10 July 2016


10 November 2013

I don't know why I wake up crying, it seems to be my habit of late. But then
again, it's not that surprising as everyday I'm seeing such suffering and death.
I feel sorry for Andrew, our family practice resident.  He hasn't seen much
death before and he's taking it hard.  But then again, when did I stop taking it
so hard? Or maybe I just bury it quick and it comes back out in the early
morning tears.

Two days ago, there was the two year old with malaria.  She'd been sick for a
long time and finally came in to the general hospital where they found she had
severe anemia.  They didn't have the reagents to do a blood transfusion so they
sent her to us.  We gave her blood and three days of IV quinine. The nurse came
to get me at night.

"She's not breathing well."  I knew that already.  I'd seen her earlier. We'd
given her antibiotics, glucose, quinine, blood.  I couldn't think of anything
else to do. Besides, her liver was very enlarged: the worst prognostic sign in
malaria. The next day, Andrew saw her on rounds and was worried, as well he
should have been. He did even more.  Put her on oxygen, gave her a little bolus
of IV fluids and stronger antibiotics.  She died shortly thereafter.  He came
back to the house. He'd been crying.  I was trying to recover from the week long
marathon of trying to save lives accompanied by a sore throat, diarrhea,
headache and fever.  Andrew then went back to comfort the family until they took
the body away.

Then today came. Another baby with malaria and not doing well.  Andrew sat and
bagged him and gave him oxygen and monitored him and gave him steroids then
heard crackles in his lungs and gave him a diuretic with no response.  His
kidneys and lungs and liver were failing.  He somehow hung on for hours...and
then died right after a four year old with: surprise, surprise...malaria. And
then one thinks of the fact that developed countries have eradicated malaria
using DDT and then jumped on the political bandwagon to ban it for the rest of
the world that continues to suffer and die from it at extraordinary levels.  I
really don't care if it does wipe out some bird species (it doesn't, by the

We all need a break.  After Miriam and Noah wake up from their afternoon nap we
go out for a walk to the river.  Sarah has Noah in the Baby Bjorn, securely
hanging in front of her as happy as can be.  Miriam has her pink Tinkerbell
swimsuit on with an aqua Swedish sun dress on over it.  She's riding on my
shoulders singing away. Andrew and Rodney plod along besides us in shorts.  We
cross the main road to many a curious stare of passing motorcyclists.  Just
across the street some young military guys are sitting on the leaning,
half-broken down wall surrounding the Armée Nationale Tchadienne (ANT in
French!) barracks.  They yell out greetings and wave.

Around the corner we hear the silence from the city power plant as Moundou
remains without power for some unknown reason. Crossing another main, almost
deserted road, we arrive in the swampy fields next to the river where the brick
making men are hard at work, sweaty, shirtless bodies glistening in the
afternoon sun as they tramp out mud, collect straw and slap the mixture into
their crude brick forms.

We finally find a way through the maze of bricks to the river.  There is a
solitary tree on a small hill with piles of sand and gravel around being sold to
push cart workers carrying it to some construction site.  We descend the small
slope into a tiny little bay of calm water next to the swiftly flowing, shallow,
wide Logone River.  The Logone is one of Chad's two main perennial rivers
joining together at the capital, N'Djamena, before emptying into the astonishing
Lake Chad which has no outlet to the ocean yet stays fresh and not salty like
the Dead Sea or the Great Salt Lake.

The water is amazingly cold.  Miriam at first is afraid but then wades out
slowly to me with a silly grin on her face.  She soon wants to go back to Mommy
and Noah who are leaning against a sand pile.


Andrew and I wade out into the swift current and then swim across to a sand bar,
barely making the end of it as the current rapidly takes us down river.  We then
walk back up the sand bar past where we put in so we can make it back to our
cove.  There is nothing on the sandbar but a few driftwood pieces and some
chicken hawks and pigeons.  A few dugout canoes ply the waters checking their
fishing nets. We swim back.  Miriam is ready for some more play time in the cove
and giggles and laughs as she jumps up and down on me and spins around crazily.

I crash on the couch at home and almost fall asleep before getting up to make
supper.  We are just watching a Jesus Culture video, about to sit down to eat,
when Josephine comes knocking on the door.

"There's a little boy who was just hit by a motorcycle.  He's unconscious with a
large wound on his head."

"I'm coming right over." I pull scrubs over my shorts and t-shirt and jog over
to the hospital.  A five-year-old is lying on the bed covered in sand stuck to
the blood on his head. He is agitated and left side is twitching in a focal
seizure.  His right temple has a 5 cm laceration.  There doesn't appear to be
any skull fracture and his pupils are equally round and reactive to light.
Remadji is just starting an IV when a couple of Chinese show up at the door.
One man is crying holding his deformed right arm and the girl is speaking French
with a Chinese accent.

"This man is serious.  He hurt his arm playing basketball. It's come out."

I usher them in to a bed and feel his shoulder which has an anterior
dislocation.  I go to the OR, get 5mL of Ketamine and give it to him in his left
deltoid.  Then I go back to the boy who has the IV now and is getting diazepam
for his seizure.  His breathing sounds labored so I open his airway by putting
an OR gown under his shoulders and check his O2 sats.  They're 78% so I rush to
the OR and bring back our one O2 concentrator.  Quickly the sats go up to
98-100%.  The father speaks to me in Arabic.

"Look at his leg, is it broken?"

"Which one?" I ask back in Arabic.

"The left one, there."  I check it and it's fine.  But when I check the right
one it is obviously a mid-shaft femur fracture.

"That one's ok, but this one is broken."  I have the father hold the leg out to
length while I get an ace wrap and tie the two ankles together to temporarily
keep the leg from shortening. "If he comes out of his coma, we can fix the leg,"
I inform the dad.

Meanwhile the Chinese basketball player is out.  The man with him doesn't speak
French so I try English.

"Hold his arm under the pit," I show him what I mean and he understands.  I put
traction on the arm and after a few minutes I feel the humeral head pop back
into joint.  I check it and there is no more deformity and full range of motion
of the joint.  I recheck the boy and his pupils are still reactive and he's not
seizing and his O2 sats are normal.  I go home and watch "Capitalism: A Love
Story" with Andrew.  Then I go back to check on the boy.  He is still agitated
but more awake, not seizing, normal pupils and doesn't need oxygen anymore.  I
go back home and crash.

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