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The second day of the Christian wedding;

It was supposed to start at 11AM, and it was announced to be there at 10:30. We arrived at 11 supposing everyone to be later. We were about the 10th person to arrive. The church ceremony was in the outside tin-roofed structure. It holds more people and isn’t as hot. People slowly filtered in to the “hangar”. We were the guests of honor since we are good friends with both sides of the family and had come the farthest. We were seated on the groom’s side in the second row. Slowly people came. At the beginning, a bible boy and flower girl came down the isle. The flower girl was spreading little hole punches of white and pink paper, as the flowers. She ceremoniously spread them all over the red carpet that went up the middle between the white plastic lawn chairs that had been moved from the previous site to here. There are a defined number of these in town, so any event requires borrowing them from the school, mayors office, sous prefet… to get enough to have a large crowd sit down in one place.

After these entered then teenaged boys and girls danced their way in, on the red carpet down the center. The music was a classical march on the speakers. A small step forward with the left foot. Shake the right foot out in front of you. Boy and girl face each other, the girl bows, she rises then twirls facing away. Grasps hands with the boy behind her, and does a few right foot pumps in the air about a foot off the ground. Then twirl back to him, and grasp hands again and make an arch with their arms. Then forward one step and REPEAT…. Till they have arrived at their designated seat along the isle. They all join hands across the isle and make an arch that the bride walks through with her one bridesmaid. She arrives in a small red Toyota four-door car. It has been decorated with pink toilet paper ribbons and toilet paper flowers. All stand. She slowly walks down the isle underneath the arch of arms, to a tune by Enya, tripping over her long white gown periodically. Arriving at the front of the arch her groom meets her. Everyone sits down. The bride and groom are sitting on chairs facing each other in the front. They have been decorated with a shiny white cloth and some toilet paper flowers. A row of balloons crosses the front of the stage, and a gust of wind rips it off at one corner, making a trail of balloons fall to the side. There is an audible gasp, but all continues as planned. The maid of honor and best man are on chairs directly behind the groom and bride.

The service continues with music by several choirs, some visiting from Maroua, about three hours away, where the bride is going to her last year of high-school, very uncommon for a local girl to make it through high school. Here there are about 100 that graduate each year. About two are girls, and usually one if from the south, as her parents are here as teachers, or government officials. The choirs end their songs, and the pastor has a short sermonette about love and working out differences and being faithful to each other for the rest of their lives. They each say rehearsed vows. Rings are exchanged as a symbol of their unity. And they march out to the car decorated in toilet paper.

They head out to the reception that is to follow by invitation. Food and drinks for MANY people. We are seated under the circular tin roof with all the important people and the married couple and their close family. Food consists of chicken, beef, goat meat, plain noodles, salad with dressing, popcorn, a green bitter vegetable, fried plantains, boiled taro root, fried sweet potatoes. All eat till they are full. When the foods done, everyone leaves. The family looks tired. Audrey, Sarah and I get on the small motorcycle and we head home. G

He lay crying on the emergency room table, grabbing his lower abdomen. He got up and slowly walked outside, all bent over. Nearing a tree he lifted his gandara and tried to pee. Nothing! With a grimace on his face he walked back in. He had come to the hospital a couple weeks ago. He had taken the antibiotics and felt better for a little while. Yesterday he couldn’t pee, so he went to a hospital in Mokolo and they put in a urine catheter. After his bladder was empty he felt pain and the need to pee but nothing was coming out the tube so he asked for it to be removed. He went home that evening and couldn’t pee all night. Then he came to “our” hospital.

The nurse tried to place a urine catheter, but it wouldn’t go in. I walked back into the room as the old man is yelling, grunting and deep breathing, trying to tolerate the placement of a catheter that was trying to enter the prostate that is to tight to even let urine through.

So I get on sterile gloves and give him a hand. More yelling ensues. I get it partially in, but not enough to get urine. As I pull it out it tugs significantly and he jumps and yells some more. The curtains the we put up have been removed between patient beds in the emergency room, so the 13 year old girl who has pneumonia and is breathing at a rate of 50/min, looks on at the commotion. Neither he nor she seems to be bothered by the indecency of the situation. I call for the nurse to bring me a smaller catheter. The pharmacy doesn’t have one. Dr. Roger, a Congolese doc that is covering for a while, walks in and says he thinks there are smaller ones. No one can seem to find them. I take off my gloves and check out the stock. Fortunately for the patient, we find some and it goes in much easier with only short yelling and grunting. We send his family off to the pharmacy to purchase all the materials for a prostatectomy.

I take a look at the 13-year-old girl. She came in that morning after 4 days of not breathing well. She is thin, in the first stages of puberty, and breathing fast and deep with a LOT of effort. She had been started on penicillin. Her bed is in a sitting position, and she was leaning forward to try to get in more air. The oxygen concentrator was giving her 2L of oxygen. I ask for the oxygen saturation monitor, and they tell me both have been broken. I ask for one of the nurse’s motos and go home and get a finger monitor that my anesthetist in OR, gave me to come over with. I head back and check her oxygen, its 77%. I listen to her lungs and there are crackles all over, with quite a bit of wheezing. Let’s see, what antibiotics do we have right now? Amoxicillin, Ampiciillin, Chloramphenacol, Cipro oral, and metronidazole, penicillin. What bacteria are possible here? What’s common here? I’ve forgotten what I used to think when here! I start her on Ampi and Chloramphenacol, thinking it will cover Strep, Staph, and H. flu. (common bacteria in the US). In the US I would intubate her, here I just hope she keeps breathing.

