The next thought that runs through my mind is how long should I sit here holding the baby. As we have been back here it is easy to fall back into my previous roll and concerns. Again, how long will I sit here taking care of this baby. It’s a little different this time because I only have to have enough energy for two more weeks, not a year. So I sit there longer. After about an hour there seems to be no change and everyone is done with their cleaning and other tasks and ready to head home, 10PM.

I take the baby to the nurses sleeping room, office. I set up the oxygen concentrator, monitor, and voltage converter to keep all running. The nurse finds a padded foot of the bed to move into place on the floor. I place the baby on it and tape the monitor to his foot that is moving constantly. It seems to pick up his vessels and oxygen concentration. Tape the oxygen cannula to his face and cover him with all the cloth the family was able to come up with. A couple small pieces. I watch the pile on the floor move a few minutes and everything seems to be working.

I check on the 17 year old girl that had a bad motorcycle accident. She arrived unconscious and on palpating her head I felt she had a depressed skull fracture. I had rushed her to surgery yesterday afternoon. I explored her scalp. There was a large hemotoma (blood collection), but no apparent skull fracture. I closed up my incision. I talk to the family who is sleeping on the mats beside her bed. They say she has not moved or done anything since surgery. I uncover her from the large blanket that is on her and she feels hot. She’s about the age of Sarah, and I worry about her, knowing I can do nothing more. We get a glass thermometer and check her temperature, its equivalent to 104.5 deg F. Is she having malaria, or a central (brain) fever? Well I can treat malaria and not the other, so I treat malaria, and give her IV asparin to help bring down her fever. IV asparin is the only med here to give for fevers.

I check on the small pile of fabric in the nurses room. It’s still moving with the baby boy inside. The oxygen numbers seem OK, so I head out to the ER, on the way home. There I am stopped by a nurse who just brought a pale baby to the the ER from the pediatric ward for oxygen. A hematocrit (blood count) has been ordered since 2PM but not done. I ask them to call the lab tech and get it. Then to verify the blood of the mother who is present to give it to her baby. They are instructed to call me if there is no match as I am O+ and can give to most people. I head home.

…

I am thanking God! HE protected the child through the night and the kid had breast fed a couple times before I saw him. Mom is complaining of pain, but then again why not, I forgot to write our strongest pain medicine, Ibuprophen! The mom is laying in her bed on her back. She is covered by panye (colorful cloth) from the waist down, the top bear with the baby attached to her right breast. She is smiling because her baby is alive. This one moment makes my hours last night worth ALL of it!

It was Sunday, market day in Koza. I awake with diarrhea at 4AM. I cant sleep after this. Have diarrhea a few more times by 7:30 when I head in to the hospital for morning worship and signout.

Sunday means that hundreds of people are in the market and extra people are in the hospital too. Dr. Roger and I saw about 24 outpatients. One had a huge abdominal tumor that was a little mobile, and we will attempt surgery, another had a muscular tumor in her upper tricep that appeared separate from the important vessels on ultrasound, a 5 month old child with Pertusses (whooping cough, that normally children, even here, are vaccinated against), a child with Beri Beri and malnutrition, and another malnourished, dehydrated and with malaria, and the rest were pneumonia, malaria, typhoid and dysentery. Also saw one of the workers boys who had a huge leg abscess. It had begun with ankle swelling, then the leg swelled and they drained out pus at the ankle and mid calf. I looked at the leg and after giving the kid Ketamine to help him sleep, I felt his joint. At the opening I can feel the ankle joint exposed. I filleted open the leg from about mid calf down, exposing the musculature below. Drained a lot of pus, and packed it. Saw a few patients in clinic again. Then by 4PM made it home for lunch. G

I went to bed last night with my belly all distended. I felt like diarrhea was coming but it wasn’t happening. Finally about 10PM I drifted off after flopping around in bed. The night before there must have been a mosquito under our net as Audrey and I had bites in the morning. I fall asleep with the buzzing sound, not knowing whether they are outside or inside the net. About midnight I wake up with abdominal cramping and go quickly to the bathroom…diarrhea. I fall back asleep and wake up at 4AM as I turn over and my belly makes a huge gurgling sound. I cant fall back to sleep. Guess the time change is still affecting me after a few days here. I go to the bathroom and squirt some more. Guess I’ll stay up now and write you all. I am tired but can’t seem to go back to sleep.

Yesterday was a special Sabbath day. We had the usual church service. A Sabbath school, followed by a church service. That consisted of choir groups singing and a sermon. This was a special Sabbath because it was a baptism day. Outlying churches walked many miles to come to the communal church today and bring their candidates for baptism. They slowly showed up during the whole service. At the end of the service, the fundamentals of following Christ and wanting to be a part of this church were read, with the candidates verbally agreeing after each statement with a “halaow”. The service ended and a water immersion baptism ensued. Each was given a white robe over the cloths they wanted to keep on. The baptismal water is a concrete structure built into the ground outside. It is filled with water. They enter four at a time with the pastor and elders performing the baptism, four at a time. It took a while for about 120 people to be baptized.

Many people greeted us after all was finished. Each stated they were happy to see us shaking our hands, asking how our families were, how our parents were, how our siblings are. We in turn asked the same questions of them. Nearly each stated their desire for us to come back.

In the evening we ate some spaghetti with home made sauce and as I went to bed early, I felt bloated all over my abdomen. Suspecting diarrhea would be coming, I went to bed. I lay there tossing and turning, thinking about my patients, and finally convinced myself that I am not in charge here and was able to fall asleep. It’s easy to fall back into the same thoughts and feelings as before. G