22 March 2004

Wait, hurry up I'm not patient yet...

Tout le monde,

As I sit here finishing off my nutritious, delicious evening meal of Southwestern barbecue goulash with Paul I think back to one word to describe N'Djaména (besides Sodom, Gomorrah, Babylon, frustrating, filthy, dangerous, corrupt, etc) it's BUREAUCRATIC. (Actually the goulash is just corn, old rice and burnt lentils...hence the "Southwestern" flavor).

So I'm in N'Djaména. I'm waiting as usual. All I want is some fabric to have some extra surgical gowns and drapes made. I've come to the "Grand Marché" (Great Market) where one can buy everything from dried beans to pharmaceuticals to door locks to plastic pitchers to dried flowers for making "Jus d'Osais" to axes to radios to turbans to cloth to shoes to...I've come here to the fabric section and they've run off somewhere. A boy passes wearing the long flowing Muslim robes with a small bowl balanced perfectly on his head. I'm sitting with Bichara who has his legs crossed contemplating the passersby. He orders a glass of red tea from a turbaned vendor and then buys one for me as well. As I try to balance to glass in my hand without burning myself with the tea-heated-glass a pair of Arab women with brightly colored wraps and shawls pass by giggling in Arabic which Bichara translates as "So, Nasara [whitie], you drink tea, too?" Hee-hee-hee. Several Arabs across the street start the ritual washing for prayer. The prayer mats are rolled out and taking a small plastic pitcher they carefully wash first the hands and forearms then the face and lastly the feet and ankles moving them onto the mat when finished. All is done with a fluidity and grace that comes from doing this five times a day for the last who knows how many years. It is a communal event as an old man will be joined by a merchant who'll be joined by a passing youth. They will stand together facing east. They will bow together. They will pray together...shoulder by shoulder. Finally, the man comes back with the thick green cloth I've been looking for and we move on...

I'm just trying to make photocopies. The place said only 30 Francs per copie so I couldn't pass it up. I sit on thinly covered pole chairs...not comfortable. The generator has been fired up for me. I'm trying to copy 200 "Dossiers" or medical charts so we can document things at the hospital. That took forever yesterday with me finally coming back this morning only to find it still not done. I then gave them a Nangdjere (Béré's local language) song book so we can turn our church service into a local language speaking church rather than a foreign French/whitey church. I gave it to them at 8am and it's 10am and still not done. So I wait...at least they call me by name now...Oh, here comes Bonaparte...what's he doing here? He just seems to be everywhere. He's going to help us lay the foundation for the staff housing we'll be building in June with the help of a group from the states...he seems to show up everywhere...I greet him and continue waiting...

I'm in the bureau of the State Police. I came here yesterday to have a paper signed authorizing Paul to film us in Béré. It was already signed by two other offices. This is the last signature. I was told to come back at 0930AM today...then noon. It's now 2pm. The office is sparse with three desks. Behind one works the secretary, a wiry man with a little gray and purposeful movements who is always coming and going, bringing and taking papers...I'm not sure if he really does anything with them. It's hot but a little breeze comes in the doorway right where I'm sitting next to a large woman reading the Bible in French. She's in Genesis and says she's going to read through it all when I ask her if it's interesting what she's reading. The other desk has another large woman behind it reading some other book. I make small talk. They don't seem to mind their reading being interrupted. The man comes back and says he can't find my paper amongst the visa requests. I say that's because it's a request for authorization to film. He says "Oh that shouldn't have taken any time at all...I thought it was a visa request." He comes back in two minutes with the paper signed and puts the all important "cachet" on it and I'm outta there...

Ah yeah, the omnipotent "cachet" or rubber stamp. One cannot survive here in Tchad without it. I'm just beginning to discover it's secret powers. Paul and I went to register him with the National Security Office. He filled out a small form and we wait. Then the guy starts to ask me some questions. He seems suspicious. What is he doing here? Where will he stay? Who's responsible? Give me the address. I write down my name and the PO box of the hospital. He still has a scowl of disapproval on his face. Then, thinking quickly I reach for my secret weapon. To the untrained eye it is simply a piece of wood with some carved rubber pasted on the end. To the one who has wisdom...it is power. I place the rubber stamp in the ink and stamp it down forcefully on the paper in purple ink. The man's face lights up. He smiles approvingly and shows me a stack of similar papers all with a variety of stamped ink. He returns in 1.5 minutes with the document approved having placed his own stamp in Paul's passport...he is now legally in Tchad!