The family returns, having paid the materials for the prostatectomy. I’m surprised, but then remember that they had been home preparing to come back for surgery, when they heard that I was coming. I head off with Audrey to go home and change cloths to attend the wedding of Avava and Valantine that we came for.

After the wedding I head to the operating room with Dr. Solomon (The other Congolese doc that’s covering here). They have done one prostatectomy and the patient didn’t do well, so they have been telling the old men with urininary problems to come back in Dec, when I arrived.

Ketamine, Valium and Atropine are given and the old man is off to sleep, making the funny faces people make when hallucinating on Ketamine. We open the pack of sterile equipment and find they are out of gowns and have put yellow, infectious gowns in the packs. These are a thin, see-through, material that is NOT sterile. We open other packs till we find the one with cloth gowns. We put these on and I have to say something to the other Doctor about sterility as he grabs his gloves with his bare hands and pulls them onto his gown. We change the gloves and continue.

I press the blade against the dark skin, and it fillets open showing the white and yellow inner layers. It’s been a while since I’ve operated on dark thick skin. Essentially no fat is there. I divide the fascia and open the space above the bladder. I fill the bladder with saline, and then open it. My finger examines a huge nodular prostate at the apex. Cancer? I crack the prostate anteriorly with finger pressure. The other doc feels the same area. I realize that my thin gloves must have a microscopic hole, as my index finger is wet under the glove. I double glove. I attempt to shell out the prostate unsuccessfully. I think about a different approach, and decide that it’s not wise under my current circumstances. I have opened the prostate enough that he should be able to pee again, but the prostate will stay. We close the bladder, fascia, and skin, leaving a glove piece as a drain. Wish I had brought in the drains someone gave me before coming! I always worry about part of the glove tearing off inside as I try to pull it out a few days later. As we are closing the irrigation starts filling in the wound. The catheter must be blocked. I irrigate it and a large clot comes out. I reinforce with the assisting nurse that is giving Ketamine that this is the reason we need to be vigilant of the irrigation. He assures me that they are. (even though it is truly the family that does the irrigation and empties the urine sac).

I return to see the 13-year-old girl in the emergency room. She says she’s breathing better, but looks about the same. Her oxygen saturation is better after increasing the amount, but she is still breathing very fast.

I head home to prepare for the evening party of the married couple for close friends and family. That night I pray for all our patients, but specifically the old man and the young girl. “God protect them from poor care, dirty surroundings, and their disease. Thanks.” G

It is rare to have a Christian wedding. Muslim weddings are common here. Animists (“traditional” believers as they call themselves) may just go the market on market day, and grab a girl and take them home. Or it could be a planned day between two families that have agreed. If this is the case then sometime after midnight the guys friends go find the girl at her house and steal her away to his house, and the rest is history.

From my understanding, the reason Christians don’t often have a ceremony, or just have a small one at their house with the pastor and family, is that it is expensive. To do a “proper” Christian wedding it takes two services and quite a bit of money. One service is in front of the Mayor, who is the one who performs the civil wedding. He generates the official paperwork of marriage. Many people attend, and all expect to be fed and given soda afterwards. Then next is a church wedding. After that, anyone who attends also expects to be fed. So in a place where there is never enough food, EVERYONE, who is remotely related or interested, attends. And little boys come in by droves afterwards to clean up residual soda in the bottles, food, crumbs, empty plastic bottles, everything!

So yesterday we attended the first part of the wedding of Avava and Valantine. It was to start at 10:00. So we arrived at 10. There were about 8 people there before us, as of course it was not starting at ten, but at ten African time. Sarah, Aud and I borrowed a moto and with both of them sidesaddle, we arrived “early”. With time a loaded car brought 8 or nine women, the first family members. The men gradually showed up on motos and the car came and went several times, and others walked. The hospital pickup arrived loaded with workers, waving hands, yelling yayayayayayaya, with some fists pumping the air (about 20 people). Eventually the groom came with his close friends, and last to arrive the bride with her friends.

Early on, people started taking seats in the meeting room. It is the only large meeting room in this government building. It is a white concrete building with a tin roof and yellow trim. Windows are slats of glass. The meeting room had wooden school tables piled in the back, slat windows and a raised platform with a desk and chairs. The remainder of the room was filled with white plastic lawn chairs. The most interesting thing was the signs up front to encourage people to get the free treatment for filarial worms. It encluded a poster with writing in French and pictures of elephantiasis of the legs and huge scrotums!

Each took a seat early, because only those there early (before the service started on African time) would have a seat. The rest stood outside or along the edges. We were seated right at the front with the families, as Audrey is best friends with the mother of the bride. Much talking ensued as we waited for the bride to arrive. Finally she arrived with the car horn constantly announcing her arrival. She and her groom entered unceremoniously and took the front two seats. As the mayor entered everyone stood, then reclaimed his or her seat.

