Saturday, December 5, 2009
So......no sewing.....yet! Well, almost none - I brought my coverstitch maching and was able to get it to work sewing binding on an apron. It was so much fun and I can hardly wait to have more time to spend playing with it.
I found this video and video two on you tube that showed a method of making bias binding that I had never seen before. I tried it and was really pleased with how it turned out and how much I was able to get from a yard of fabric.
The good thing about being here in Tennessee is that I am getting to spend lots of time after work with the grandchildren so I can't complain at all.
Wednesday, June 10, 2009
"Hurry to the ER! James! Run!" The familiar words come not in the usual African French but in the familiar English of our friends, Gary and Wendy Roberts (our mission pilot & his wife, based in Bere) as they whiz by the house on their motorcycle.
I'd just gotten up a little before 5:00am to write email when I heard the roar of the moto and the cries of the anguished parents.
I quickly pull on some scrubs and rush out the door where I run into Sarah who's just come to get me. She is just finishing up a night shift in the ER. It's about 6:00am.
The hospital is bathed with an early morning tranquility that would've been soothing on any other morning but this one.
I arrive at the ER and see Gary bent over his son, Caleb, giving him mouth to mouth as his pale, limp body wants to sink into the top of the desk he's lying on.
"He was still breathing as we were coming but he just stopped. He has no heart beat!"
I start giving chest compressions as I bark out orders to Sarah, Wendy, Koumabas, Hortance and Augustin who luckily happens to be there.
"Get some IV glucose and some IV tubing!"
"Someone look for an IV!"
"Call the lab for a hemoglobin and glucose check!"
"Get the pulse ox from the OR!"
As they rush off to find the material I look closer at Caleb. His body is flaccid, his face is pale and haggard, eyes closed, mouth half open, a mild gurgling coming out of his throat with each chest compression. He has no heart beat and his lungs sound filled with fluid. His belly is soft with an enlarged liver.
Gary takes over chest compressions as Hortance hands me the D5W attached to some IV tubing which I quickly insert under the skin of his stomach for a subcutaneous perfusion of glucose in case his blood sugar is low.
"Give him half an ampoule of IV furosemide IM.
Augustin is patiently searching for an IV on Caleb's small, white hands and arms. Sarah arrives with the pulse oximeter. We continue chest compressions. The O2 sat is 15%. I have Gary start rescue breathing again. The pulse ox stops working.
"Sarah, get some Adrenaline and Atropine from the OR!"
Still no IV.
"Koumabas, get me a blue IV catheter and a 5cc seringe!"
I keep doing compressions while Gary does two rescue breaths every 10 cardiac compressions.
Wendy has come back with an epi-pen and accidentally sticks her thumb with it instead of Caleb's leg.
Sarah gives Adrenaline and Atropine intramuscularly.
I listen and detect a faint, slow heart beat.
We continue CPR.
"Wendy, find me one of those small red, urine catheters in the OR so we can empty his bladder!"
Koumabas gives me the IV catheter with which I miraculously find his right femoral vein on the first try despite feeling no pulse and am able to thread the catheter in. I attach the IV glucose bottle and let it run in.
Meanwhile Mathieu has arrived and now has the results: hemoglobin a little low and blood sugar extremely low.
Wendy returns with the foley and Augustin drains Caleb's bladder. Calebs lungs are clearer. He still has a faint heartbeat.
"Sarah, inject the Adrenaline as rapidly as you can....now!" I quickly pump Caleb's heart has fast as I can with my external compressions to get the medicine to his heart.
"Sarah, take over chest compressions, I'm going to find some Magnesium in my office!"
The magnesium goes in the IV fluids and slowly trickles in.
Gary still does rescue breathing. Wendy offers to take over but Gary wants to keep going.
"Mathieu, can we do a Potassium?"
I draw a milliliter of dark blood from Caleb's femoral vein and Mathieu hurries off to the lab.
CPR continues. We've been going for 40 minutes.
I listen to Caleb's chest. No heartbeat.
We continue CPR.
"Sarah, more atropine."
Gary speaks up after his 2 rescue breaths. "Should we stop?"
"Let's go just a little more."
Atropine is in. We continue CPR 5 more minutes.
I listen to Caleb's heart...
Gary and Wendy collapse weeping into each others arms as sobs explode from within my chest. I grab Gary from the side my arm draped across his neck. Sarah is on the other side hugging Wendy.
Gary solemnly wraps up the still, little body.
"Do you want to use the van? We can drive you back home."
Gary turns to Wendy, "No, let's just put him between us on the motorcycle and go home."
"Anything we can do?"
"No, we just want some alone time. Then in the afternoon we'll have a service." The trudge out to the motorcycle, the quiet bundle in Gary's arms.
