10 July 2016


16 September 2013

Early Saturday, I find myself driving my Vanagon up and down the rolling hills
just northeast of Moundou.  Everything has transformed itself from desert brown
to jungle green.  Patches of red earth show out between the lush tropical
vegetation.  The air is cool.  The sky is blue and dotted with puffy white

As if I didn't have enough work already, I'm off to seek and heal that which was

Yesterday, I came out of surgery and found David talking on the phone.

"When was the accident?  She has a broken femur?"  My ears pick up.

"David, who is that?"

"Abbas..." he whispers.

"Let me talk to him."  David passes me the phone.

"Abbas, it's Dr. James, someone broke their leg?"

"Yeah, it's my niece," Abbas voice replies on the other end. "She was in a
motorcycle accident last night.  She and two other women were walking along the
road and some guy came and knocked them into a ditch."

"It's the femur?"


Contrary to my usual cautious, take-it-safe attitude I reply spontaneously,
"I'll come get her tomorrow with my van.  She needs to be operated on."

"That's what I told them too, but they've already called the traditional bone
setter and he's set it.  But I'll talk to them.  You should come."

The next morning, I grab my passport, a little money and two jugs of water.  I
open the gate, drive the Vanagon out onto the road and come back to close the
gate when I see David on the verandah of my house.

"Bon jour!" I greet him.

"Salut! Where are you going?"

"Off to Abbas' village like we talked about yesterday."

"But Abbas called me this morning to say that the village elders decided they
wanted to wait a couple weeks and see how the traditional method works."

"David, when were you going to tell me?  What if I'd left earlier like I
planned?  Never mind..." I go drive the Vanagon back inside and shut the gate.
I go shake David's hand and we have a little small talk.  In the back of my
mind, though, I'm starting to regret not going.  I was kind of excited about
getting out to the bush again and see a new village.

"David, I think I'm going to go anyway.  No matter what the case, talking to the
village elders, trying to persuade them, seeing Abbas' village, it'll be an
enriching experience for me."

I get back in the Vanagon, attach the two wires off the ignition, hold in the
button for the glow plugs for 20 seconds and then touch the loose wire to the
two connected wires and the diesel engine roars to life.  What can I say, the
Vanagon has become Tchadian!

So I find myself on the road from Moundou to Kelo.  Abbas told me the village
was 31 km past Kelo on the road to Bongor.  He said when I get to Batchoro I
should call him.  I note the mileage as I leave Kelo and calculate that about 20
miles should equal 31 km.  I'm at 165 so at 185 I should about be there.  I
don't see any signs for Batchoro but when I get to Gang I'm at 185 miles so I
call Abbas up.

"Salut! I'm at Gang..." I inform him.

"What?! You've gone to far, turn around and I'll go wait for you at the side of
the road."

I do a three point turn on the narrow main highway of Tchad and head back.
Within a mile or two I see Abbas waving by a straw mat covered rude shelter by a
sign saying Teleou. I pull off the road next to the shelter and sign, lock the
doors and greet Abbas.


"Ça c'est le village," Abbas points to the sign. "We have to walk through water
to get there." He points to his pants rolled up to his knees and his sandals in
his hands.  I follow suit and soon we are wading up to mid-calf along what used
to be a road.  After a few hundred feet we hit dry ground again and Abbas points
to a rudimentary brick structure half built up to the tops of the windows over
to the right behind the school.

"That's the clinic the village is building with their own resources.  There's no
medical care for over 20 miles in any direction."

We continue through small paths around huts, millet fields, pigs, cows,
chickens, goats, kids and winding fences until we come to a few chairs and
benches arranged under a mango tree.  Some of the elders are already there and
we go around shaking hands.  Most don't speak French, only Marba.  Abbas motions
that we should go on a little further.