I go later to the Central Referral Hospital for the country. I'm dressed in cargo pants, a t-shirt and tennis with uncombed scraggly hair. I say I'm the Medical Director of the Béré Hospital...for some reason the guard says he doesn't believe me...where are my credentials. I start to panic. I don't have any. They've all believed me before because I'm white. I need to see the director of Women's Health there. Then, I remember my secret weapon. I pull out my "cachet" and present it reverently to the guard. He nods knowingly for me to enter. Once again, rescued by the power of the "cachet"!

It's so good to be back in Béré. The first day back I released 13 people from the hospital. They were all complaining about having no space and patients sleeping on the floor but there were patients who hadn't been seen in almost a week and had been ready to leave for several days. Saturday, I cleaned house some more. Unfortunately, the baby I'd operated on just before leaving for N'Djaména had died. The boy with the skull injury though was awake and eating. He won't see out of his right eye though and he has lid lag. I casted his tibia/fibula fracture and sent him to another hospital for an xray. Things were smoothing out...until the "Sunday of Pregnancies from Hell"...

I rounded and did clinic while Dr. Claver did a C-section. No big deal. Then about midday three women came in to labor at once. One was tiny with a huge baby that then didn't progress. I did a symphysiotomy so her pelvis would open up and she still took forever to deliver and required an episiotomie as well. Then the baby wasn't breathing and was floppy. We mouth to mouth suctioned with a tube and I took a bag-valve-mask and tried breathing. THe heartbeat was slow. Sarah was listening and air wasn't going in. I adjusted and finally air started going in. The baby was limp and blue. Then the heartbeat picked up. Then the baby opened it's eyes with a look like a deer in headlights and coughed a few times. Some of the ever-present onlookers murmered "its a miracle." I had to agree. The baby is still alive today. I then went and had supper and was talking with Sarah outside in the early evening when the "Gard" came to tell me about a woman who'd just arrived with the baby's arm sticking out. Things were looking up though because the baby kept waving it's hand to let us know he was still hanging in there! At 9pm I was called to see her. At 1030pm we'd finished mopping up the mess from the c-section and the woman was already in recovery with a healthy baby girl. I really prayed for that one though because first of all the baby just didn't want to come out of the uterus and secondly I nicked the uterine artery with a suture needle and it bled like stink. I just pressed on it with gauze and tried to calm my panic. I asked for a suture hoping my voice wouldn't crack and was able to control it without much blood loss. Whewwww...I then returned to see the last woman in labor who had also not progressed despite adequate contractions. The woman and baby were big, but the pelvis was small...time for another symphysiotomie. After the procedure she pushed twice and the baby was screaming almost before it hit the mattress and the cord was clamped. By then it was midnight and I didn't even want to deal with the woman who'd just come in with a retained placenta after a home delivery. Fortunately, I didn't have to since I didn't find out about it till the next day! Oh, yeah, today, the next day. I woman comes in by oxcart from one of the outlying health clinics for a breech presentation (butt first instead of head). Another C-section, which fortunately went smoothly with another screaming, healthy kid.

Today, the men from Lai came who'd offered to give us another estimate on a wall to enclose the hospital. The pigs just keep getting more numerous and fearless and the hospital is a zoo. I spoke with the Architect of the government project that we have partnered with as well as the engineer in charge of the implementation. They had planned to give us $60,000 for a wall but not until the second phase which would be at some unknown time after the first phase which will start in September and include a new operating block. I felt we couldn't wait and had seen a beautiful fence around the Catholic school here made of 3 feet of brick with a cement and rebar header imbedded with another 3 feet of heavy chain link fencing on top. It was strong, durable, funcitional and yet open and not prison or concentration-camp like since you could see through and know what was happening inside. And, most importantly it was much cheaper. So these 2 guys from Lai gave me an estimate today of $26,000. Still way too expensive but I think we can negotiate as the Catholic Sisters got a much better deal. I think if we had $18-20,000 we could enclose the hospital, keep out the animals and extra people, keep in the patients, start to really clean things up and provide a hospitable environment as well as move forward with other projects such as providing mattresses and mosquito nets. Without a wall those things just walk away. Then, the government has said they will use the $60,000 to build us a new hospital ward which we also desperately need. I think it could really work out for the best if we can somehow raise the money for the wall.