Tears streaming down my face I walk slowly back home thinking back to September 3, 2001 when I also found myself stopping CPR on someone I loved and sadly giving them up temporarily into God's hands. Just like then when I told my twin brother, "I know where you'll be...I just better make sure I'm there as well," I think the same thing about little Caleb and can't wait to see him again, maybe even by my brother David's side, when things are finally finished down here.
But, meanwhile, I'm back home sobbing like a baby. Sarah walks in and kneels down in front of me. We embrace and cry together. Outside, the wind is blowing, whipping up a storm. It starts to rain. God is crying too.
Sunday, April 19, 2009
I'm trying not to move. The feel of sweat trickling slowly down my face is not as bad as feeling the stickiness of my back against the cheap mattress. Crickets and other night insect sounds are the only relief from the otherwise oppressive heaviness of the still, hot Chadian night. I am lying down on Gary's porch listening to the Pineapple Story on Gary's MP3 player. Trixie, Caroline and Stefan are there along with Wendy, Jeremy and Annie. It's a boring Saturday night in the bush and we've just polished off the popcorn that Gary somehow thought would be better with left-over pesto sauce.
Gary's phone rings.
"It's for you!" Gary hands me the phone.
Jacques is on the other end. "We have an open tibia fracture that just came in."
I drag myself out of the pool of sweat that has gathered underneath my half-naked body and pull on my shirt. Stepping outside I feel a slight change in temperature from about 110 degrees Fahrenheit to about 100. I slip on my Tampa Bay Buccaneer Crocs and swing into the saddle. Sarah's in N'Djamena welcoming Dr. Bond and his team back to Chad so I'm riding Pepper, aka Mini Seabiscuit.
It's pitch black, no moon and while the stars are brilliant they only give a vague outline of trees and shacks from time to time. Pepper likes going home as quickly as possible and I can feel his muscles tense in expectation under my thigh as he stamps and snorts while I wait for Trixie who's riding Bob.
A slight release on the reins and Pepper starts out at a fast walk which quickly turns into a fast trot. Up and down, up and down I keep in rhythm with my fast little pony's cadence. Suddenly, things smooth out and the wind kicks into my face as Pepper leaps out into a gallop. Unknown dark shadows are hurtling by right and left. The road is windy and while Pepper somehow knows the path I can't anticipate in order to keep my balance. I'm hanging on by a thread when he suddenly turns left. My right foot pops out of the stirrup but I manage to stay on and with a quick pull Pepper comes to a stop. Sarah has trained him well and I'm grateful as I'd have certainly fallen off if I hadn't been able to stop quickly.
Feet back in the stirrup and we're off again on our mad dash to the hospital. The 2-3 kilometers whirr by in a matter of minutes as we pull up to the front gate. Lazare runs up to open up, I unsaddle at the stable and rush home to change into scrubs.
In the ER, a light-skinned Fulani man sits with his left lower leg twisted and contorted in a pool of blood draped with a dirty cloth. We hurry him off to surgery as Samedi calls Simeon and Abel.
Washed, scrubbed, prepped with Betadine, draped with sterile towels and anesthetized with Ketamine (aka Vitamin K or Special K for you US druggies) the leg still looks bad under the glowing overhead lights. We pray and I take a 10 blade scalpel and enlarge the wound inferiorly down the middle of his shin to expose the fracture. It's a clean, 45 degree angle brake. I wash, scrub and irrigate with liters of Dakins and normal saline. I put the bone back in place and have Abel reach under the drape and hold it in place while I suture up the wound leaving just the most superior part of the original cut open.
Breaking scrub but leaving one hand sterile, I grab a cordless drill and insert a threaded Steinmann pin. I slice open a tiny hole and start to drill the pin into the lower tibia. The drill runs out of power, it hasn't been charged.
Now what? I call for some hand drills, they finish the job on the lower pin but I can't get the two upper pins started. I completely scrub out and walk home. I find another drill with a cord, saw off a couple pieces of old PVC pipe, wash the mud out of the center of the pipes and come back to the OR. I put sterile gloves back on and drill in the last two pins. Then I make sure the bone is still aligned and drill holes through the PVC pipe so the pins can be hammered through holding the bone in position.
As I'm finishing, Simeon tells me that he thinks his jaw is broken. Sure enough, his mandible has at least two fractures leaving the front part of his lower teeth completely mobile. I search for and finally find some 4-0 steel sutures. I twist tie one of them around the tooth on the posterior side of the right sided fracture and another one on the anterior side. Then I have Jacques push the jaw into position while I twist the two ends together to bring the two teeth (along with the mandible) back together. I do the same for the left fracture. It's still unstable. I then do two more teeth on each side of the fracture and the corresponding teeth on the upper jaw and wire those together so his mouth is completely wired shut with his teeth coming together in a functional position.
It's then I notice that my shirt, pants, surgical cap and hair is all soaked despite the courageous efforts of the small AC unit. I take a few bried moments of pure heaven with my faced almost pressed against the cold air coming out of the AC before going home to my own personal pool of sweat.
