Shanksteps Bere April 2023 #1
As you know, When Im on a mission trip, I like to share with you my experiences in these Shanksteps. They are shank steps of faith. So we have chosen to try and follow wherever God leads us and right now that’s Bere Chad. We had been scheduled to help out medically in the aftermath of the earthquake in Turkey. When that was no longer needed and we were cancelled from going, we offered our time to Bere Adventist Hospital so I came here. Audrey didn’t join me this time so you’ll here things from my perspective only this time.
Getting here is always a bit of an adventure. It went like this. Fly from OR to Seattle, Seattle to Istanbul Turkey, Istanbul to Ndjamena arriving around 10PM. Passing through immigration, and health screening, and then picked up my baggage. Through customs where they requested to open my boxs, then after a bit of a discussion and showing my donations that I was bringing in and scanning my cases, they let me through. Changed some money to Central African Franks and picked up by the taxi guy who has picked us up for years. Slept in a mission guesthouse for a few hours, then the same taxi guy picked me up at 5am to catch the “first bus” south. About 5:45 the bus is full and we head out. Its a big air-conditioned bus that’s worn but still cooler than what’s 100deg plus outside. Each of us has a seat that isn’t shared with anyone else- so that’s my preferred way to get here.
As we leave Ndjamena, I listen to my audio book and watch the scenery go by in the window. First its the city with all its little shops and motorcycles and people milling about. Whenever the bus stops people are just outside the window trying to get the passengers to buy whatever they are selling. Peanuts in 1 liter bottles, shoes perched on their heads and others in their hands, mangos on a platter on their head, bags of sugary sesame seeds baked into little flat cakes, and a number other nuts or grains I don’t recognize.
As we get out of the city, there are the nomadic camps of people with camels and others with cows. They are traveling through seeming to follow wherever the sale of the animals occurs and where food for the animals is available. We pass other little villages of more people, motos, shops. woven mats can be seen for sale outside some little building. Most buildings as you get more rural are mud walls and a thatched roof. There is a business selling mattresses and so mattresses are piled high in a stack outside it. Women are out in the morning sweeping off the dirt in front of their business, to make it clean and get the days trash away.
We pass a number of communal wells that have a hand operated pump. Lines of little girls or boys with their buckets are outside these. we pass on with a boy pumping that is completely naked. He’s about 7, and is a face on profile, legs spread as he pulls down on the pump lever repeatedly. water flows out the other side into his bucket.
I get to Kelo and the missionaries have arranged for two motorcycles to get me. So I get out of the bus and indicate my luggage to the bus guy who takes my things out from under the bus. a crowd of moto taxi guys want to take me wherever I want to go. Finally one comes up to me and says he’s Christoph, he makes a call and gives it to me, It’s one of the missionaries. I realize he’s confirming with me who he says he is. My plastic boxes are tied with rubber cords to the back of one motorcycle and I get on the back of the other. Then it’s about a two hour ride to Bere. It’s the dry hot season here. It is about 105 degrees and the hamartans are occurring. These are winds coming off the sahara going south that bring in dust. So the air smells dusty and the sky looks sunny with what appears like smog but is dust. There is no water on the roads as it’s dry but there are big “potholes” that we weave around as we go along. We go through barren fields, little villages, and open areas where there is a lake in the rainy season.
After arriving at the hospital I bump into a number of my friends who are missionaries here. The missionary kids are first to see me and they say hello then the others. Im tired and hot. But I came here to help so I hear there are some operations going on because the generator is running so I offer to help. I guess one fo the two generators blew up yesterday, so only one is working and it’s leaking oil enough that someone has to stand near by and put in oil frequently so it doesn’t burn up. We hear that a mechanic is coming today to fix it. The other one apparently had something go wrong inside and a piston came out the side of the case- sound like that one is a goner.
I get to my place to stay- which is a hours I’ve stayed in before and now is a missionaries house but they are gone and have agreed to let me stay in their place- THANK YOU! I go though my stuff and find my scrubs… OR gear.
In the OR there is a diabetic with a very infected leg up to the knee. He’s been told he needs an amputation, I agree, and take him into the OR. We have visiting ER docs who do the spinal anesthesia and I take of the leg below the knee with the help of the other ER doc. Part way through the leg I get a lot of pus out. I think it needs to be a higher amputation but since he was told he’d loose it to this level I stay there below the knee and leave it open. There is good blood flow so it may heal. The saw to go through the bone is missing a pin so the blade keeps on falling off the handle. I put some suture where the pin used to be and that helps. the saw is old and not very sharp so I get a workout cutting through the bones. I clean out the pocket of pus that was between the soleus and gastrocnemeous (between calf muscles). I wash it with dakins solution (diluted bleach) and wrap the stump after controlling all the bleeding spots.
Next is a 14 year old that had a bicycle accident that put a cut in the back of his leg just above the heal and he has a hole and a gap in his achilles tendon. He can still flex his ankle so the tendon isn’t cut all the way but there is definitely a gap. So after he has his spinal anesthetic, I open vertically next to the tendon. I find it is all cut except for about 2 mm left on one side. I clean it out and go higher till I find the other end of the retracted tendon. (as the muscles contract the tendon disappears up the leg) I grab it and pull it back down. I debreed off the dead edges and suture it back together. Then I fashion a cast to hold his ankle still so that it can heal over the next 8 weeks. He will need another cast in a couple weeks that likely won’t happen, as he won’t come back to the hospital, I just hope I can impress on him the importance of not walking on it and rupturing the repair.
The last one is a woman with a sever neck infection. I feel there is pus in her mouth and feel a fluctuant area on her neck. She also has gas in the tissues of her lower neck and upper chest. This is a bad sign. She is to sick to intubate and cannot open her mouth hardly at all, so we give her local. Denae (missionary surgeon) and I open it up and get a lot of pus. We open her chest and don’t find much there. No tracks along her muscles or fascia. WE pack the open areas with dakins solution and wonder if she will survive.
I go to Netteburg house and eat supper about 8:30PM. Im grateful for food. We talk for a while and I head back to take a “cold” shower which is more of a trickle coming out of the tube from the shower. If I squat down I can get enough pressure to get wet. It feels real good! I go to bed completely wet and am able to fall asleep before I evaporate. If not then Id do it again. It’s the only way I can fall asleep in the heat. its about 95 deg when I go to bed. I wake up this morning at 5am when the power goes off and the fan stops. Another hot dusty day.