Your encouraging letters mean more than I can say to each personally. They keep me going knowing I'm not alone out here but that there are people all over the world praying for us here at the little lost hospital of Béré.

05 March 2004

I'm finally a real missionary!

March 5, 2004

Salut a tout le monde,

I finally feel like a real missionary. Yesterday, I awoke not feeling the greatest. Sarah and I had just had an important talk concerning trust where we were learning a little to trust each other by sharing some personal things. Unfortunately, that went late. So I attributed my tiredness and soreness to that. Also, it has been very hot here, over 100 F. That must be why I've been sweating so much the past few days. Anyway, at morning report, the "Garde" (Jean Bende) reported on several cases where he had done treatments we'd discussed many times before as inadequate. Then, he talked about a Pediatric case that should have been hospitalized that was sent home. Then, another case that he put on "observation" because, as he said, only the "Médecin" (moi) can hospitalize. That was the last straw. I exploded. I tore him apart. I told him that they've been hospitalizing patients for years without me. I asked the charge nurse how many patients he had personally hospitalized the day before. He said "three." I continued until he spoke up very hurt and said he could tell I was displeased with his work and he'd worked virtually without sleep and if I wanted he would just go back to the District and not work at the hospital any more. I told him he was tired, he should leave and rest and we'd talk later.

That afternoon I did a mastectomy (removal of a breast) on a man (!) with a mass there. During the surgery all my muscles began to ache. I began to have a stomach ache. My head began to kill me. I had a strange premonition I was about to become a true missionary. I finished the surgery and went straight to the lab and had them do the "gout d'espece". Sure enough, it was positive. I finally had Malaria. I was kind of excited even though it meant I'd lost the bet with Sarah and owed her my last bar of dark Swiss chocolate. I got some Fansidar and Quinine from the Pharmacy and headed home to rest. I felt like...well I better not use that word...let me see, oh yes, I can say "awful". But let me tell you...the sleep was sweet. Aside from not being able to hear well and the worsening of my pounding headache (both side effects of Quinine) I felt great. It was the first time in a long time I got a prolonged sleep. The next morning I felt wonderful (but still couldn't hear well...it's like having partial earplugs in).

I also had to to reflect.

At morning report we had worship and then I got up and apologized to Jean Bende. He reported that he too had thought about it a lot and felt like the Devil was trying hard to divide us and he didn't know what to do so he was very glad to accept my apology. Today was the most relaxed day I've had with the best interactions among the staff that I've seen. It was like everyone let out a long sigh that lasted all day long...

To top it off we got our autoclave working just by a little trial and error to figure out the two different knobs! Now we can actually operate with sterile instruments, gowns and drapes.

As for the Malaria...what's the big deal really...:)

Don't worry...


I've got some letters from people who are worried about me...don't worry. I'm trying simply to be real and honest. To say that things are always rosy, exciting and rewarding here would be a lie. But just because I share them doesn't mean that there is any less joy, happiness or fulfillment in being here. I could have shared the same feelings probably from any point in my life. We live in a world that is full of doubts, fears, rejection, disappointment and disillusionment. That is what living in this world is...no matter where we are. But that doesn't mean that God doesn't also fill up each day with visions and reminders of how things are supposed to be. It doesn't mean that I am not satisfied to the core. It doesn't mean that I'm not at peace. Au contraire, I can say that not a day goes by that I don't humbly thank God for bringing me here. I also have not lost my respect for the highest levels of medical care just because I jokingly describe what we have to do sometimes here in order to save lives. We would love to have all the equipment, all the clean and sterile conditions, all the availability of specialized services and specialists, etc to practice medicine at the high standard that I have been well trained to do. But I have had to sacrifice a little professionally as well. While I try to inspire and little by little improve the standard of care here, most of the time I find myself doing things that I know is below the standard I am used to and would love to incorporate here. We slowly work towards that objective but in the meantime we do our best and God does intervene...that doesn't mean I practice below the standards available to me here just thinking "Oh God will help." I work hard and with joy to bring the highest standard of care possible here knowing that it will still be lower than the standard I am used to but that I always hold that higher standard up in my mind as guiding light.