Friday, April 17, 2009
Tuesday, April 14, 2009
I did contact a place in the San Diego area that had the machine I was looking for and they told me that they could not sell to me if I didn't live in their area - in fact it was one of the first questions they asked - what's up with that?
Oh, well, I am off tomorrow morning to see if I can't snag me a coverstitch machine of some kind...I am really looking forward to bringing one home!
Friday, April 3, 2009
I finally put a couple more pieces of fabric through the washer and dryer in anticipation of really hitting the sewing machine on Monday...I only have to churn out 2 1/4 garments each week to finish on time for the SWAP. I'm thinking that the busyness of getting it done will be a great mind relief and I'm looking forward to it.
While at Hancock's one day I saw this great piece of fabric - rather like candy apple green or maybe chartreuse that was labeled as silky wool but on the selvage it had Donnegal Linen Ireland. I asked the help just exactly what the fabric was and of course they had no idea. It was really pretty so I bought it anyway. Well, before deciding how to pre-wash it I decided to do the burn test and cut a piece to wash and dry. The burn test indicated that it was actually polyester and the test piece that was washed and dried showed no shrinage whatsoever. Not what I thought but it is still pretty and I'll just have to figure out what to make from it.
Next week, I am looking to buy a coverstitch machine and have seen the Janome 1000 demonstrated. For the price, I guess it is a pretty good machine, although I wasn't totally sold on the stitch it made. Had thought about a commercial machine but just don't have the room. Any ideas about coverstich machines?
Tuesday, March 24, 2009
At my son's wedding in 2000.
The picture from their Christmas card that is still on the refrigerator. The memorial is this weekend and I know I have time to sew the black dress, tonight I am wondering if I have any energy to put in to it. It's hard to sew with a broken heart.
Sunday, March 22, 2009
Sunday, March 15, 2009
It's early Sunday morning and the drums are pounding. Deep, holding bass thumps with rhythic higher pitched hypnotizing beats wafting through the background. In a few minutes, a mournful call pierces the African pre-dawn calling the faithful to the first prayer of the day with a long, drawn out "Allahu akbar!" Finally, to complete the symphony, church bells start tolling across town as the dawn breaks. But the music is rudely interrupted by a harsh clanging on our sheet metal door that can only be pounded out by the bare knuckles of a nurse seeking a doctor.
"Yeah?!" I mumble.
"C'est moi, it's me, Augustin."
I fumble for my shorts hanging over the foot of the bed and stumble out the door to the porch where I open the screen door and come face to face with our charge nurse bearing a flashlight and a small carnet which serves as our patients' portable medical records.
"I just received a young boy who has respiratory distress. His whole chest caves in and you can hear the noise of his breathing clear across campus."
As I hurriedly put on my scrubs and follow Augustin through the bushes, around Lazare's fire pit, under the mango trees, on top of the straw and horse poop, to the side of the container, and through the gate into the hospital compound I understand what he means as I can hear a high pitched rasping coming from the dimly lit emergency room door.
A young boy is slouched across his mother's lap as she balances on a stool holding him up under the arm pits as his lower chest literally caves in all the way to his spine while desperately trying to suck in oxygen as he lets out a stridorous breath. His eyes are bugging out and almost rolling back. I listen to his chest with my stethescope and hear practically nothing. I place it on his neck and hear loud stridor. I get him to open his mouth and where the back of his throat should be is a smooth, bulging mass.
I'm afraid I won't get him to the OR in time. I call Caroline to help me and pick up the child in my arms as I jog over to the OR, flip the padlock to the secret code, insert the key in the door and burst into the OR. Fortunately, this morning the batteries have held their charge through the night and we have light. However, I'm afraid the power will go out any minute so I send Augustin to wake up Steve to turn on the generator.
Meanwhile, I lay the child on the operating table and give him a shot of IM Ketamine while Caroline searches for an IV. Just then, power goes out but I hear the slowly increasing thump thump thump of the Lister engine starting up and in a few seconds I can turn on the overhead OR lights and we are back in business.
I dump the cardboard box of endotracheal tubes on the floor as I rifle through them searching for one small enough for my patient. I finally find a 6.0 uncuffed tube and grab the laryngoscope out of the bottom drawer of the anesthesia machine as I slip on gloves. Caroline now has the IV running and the boy is now under Ketamine anesthesia. I find a guide wire, put it in the ET tube, check the light on the laryngoscope, raise the bed and open the kid's mouth. There is no way I'm going to see the vocal cords, the entire back of the throat is swollen shut.