The marriage took about an hour. The mayor happens to be a Christian, so I suspect could be different than others, however there are certain things that need to be defined in the service and recorded on the wedding certificate. There is a father or a family representative of the father in the front, and two other men that have been chosen as witnesses. The mayor asks questions like; First, is there any girls that are opposed to this marriage? Has Avava made any promises to any young girls? Anyone that contests this marriage? These three questions are repeated numerous times at the beginning and end of the marriage. Other questions included: Why do you want to get married? What about him attracted you? How do you plan on managing your money, separate or joined? Do you want to have one wife or many wives (monogamy or polygamy)? When difficulties arise, as they always do in Africa, how are you going to manage them? Avava, when your wife is sick and at the hospital and can’t cook and clean, and till the garden, and you cant afford to pay someone to help in the home, what will you do? – take another wife? Leave her? To each response that the crowd agrees with there is an outbreak of women yelling their approval, especially when the man chose to care and cook for his wife when she was sick (unheard of here) Once they have each answered these questions to the mayors satisfaction, the papers are signed by the couple, fathers, and witnesses. They stand and embrace and perform long, rotating, suck your face, kiss as only seen on TV, making everyone feel uncomfortable at seeing public affection. Then the sugar coated roasted peanuts, small donut appearing things, roasted peanuts, and sodas are distributed. First to the ‘important” people up front, and then the left over’s to the crowd, inside and out. Within minutes all is gone and people go outside to get pictures taken with the couple. Chaos ensues as each tries to be in the picture. Eventually a family member organizes who will be in the pictures. When they are done, the couple gets in a car and slowly drives with horn blaring, to their house. Many motorcycles, also with horns blaring, lead the way. We return to the hospital to do a prostatectomy that has been waiting. G

I awake at 5AM after only a few hours of sleep. Audrey and Sarah are already up. Sarah slept till 5PM yesterday and couldn’t sleep the night. Our bodies are about 10 hours off the time zone here. I awaken and hear Allah… being sung over a loud speaker. It’s the Muslim call to morning prayers. About the same time I hear about four other mosques start their morning call to prayer too. We are back in Cameroon! about a half hour after that the roosters start crowing and the world is awakening.

The trip here was rather uneventful. All our planes and connections were on time. In Addis Ababa, Ethiopia, we checked and all our six pieces of luggage had made it that far. Boarding our last plane to Chad, I started getting more nervous. We hadn’t been harassed about our carry on luggage weight (15lb limit, and ours was 35) in Addis like usual, and that was a relief. But there is the constant worry of what will happen in the customs of Ndjamena, Chad? Even thought we just pass through, we often got harassed about opening boxes, checking documents… to try to find contraband or get a little extra pocket money. Now there are X-ray machines there that they can “see” what’s in your bag. So I thought it would be worse. We got ALL our luggage without much problem. Then went through the X-ray machine, gave our papers to the customs officials, and 30 sec later we were on our way out the door with all our baggage. WOW, what a relief! Our taxi driver, Adama, was amazed at the number of pieces we had brought, even though he was forewarned and it was the least we have ever come with. He had a little Toyota four door to pick us up in (he used to have a Toyota wagon). So three large pieces went in the trunk and three in the back seat. Leaving one seat in the back for two people and one in the passenger seat! My wife and daughter squished in the back seat for the 6 hour ride.

The road is brutal. It would be better if it WERN’T paved. It has trucks going over it that are about 100tons overweight and this creates huge potholes in the pavement. so its a few seconds of acceleration then slam on the breaks to go 2mph through a hole, then repeat 5000 times! At every police barrier, toll booth, or stop for our driver to do his Muslim prayers; we had the usual swarm of boys with their wares for sale. We call it the mobile market. Some had packaged cookies, water bottles filled with questionable water, juice in a used bottle, boiled eggs, meat on a stick, a metal bowl- asking for a handout, or just a request for 10Francs! At one of the stops Adama filled the car with gasoline. He stopped, and a boy ran up with a funnel and a jug of gas, filling it with 40 liters. Of course it was Nigerian gas because it was in a bottle and not a station. Anyone with jugs under a tree has Nigerian gas. Finally we made it to the meeting point with Yves.

Oh what a beautiful sight! There was our old truck, with Yves, Jacques, and Hawadak! We had a joyous meeting then started the hour long drive on the sandy, dusty road. It was getting very dark. But we still had to swerve to avoid the goats, sheep, kids, dogs, and a hedge hog. The road wanders through a desolate area near the Nigerian boarder that I have always worried about bandits, but we arrived safely at “home”. They put us in our previous house, to our delight! Ngatsbi had prepared a meal for us and there were about 15 of the workers outside waiting to greet us when we arrived. There were many hand shakes, embracing three times, and exclamations of joy at our meeting again. Now at 10PM we were wasted but couldn’t sleep yet. So we unpacked our things and separated out hospital items. Somewhere around 1AM we fell asleep. Three days of travel, FINISHED! Greg