If you would prefer I not share my struggles as well as my successes I can limit my stories to the miracles and write only when I am on top of the world so that everyone can be at ease. However, I would prefer to paint a realistic picture without making anyone too anxious...never for a moment has the thought of leaving or not wanting to be here entered my head. As far as fatigue is concerned, this is nothing compared to what I have endured the last 5 years of my life in the clinical years of medical school and residency. Yet even during those five years I can look back with nothing but joy and satisfaction and thanks for what I experienced. Here I have never gone a night without sleep and most nights I get at least 6 hours. And when I am up I feel it is for a good reason, not like residency or medical school when sometimes I was up just because that was part of the process or initiation or "we had to do it so, so do you" attitude that is found in medical education. When one is up knowing he's saving a life not just writing in some chart or standing by observing on feels satisfied and one is less fatigued. Also I've never slept more at peace in my entire life. When I lie down I go directly to sleep whereas for most of my life up till now I've always brewed on things before falling asleep.

The bottom line is, please, keep praying for us but know that I am not only surviving fine but have really never been more satisfied in my life...I'm just sharing bits and pieces and sometimes the bits will be the doubts and fears that can come and sometimes the pieces will be the tremendous successes, surprises and satisfaction that also come each and every day.

I have learned the secret, when in plenty or in want...I can do all things through Him who gives me strength (Phil. 4)

03 March 2004

I must speak...

I am weak. As I lie here on the first carpet I've felt in two months with a welcome fan whirring overhead to chase the suffocating heat away; as I lie here without the ever-present dust suffocating and making it hard to breath; as I lie here having eaten more than I should for consecutive meals for the first time in a long time; as I lie here having chosen to lie here over going to church; as I lie here I have time to truly think and reflect for an extended period of time and I am afraid. An uncontrollable fear descends on me. I think of where I am and I want to be elsewhere. I think of what I have done, not done and what I face and I know I cannot face it alone. As you have heard so many tales of excitement, adventure, sorrow and joy you may have been tempted to think that somehow you couldn't do that. Let me tell you that's exactly what I think: I can't do that. I know that everything in my nature rebels against what I am doing, where I am doing it and why I am doing it. But when I do it, somehow the strength is there and everyday in some unexpected way there is joy as well.

I think of the young man who consistently approaches me about work. He is about 18 years old, married with a couple of kids. He wants to be my gardiner. I say we would like a garden but without a fence or wall the goats and pigs will make short work of it, come back to me when we have a fence or wall. He keeps coming back anyway..."just to make a social visit." He brings tomatoes and lettuce from his own garden...they are impressive. He comes one time when I'm with Bichara, the chauffeur, with the smell of alcohol on him. After he's gone Bichara, a strong Muslim, shrugs in disgust at anyone who drinks or smokes. Later, he approaches me after a long day of work and says that he has not eaten in 5 days. Everyone asks what kind of man he is to have taken a wife when he can't provide. He has looked for work. There is none. Isn't there some work he can do for me. I say that the only need I have is for laundry. I've already given the work to Bruno. He says that he'd approached me first to ask about doing laundry or gardening. That is possible. I acknowledge that with my poor French I may not have understood that from him. He says Bruno has other work already. It's true. Dr. Claver pays him $40/month to clean, guard, cook for him. I pay Bruno $1/week to do my laundry once a week. This guy offers to do it for 50 cents. He's desperate. He asks me to have pity on him. He's been coming to the Adventist church he says. Shouldn't Christians help other Christians. I acknowledge that. Inside I feel he only comes to church because he thinks it will help his cause. But I don't want to judge. I say that I will talk to Bruno and see if he's willing to give it up. He's not. That night I happen to come to the hospital and he's in the ER with his wife who has a cut over her left eye. He says she fell. Both the catholic nun who's with me and I think its because he hit her. When I see him next he gets me at a busy time. I'm annoyed. It seems like no way out and I'm tired of being bothered. I tell him so. I haven't seen him since.

Did I do the right thing? Maybe he is a drunk. Maybe he beats his wife. Maybe he comes to church just to get some work (he hasn't been back since.) So logically I did the right thing. Then I read about Jesus and think what he would've done and this guy is exactly who Jesus welcomed, hung out with, healed, and served. If I start helping people everyone will start to crowd around thinking the rich white man is the answer. It will never end if I start. Then I read that Jesus also was bothered. When he started healing people crowded around and never would let him have a moments peace. Even when he tried to have some quiet time with his disciples they found him. What did Jesus do? He had pity on them. What did this guy ask of me? To have pity on him.