I toss the equipment aside, grab a 15 blade scalpel and a suture removal kit, slice vertically down the middle of the neck, find the space between the tracheal and cricoid cartilages and poke through into his wind pipe with a hemostat. I spread it open, suction out blood and shove in the ET tube. I then hook up a bag and give him some breaths. The chest rises and I see vapor in the tube. I check with a stethescope hear breath sounds only on the right. The tube's in too far. I pull it out slightly, confirm there's now bilateral breath sounds, suture the wound closed, suture the tube in place and continue bagging.
His oxygen saturation is now up to 92% from the initial 35% so I stop bagging and just let him breath through the tube. His sats hover around 84-88% which isn't great, but without a ventilator and labs to follow it's more dangerous to bag him then to let him breath on his own.
I then try to place a nasogastric tube so he can be fed past the obstruction in his throat. It won't pass the mass. I stick my finger in his mouth and try to shove the tube in through his nose while feeding it past the mass with my finger. Suddenly, pus gushes out his mouth. I've ruptured the peritonsillar abcess. I quickly suck out the foul smelling pus and am relieved that it was so easily taken care of.
We wheel him out to his room and give his family instructions.
Later that evening, I go to check on him and find his tube choked up with secretions. We have a suction with a trap that allows me to put one end down the ET tube and then by sucking on the other end pull out the gunk into a chamber between the two ends. Very high tech. He starts to breath easier. I tell Jason to check on him every hour and suction as needed.
The next morning, he is awake, but tired and breathing fairly easily through the tube. I have the family members sit him up, suction him one more time even though it's pretty clear and move on to the other hospitalized patients.
In less than 15 minutes, Annie comes running up to me.
"Stuff's coming out his trach, he's not breathing!"
I run back to his room, chase out the family members and see instantly his tube is clogged up with pus that's dripping out. As I grab the suction to clear his airway I see he's not breathing and his eyes are rolled back. He has no pulse. As I suction, Jacques starts chest compressions. When the airway is clear I attach the bag and start breathing for him.
We take him to the OR quickly. We attach our cardiac monitor. He finally gets a heartbeat back with a pulse but after a few minutes it slows down again until we do more chest compressions to bring it back. We try multiple doses of Atropine and Adrenaline. His oxygen saturation stays in the mid to upper 80's when we bag him. But he just doesn't want to come back. Finally, after 90 minutes we are forced to stop. We wrap him in a cloth and call in the family. The dad nods, he's been expecting it. He wraps the boy up in his arms, carries him out and the family mournfully walks out the gate.
The drum beats on. The call to prayer continues. The bell keeps on tolling.
Tuesday, March 10, 2009
Of course, I am devastated because it was a horrible time for me physically and mentally, but beyond that I am sad that our society has come to this point. How is it that we have gotten to the point that responsibility only has a time frame attached to it - statue of limitations - if we're responsible, aren't we responsible until we have made restitution? If we know we are responsible don't we take the initiative to make sure that the innocent party is taken care of without making them seek legal counsel and try to ring even the out of pocket money out of them?
I am sad that my son said "I told you to get a lawyer" and I told him that I wasn't trying to get anything but my out of pocket expenses that I could document and I was sure that it was so straight forward there would be no problem. What in the world are we teaching our kids about how to do business and take care of our responsibilities without having to be made to by the courts.
Still thinking that someone would recognize their responsibility, I have called Bill Maleski in claims, who was very nice but passed it off to some one else, and Ivitte Melillo in claims that thinks she is being gracious still offering the original offer. (Which I am sure is really a concession on the part of the company and I am grateful that they are still talking to me - BUT - it isn't what if morally right or even fair, in my opinion.)
Thanks for letting me vent...I am still sad that we are at the point when we can't deal in confidence with others in businesses in fairness without going for the throat to just get what is documented. It's not the kind of thought and action that I wanted to pass on to my kids...
Sunday, March 8, 2009
The plane has stopped. I thought we were going directly to Lubambashi but we suddenly find ourselves on the ground at another airport. Apparently it was planned since I see people getting up and climbing down the stairs that open up from the tail of the old 727 airplane. I was actually extremely cold during the flight so I decide to take a breath of Congolese air outside. A sharply dressed young Congolese man is standing at the foot of the stairs just under the middle engine. We strike up an easy conversation until he notices something dripping on his suit.
I think it is fuel at first, but on closer inspection, it turns out to be simply water. The man is very friendly and I explain that we are with Adventist Medical Aviation and are doing some research on maybe doing some medical work in Democratic Republic of Congo and in Congo Brazzaville.
At this point our attention is caught by a large mobile staircase being pushed past us to the right engine of the plane a few feet away. Some men scramble up to the engine and start taking off the bottom enclosure. As jet fuel starts to cascade out, the ground crew rushes around collecting plastic buckets to catch it in as a small lake starts to form and flow off the runway.
A man in a suit rambles up lugging an ancient, twisted metal tool chest that folds out from the middle into several trays carrying some large, simple tools. He selects a large screwdriver and climbs up the ladder to the now-exposed engine as a couple of blue-overall wearing maintenance guys scrape out the fuel left in the bottom of the casing.
