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).

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