These are the difficult things I am faced with all the time. It's not just the medical work or administration or finances that is challenging. It is the myth that the white man is always rich and a source of gifts, hand outs, money and work. I want to break that tradition. I want them to recognize me as someone who has come to work with them side by side as their equal not as just some magician or philanthropist. How do I do that and yet still not ignore their cries for help when I CAN help them? Where do I draw the line? These are not easy questions...the expectations are high...the myth is deeply rooted...

I'm in N'djaména now and I see the hopeless position many feel because of the corruption of the government. A man's car breaks down in front of the president's mansion at night. He gets out to look under the hood and is shot down. The president hands out lists of people he doesn't want around and bounty hunters collect $100 a head for their deaths. A neighbor of Jabel, Jared and Caleb happens to walk onto a street that has been shut down so the president can drive through. She is beaten within an inch of her life. He has been in power for 14 years as a "democratically elected" president and is not about to step down. The US supports him because of the oil deal recently struck. Two days ago I went to the bank. To get there we were redirected down small dirt lanes packed with people who had to find another way around the main road whick was being cleared off for the president. Shops along the route had to close down. People had to evacuate. We got to the bank finally with the last few blocks on foot. We finish and walk out only to be gestured back in by a soldier in camo bearing an AK47 saying go inside it's dangerous out here. We go inside just as about 10 brand new SUVs, Humvees, and Jeeps bearing soldiers and large machine guns go flying by at about 90-100 mph through the soldier-lined, empty streets. The people starve and beg and are helpless as the illiterate relatives and tribe members of the president live in luxury.

And yet, still life goes on at Béré. A woman very pregnant with twins comes in with a kidney infection. She gets up one evening to use the restroom and discovers a small foot sticking out below. She tells Felix who runs to tell me. We get things ready for an emergency ceasarian. Someone runs to borrow the small generator from UNICEF while we go ahead and get started. It's pitch black but fortunately I have my trusty head lamp. Sarah assists me...very well except for the brief moment when she almost faints due to the diarrhea she's had caused by Amebiasis...but she stands strong and finishes! As I open the uterus I realize how nice it would be to have suction as a hugh gush of amniotic fluid rushes out to join all the blood already in the operating field. I reach in the bloody puddle and find the first baby. I pull the leg out of the vagina and into the uterus and then do a breech extraction. She is fine. I then break the other bag of water. Also a breech presentation who I deliver with a little more difficulty. He is fine too. I then try and see what's going on down in the uterus with all that fluid and blood. Somehow God helps me to sew it together so that the bleeding stops and we finish the surgery. All three are in fine shape. As I'm about to close the skin the generator shows up and roars to life...thanks.

I get called another day for a strange case. A young man about 17 or 18 years old had been hospitalized here in December after being stabbed in the upper right chest and treated with a drainage bag for blood in the chest around the lung. Now he has right upper abdominal pain, a large tender liver, a rapid strong pulse and veins on his right abdomen, chest and neck that are bulging. I think this has to be something different as the chest wound was so long ago and looks healed. I did a quick but not complete exam, gave him IV fluids, hospitalized him and went home. I saw him the next day and the right side of his face was swollen up and when listening to his heart I noticed it was really displaced to the left and had a massive heart murmur that sounded like mitral regurgitation. THen I thought maybe he had heart failure from Rheumatic Heart disease or something else. Fortunately, God will help even sometimes stupid and blind physicians to make the right diagnosis so that they can actually help their patients. I listened to his lungs and found that their were no lung sounds over his right chest and it was dull when I percussed it with my fingers. I had the family buy a syringe and needle and stuck it into is chest withdrawing brownish liquid. The lab told me it was almost all white blood cells indicating infection. Since we have no chest tubes for tube thoracostomies here I found a piece of rubber tubing about the right size (large) and cut small holes in the sides. Having heard one of our Thoracic Surgeons in Ventura talk about how unnecessary it is to have a sterile tube ("spit on it before you insert it") I took him to surgery, gave him Ketamine, sliced a hole over a rib, and poked a clamp over the rib and through the muscles into the chest cavity. Immediately, the coffee-colored fluid shot out across the room under a lot of pressure. I put in the tube and then slowly took off about 3-4 liters of that fluid and saw his heart return to normal, the swelling in his face go down, and his engorged veins flatten out. Not having the appropriate equipment for putting the tube to suction or water seal I tried to rig something but ended up having to just stick the end in a huge jar of water so fluid and air could escape but air couldn't get back in. He's doing fine now.