The mechanic tinkers around and eventually manages to pull of what appears to be the fuel filter. He takes off the filter and examines the cover which appears to be missing a gasket. He shows it around to a few other people amidst the shaking of heads and then puts it right back on. He tightens it up well as the blue guys mop up the remaining jet fuel with rags. Meanwhile, more ground crew have sloshed the tarmac underneath the engine with buckets of sudsy water.
The engine cover goes back on and we are escorted back up the stairway into the plane. Miraculously, we take off and land again at Lobambashi without further incident.
A thin, lighter skinned man with a huge smile, blue ringed brown eyes and a warm handshake greets us at immigration along with a short, stocky dark man who speaks some decent English. We breeze through passport control and are taken to the Adventist Surgery and Gynecology Clinic in a Toyota Hilux Surf SUV. The Hilux Surfs are everywhere but unfortunately no boards or waves are to be seen anywhere.
Most of the vehicles in town have the steering wheel on the right side of the car even though they drive on the right since most of them are imported from British East Africa.
We arrive at the clinic and are told there is an emergency. They are just waiting for the surgeon, Dr. Delgado to arrive.
When I inform them I'd like to assist, they drag me up some steep winding stairs to the attic which serves as pharmacy and stock room. I'm given a pair of elastic waist band scrubs and slippers too small for my feet and I quickly change and enter the OR.
It is small and long with tile running from floor to ceiling. Xrays showing obvious bowel obstruction are illuminated on a viewer straight ahead over the operating table. On the table, covered in a hospital gown is a young, 14 year old girl with a nasogastric tube coming out of her nose attached to a bottle of 5% dextrose for gastric lavage.
At the foot of the table is a metal table covered with a dark green cloth covered with shiny instruments and presided over by the surgical assistant robed from head to foot in the same dark green. His white surgical gloves rapidly arrange the instruments guided by his barely visible eyes behind a blue mask and protective goggles.
At the head of the bed is a jolly, pudgy man in ill-fitting scrubs whose large smile can't be contained by that silly piece of paper trying to pose as a surgical mask. In answer to my inquiries he shows me his anesthesia setup.
The archaic monitor is black and green with erratic QRS complexes running together on the EKG lead making their form, rate and rhythm almost impossible to interpret. But that is child's play next to trying to read the systolic and diastolic blood pressure and heart rate which for some reason are projected as mirror images of themselves.
The anesthesia machine consists of a metal table with bars on the back. An oxygen extractor behind the machine runs a jerry-rigged tubing apparatus up to a canister attached to the bar. The inhaled anesthetic is put in the canister and regulated with a twisting knob that the anesthetist proudly says he made himself. He shows me the scoring marks on the knob that let him roughly know the concentration given.
Laid out in an orderly fashion on the table are 4 endo-tracheal tubes, a laryngoscope and three unmarked syringes containing, according to him, Valium/Atropine, Thiopental and Succinalcholine.
Just then, Dr. Delgado bursts into the room. An Argentinean of Peruvian descent, Delgado has been in DRC for over 20 years. He started at the Songa Adventist Hospital before moving to Lobambashi and opening this surgery and gynecology center. He is known all over the region as the best surgeon around, is personal friends with the governor, has performed over 12,000 major operations there and has trained countless young, Congolese physicians and medical students in the art of surgery.
But I was to learn all that later. For the moment, Delgado was focused on the task at hand.
"What's her story?" He asks the resident who called him in.
"She was sick since Friday, went into another clinic on Saturday, was given malaria treatment and sent off for a bunch of lab tests and x-rays. After three days, she was getting worse and the family brought her here. When we examined her, she had an acute abdomen with signs of obstruction. As soon as we told the family she needed an operation, they wanted to evacuate her to South Africa until we assured them you would come yourself and do the operation."
"Ok, well she obviously needs surgery, it's too bad they waited. I'll go scrub."
Soon the operation is under way. On entering the abdominal cavity, we find pus everywhere with the small intestines stuck together. It takes awhile to clean things up and separate out the intestines to find just what we suspected, a perforated appendicitis.
After the appendectomy, massive irrigation and placement of a drain, Delgado leaves the closure to the residents and he starts telling me about his latest project: a new surgery hospital on the outskirts of town.
The girl is extubated and wheeled off to post-op recovery in stable condition.
The next morning, Delgado is flying to South Africa himself so we meet him at 7:30 in the suburbs of Lobambashi. He has been given 100 hectares by the government where he's built himself a beautiful house and is almost finished with his new surgery hospital. A local Muslim business man from Lebanon has financed the project to the tune of over $1,000,000. The equipment and initial medications are a combination of donations from the AMALF (Adventist Medical Association of the French Language) and purchases from a Swiss company that refurbishes medical equipment.