"Let's go see the patient," he says leading me into a courtyard and through a
cloth hanging over the door of a hut where 5 women scurry out of the way,
grabbing their millet paste and sauce as they go.  A young teenage girl lies on
a mat on a dirt floor with bricks stacked around what must be the fractured leg
as it it wrapped in an Ace Wrap and other bandages.  It looks to be straight and
out to length.  She has a urinary catheter draining into a dish.

"Who put in the foley?" I ask Abbas.

"The local nurse."

"Did the bone break the skin?"


"Ok, let's go talk."  We duck back outside and return to under the mango tree
where the meeting will take place.  Many more elders have gathered.  They motion
me to a seat next to a younger guy who will act as my interpreter.

We sit around in silence for awhile. It seems they are waiting for me to speak.
I start explaining the complications that can arise from lying too long in one
position and the advantages of being operated and having a metal rod stuck in
the femur so she can start mobilizing the day after surgery.

The man who seems to be the chief elder breaks in.  He talks a lot about how
happy and honored they are to have me come, blah, blah, blah.  Then he talks
about having a lot of confidence in their bone setter and they'd like to see how
it works for 2-3 weeks before trying something else.

"Yes, I saw that he is very competent.  The bone is aligned and the leg is out
to length.  It could heal like that.  However, the muscles of the thigh are very
strong and will likely pull it out of position. In any case, she'll suffer a lot
having to lie there without moving for several months..."

The arguments and debate go on like this in a calm, respectful manner for awhile
until I finally make a breakthrough.

"You know how in the past you had to mill your rice by hand?  Wasn't it nice
when people brought machines to run the rice mills?  Didn't you suffer before?
Wasn't that development good?  Didn't it relieve a lot of suffering even though
the result was the same?  That's the same way with this new method of treating
fractures, it relieves a lot of suffering."  I hear chuckles and see a lot of
nods and smiles around the circle.  They then get up and go off to discuss among

"Doctor," my translator leans over to speak to me directly. "The real problem is
finances. All their rice from last year is gone, and the harvest is still a
month or so away. They don't have anything to pay for it.  They're afraid it
will be very expensive since your surgery center is private."

Now I understand.  "C'est vrai, we are private, but we are also non-profit and
our prices are very low so that even the poor can afford them.  But I understand
it's a difficult time in the village, we'll find a solution."

When the elders come back I address them directly. "I know it's a difficult
time.  Here's what I propose: I'll pay for the surgery and then after the
harvest, I'll come back and you can find a way to repay me."

Everyone is then very happy and things get moving.  An ox cart is brought pulled
by two bulls.  The girl is brought out by 6 men carrying her gently and placing
her on a sheet in the ox cart.  They go off and we follow on foot.  I take a
brief tour of the "clinic" and then we meet them at the Vanagon.  She is soon
loaded in and we head back to Moundou.  Abbas accompanies me as well as two
family members who will stay with the girl post-op.

The surgery is done that afternoon without too many complications.  The distal
fixating screw is a little frustrating, causing some non-missionary like words
to escape my lips.  Other than that, all is routine until Dr. Roger bursts into
the OR as I'm starting to close up.

"This young girl just came in," he exclaims breathlessly, speaking rapidly as is
his custom. "She swallowed some unknown object and no can't breath."

"Are you sure she swallowed it? Sounds like she may have got it in her airway.
Go listen for stridor."

Roger comes back shortly.  "She has stridor."

"Ok, I'm almost done, I'll be right there."  I finish quickly and go see a 8 or
9 year-old in respiratory distress, agitated, with nostrils flaring and
whistling sounds coming from her throat.  We hurry her back to the OR where I
inject her with Ketamine in her thigh.  Soon she is out.  I finally find a
laryngoscope that works and insert it into her mouth.  I pull the tongue left
and see the epiglottis.  I lift up and into view comes a green plastic circular
object with spikes along the rim sitting right on top of her vocal cords.  I
reach in and grasp it with some forceps and pull it out.  It's the middle
section of a plastic flower with a centimeter or two of stem that had gone into
her trachea.  Needless to say she's breathing better now.

I go show the family and then head home for a much needed nap.

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