Dr. Claver is back so that gives me some breathing room to be here in N'DJaména to get the materials needed to repair the generator, buy medicinces and get stuff for the lab. We had just finished our last blood-typing reagents to save two kids who came in with severe anemia from Malaria. The materials I bought yesterday is the first use I have made of the funds donated by you to the hospital through AHI. Now, we can continue to do life saving blood transfusions for patients like these kids with malaria and the woman who had the retained placenta and needed three units of blood during her emergency hysterectomy and who went home in good health but would've gone home in a coffin without the transfusion. Also, now we can test the blood for Hepatitis B and C (as well as HIV which we were already able to do thanks to a national AIDS prevention program) before transfusion. We can also now check the hemoglobin to see how anemic patients are rather than relying on how pale their conjunctiva are to decide if they should be transfused. I purchased pregnancy tests as well so we can diagnose pregnancy earlier rather than waiting till its obvious. We also got test tubes and other materials needed for the lab to help us with diagnosing parasites and other infections. The lab is key as it is our only adjunct to history and physical right now for diagnosis. Also, a well-running lab will help generate money for the hospital.

We should also soon be able to sign the contracts for the staff and get them the salaries they deserve for the work they do based on local pay scales (nothing by Western standards).

02 February 2004

The Rhythm of Africa...

The drum beats pound loud and long into the night. It is the rhythm of the plain. The rhythm of Tchad. The rhythm of Africa. The young dance in tune around the drums and small fires their twisting bodies keeping perfect timing and allowing a temporary joy in an otherwise desperate life. The rhythm flows through all here. The generator giving me power and light pounds out its cadence. It is everywhere. The turbans flowing, the robes churning up and down on the pedals keep its rhythm.

The pattering of chickens feet. The bleating of goats. The crowing of roosters. The buzzing of flies. The hum of mosquitoes. The crying of Sarah's cat when left indoors. All the animal kingdom keeps time with the rhythm of this place.

The rumbling of intestinal sounds. The fast paced breathing of the severe malaria or chronic tuberculosis patient. The pounding heart of the dehydrated infant. The short grunting squeals of the 5 month old in the midst of a seizure due to meningitis. The sucking of the premature twin now breastfeeding well having survived against all odds. The popping of fluid filled lungs of a child about to succumb to severe Falciparum malaria. My own stomach demanding its own rhythmic ritual of purging as I call for the car to stop just as we're about to leave N'Djaména. The fish/sesame seed balls come up in the rhythm of vomiting as my body tries to adjust to the rhythm here. Fortunately, it only happens 8-10 times more over the next hour or so and then my body has found contentment in the local cadence. All sickness, death, healing and life marches in tune with the pounding out of this rhythm flowing in and through all here.

The lilting chant of Lazare, the maintenance man, singing hymns in N'Djeré with a rhythm unrecognizable to the western mind but in harmony with all things Tchadian. The rise and fall of Tchadian Arabic shouted and bartered in the open air markets where one can buy anything and everything to the harsh cries from the Mosque and the Koran is taught to the people. The washing of feet, hands and head systematically with a small plastic pot on the side of any road or in front of any shop prior to the hour of prayer. A hundred or a thousand forms rising and bowing and touching the forehead to the ground facing Mecca five times a day. The erect, proud stride of the turbaned Tchadian with robes flowing as he goes about his business. The beat runs through all.

You can try to fight it...it doesn't work. Show up at seven as promised...but that is Western rhythm...move on...do what you can and come back...then come back again...work with the rhythm. All we can do is take the rhythm that is here but sing our own song to it...try and find a song pleasing to God that at the same time doesn't disrupt the fundamental heart of Tchad, that doesn't interrupt the soul, the rhythm of Africa. I believe that rhythm has been placed here by God...just some of the popular songs that have been sung to it haven't been His...now its time to find what songs he really meant for this beat here at the Hospital, here in Béré, in Tchad, in Africa. The beat goes on and on and on...boom batta boom boom battata boom...