There will be two full functional Ors, a minor procedure room, a post-op recovery room, an ICU, private rooms, and an outpatient center. Everything is beautifully tiled and the solid, hard wooden doors have been imported from South Africa. It will probably be the best surgery center in between Nairobi and Johannesburg.
Also, on the 100 hectares, Delgado is helping build a Conference Office for the local SDA mission and an Adventist Church.
That evening, I check up on our young patient and she is lying comfortably with no fever and only slight tachycardia. Her abdomen is still slightly swollen, but soft and I already hear a few bowel sounds. I talk with the father who is eternally grateful and tells me that his son has just returned from a visit to Orlando, Florida where my parents live and his daughter wants to go there for nursing school.
As he gives me a ride back to the Union offices where I'm staying, I offer to put him in contact with the SDA nursing school at Florida Hospital and he likes the idea and takes my email address. He insists we come eat at his restaurant the next day but unfortunately, we already have plans.
The last day before heading back to Kinchasa, I make my final rounds and find the girl in even better condition having already passed gas letting us know that bowel function is returning. I pray with the family one more time leaving her in God's hands.
Kinchasa has a sort of sport found maybe no where else in the world. I don't know if anyone has actually named it, but it seems the rules are well known. I'll call it Kinchasa-ball and it's played out every day on the wharfs of the city where the ferry crosses to Brazzaville.
There is a walkway from the street to the pier that is enclosed by steel bars that serves as the playing field. The game starts as the ferry prepares for crossing. Somewhere out on the street, the visiting team starts it's preparations as the trucks arrive bearing all kinds of cheap, processed goods for the markets of Brazzaville. Hordes of "runners" gather. Yellow and blue vests are handed out. The players have the option of wearing them over their shoulders and backs, tying them around their necks, or wrapping them around their heads as turbans. Most wear pants cut off just below the knees, ragged t-shirts and flip-flops. The players come in all sizes and shapes, but all are wiry tough and most are quite buff.
Meanwhile, the home team gathers at the elbow where the walkway curves around through a gate, runs parallel to the river for 50 feet before making its final turn down the gangway to the rusted out ferry boat teeming with spectators. The home team consists of a couple of player-coaches and five or six large, uniformed port authorities. The one who appears to be the head coach is of average height, has a scowling face and wears Arabic robes. His piercing eyes glare out from behind small spectacles perched on his flat nose. The "assistant" coach is a huge man with a beer-belly and a large, pocked marked face with a smug grin permanently hovering ready to pounce.
Gary, Jeremy and I have stumbled upon first row seats just behind the home team where the passengers wait to cross over the Congo River into Brazzaville on speed boats.
The first member of the visiting team pads around the corner, his slippers flip-flopping across the cement in cadence to his labored breathing as he struggles under an enormous load of yellow soap bars balanced on his sweaty scalp. The home team is just warming up so they let the first one pass.
The second is not so lucky.
A smaller man, with a 8 foot wide plastic wrapped burden of cracker rolls perched on his head, jogs down the gauntlet towards the corner where the uniformed home team waits. Each of the port authorities carries a doubled up rope in his hand which he occasionally fondles with the other hand in eager anticipation of feeling it zing down on another human beings flesh.
As the man approaches, the head coach steps out and grasps the side of the opposing teams load. There is a brief struggle as the unfortunate man desperately tries to keep his precarious balance. Finally, he is forced to drop down his load next to the leering home team members. He argues briefly and half-heartedly as if it's the thing to do even though he knows it's hopeless. Meanwhile, the same scene is repeated over and over. Most get through the gauntlet, but randomly, someone will be pulled down using their top heavy loads as leverage against them.
The game continues as those who have been pulled aside run back to the street and come back shortly with something in their hands to pass on to the home team in the form of a "secret" handshake. However, they don't seem to take too many pains to make it secret and don't seem to be ashamed at all of the blatant bribery and corruption.
In fact, after a giant, hulk of a uniformed man on the home team pulls down a tiny man half his size carrying double his wait he lifts his massive head into a victorious grin as he air boxes like Rocky his fists pumping the air in jubilant victory.
The worst is still to come. The visiting team has recruited some new players. A line of 5 blind people walk slowly up each left hand placed on the shoulder of the man in front with a guide showing the way. In their right hands, they carry some small bundles of merchandise for which they will be paid a few cents allowing them to honestly earn a living playing Kinchasa-ball.
There is no mercy. The coach himself steps out with an evil grin and pushes them back. They stumble trying to keep their balance, sightless eyes rolling around in their lolling heads. Kinchasa-ball is not for the faint of heart.
Next is a man in a wheelchair. It is a tricycle that allows him to pedal the front wheel with his hands. The chair has been loaded with goods and he is perched on top pedaling furiously. Surely, he'll make it through the gauntlet! But no! Our brutish giant lumbers a few steps forward and places his beefy hand on the cripples chest as he sneers out his order to stop! He too must pay to get through.
After about half an hour of intense competition, the game winds down, the gates are shut and the ferry pulls out slowly from the dock. The home team gives each other satisfied smiles as they finger their fat pockets as the visiting team, slowly climbs back up the gangway, sweat dripping from their soaked shirts and glistening on their ripped, but tired bodies.
Tuesday, February 17, 2009
So Doug and I take our time on the iguinal hernia repair which I do with mosquito net mesh as usual. Suddenly, Hortence's head pops into the OR through the swinging doors.
"There's a woman...the legs and body're out...the head's stuck...been that way for awhile...we can't..."
"I'm coming! Doug, close up the skin." I cry as I strip off my surgical gown and bloody gloves and race out through two sets of swinging doors, a screen door, around the corner, under the veranda, through another screen door and right into the tiny delivery room where I see a floppy set of legs and arms with no head plopped on the delivery table between a woman's bloody spread legs. The room is packed with Augustin, Hortence, a mid-wife student, another nurse, Dr. Jacques, a family member and now myself.
I start to shout out orders.
"Augustin, get me the symphysiotomy kit!"
"Hortence, bring me some gloves."
"Prudence, I need a syringe and some lidocaine."
"Jacques, a 20 blade scalpel."
As everyone goes off running I slip my hand in and with a few futile tugs confirm that the baby's head, extended on it's neck, is stuck.
Everyone back in a matter of seconds. I slip on the gloves, draw up the lidocaine, open the instruments, inject quickly over the pubis, put the scalpel on the scalpel handle and speak directly to the woman.
"Don't move whatever you do if you want this to work! Augustin, Jacques, grab her legs and pull them up and out!"
I slice through the skin and cartilage and feel the pelvis pop open. The baby slithers out. I clamp and cut the cord. I whisk him off to the exam table. He has no heartbeat, tone, movement, cry, respiration, color, nothing. I try and clear out the gunk in his mouth and nose and do chest compressions for a couple minutes before silently covering him with a rag.
I turn my attentions to the mother. I start to examine the position of the placenta and notice two things at once.
First of all, her belly's still really big. Secondly, there's a bulging bag of water in her vagina. Twins!
I break the back of water and out pop's a full head of hair. Within seconds the second twin is delivered, pulling up his arms and legs, grimacing and screaming his little lungs out. He's alive!
Monday, February 16, 2009
Hazard lights flashing we make our way through the city ignoring lights and stop signs as other cars pull over to the side to let us pass. We arrive at the President's guest house overlooking the Niger and the irrigated fields crowning its banks. A sumptuous, yet simple supper awaits us. Air conditioned rooms, white table cloths, sodas and cold water on the side and comfortable couches welcome us in style. Conversation flows easily as we are from time to time interrupted to meet more important people in dark suits.
The next morning starts with a tour by Jason Brooks of the ADRA office and school where bright kids in sharp uniforms smile and shout out English phrases they have learned. The school is an impressive combination of underprivileged kids sponsored to go where they'd never have the opportunity to go otherwise, and rich kids who pay big to get a good education. All have become equals in their matching uniforms.
Then we're off to see the big wigs starting with President Mamadou Tandja himself. Circling around the winding, well-guarded roads up the the governmental palace is a little surreal. We climp up the massive steps and enter through a metal detector into an inner courtyard with high ceilings, traditional carved horses on stands, pictures and maps on the walls and a 10 foot giraffe carved out of the twisted root system of a tree.
We are finally ushered into the President's office where we are presented by Bill Kirker as the group possibly willing to take on the management of the Maine-Soroa Hospital, which just happens to be in the President's home town. I translate for Dick as he presents the President with a gift from Loma Linda University. The President is very gracious, poses for photos with us all at the end and decides on the spur of the moment to give Dick on of the carved horses in his lobby.
Whirlwind tours with more Mercedes and Land Cruisers and flashing hazards take us through the turbaned Tuareg Minister of Health, the distinguished, glasses-on-the-nose Minister of Education, and the plump, take-no-prisoners US Ambassador.
The next day we fly 800 km across the desert, east towards Chad with a quick stop at the only Christian hospital in Niger. A quick, chicken dinner probably providing the source of our later diarrheal illnesses and a too short crash on floor mattresses inspected by a mouse and many mosquitos and we take off again the next morning for the last 600 km to Maine-Soroa. Two flat tires and mostly good roads later and we are stopped at the side of the road in the middle of a desert with widely spaced scrub trees, and goats, sheep, donkeys, horses and camels wandering through.
As we get out of the cars, a crowd gathers around as we are welcomed by the governor, the mayor, the prefect and a host of other dignitaries from the region who then escort us into town in front of the king's quarters, in front of the central mosque and next to the market. A crowd has gathered. Brightly decorated horses mounted by robed, spear-and-sword-toting cavaliers prance on the sidelines. School kids in uniforms wave and chant. Turbaned, shirtless boys twist and contort in front of drum-pounding musicians beating out a fast rhythm accompanied by a bulging cheeked flute player. We push through the crowds to where chairs and couches have been arranged. The toothless, ninety-year old king nods and shakes hands as his eyes bulge out from behind coke-bottom glasses.
Speeches are made, kids dance and sing and recite and shout poems and slogans, horse-men dress out and shake their weapons, traditional dancers move and shake, and Dick is crowned "Wokil". He is brought crosslegged onto a mat in front of the king while his side-kicks circle around dressing Dick in a traditional, blue robe with elaborate embroidery, a red, felt skull cap and crowned with a turban. The "Wokil" is the king's new ambassador to the world, and in the absence of the king, his word is law. The ceremonies ended we end up at Bill and Barbara's for a feast of goat with couscous cooked in it's belly.
The next morning is another whirlwind tour of Barbara's Second Chance School for kids who have never been to school and are passed the country's maximum age (9 years old) for entering elementary school, the king's court, the Prefect's office, on to Diffa to see the governor and back to Mainé to check out the ancient air strip. Friday morning we finally get to see the hospital newly named the Kirker Hospital in honor of Bill and Barbara's efforts as first Peace Corps volunteers and then as the only doctor for years in this extreme eastern city of Niger founding a hospital where before there was none. Now, the hospital is being revived after years of neglect with some new hospital wards and the hope of a new management team, nursing school and maybe even specialty services to serve the underserved populations of Eastern Niger, Western Chad and Northern Nigeria.
We all crash Friday evening and Saturday with staggered episodes of vomiting and diarrhea. Another feast of splayed roasted sheep and couscous goat on Saturday night with the hospital staff finishes off our stay in Niger. Sunday morning, Sarah, Dick, Kari and I head off in Bill's Land Cruiser across the desert, up north and around the top of Lake Chad. 13 hours of desert, many camels, much sand, a few Lake Chad thick-horned cows, one gazelle, one desert fox, a large bird whose name I forget, clusters of white brick mud huts with flat, horned corner roofs, one half-hour stuck in the sand barely getting out episode, one border crossing where we are the only car to have passed in two days and we arrive in Chad at Bol.
I am welcomed back to my host country by a couple of moto taxi-men trying to scam us into believing that the airport is a long ways away and only they can show us. We ignore them and continue through the one road town to the hospital where the charge nurse who happens to be on duty informs us that Gary and the Bere Hospital chaplain, Noel, have just arrived and are over at the regional medical officers home.
The regional medical officer is a friend of Noel's and he welcomes us with a big smile and a feast of macaroni and tomato goat sauce which we partake together on a mat on the floor with the tray of noodles in the middle. Everyone digs in with his own spoon and washes it down with bananas and cold water. The next day, we fly off with Gary over the vast expanse interconnected lakes which is what remains of the great Lake Chad. Massive herds of cattle wander in long lines like ants across the green fields watered by what is still one of Africa's largest lakes only to end abrubtly in the sands of the Sahel. After landing in Moundou and showing Dick and Kari the progress on our Surgery Center project there, we finally arrive back in Bere.
Sunday, February 15, 2009
During this down time I have been hand knitting a little sweater for the granddaughter. It has been some time since knitting anything by hand and so I have had to rip out many, many rows. I am now trying to decide if it will look like a used garment by the time I have it finished.
As you know, there are all sorts of questionnaires that go around on Facebook, and for the most part I just press "Ignore" and go on. For some reason while I was reading Ann's post this morning I decided to do her little High School Questionnaire - my answers are boring but I had fun doing it. Here goes:
1. Did you date someone from your school? No
2. Did you marry someone from your high school? No
3. Did you car pool to school? The first two years I rode with my father and the last two years I was at boarding school.
4. What kind of car did you have? You've got to be kidding
5. What kind of car do you have now? Chevy Tahoe - I haul everything and when a semi hit me from behind going 70 mph while I was driving it in Tennessee, I was spared serious injury so I just can't part with it yet.
6. It's Friday night...where are you then? Home with the family.
7. It's Friday night...where are you now? Home with the family.
8. What kind of job did you have in high school? Babysat, worked in the library. The library sound boring but we had so many fun people working there that everyone wanted to work there.
9. What kind of job do you do now? Own a health food store, manage rental properties, one that we rent every nine weeks specifically for patients with cancer coming for Proton treatment.
10. Were you a party animal? No
11. Were you considered a flirt? If you don't tell my kids - yes
12. Were you in the band, orchestra, or choir? Of course!
13. Were you a nerd? Oh, no.
14. Did you get suspended or expelled? With my dad as principal for two years - he always took care of "things" when we got home.
15. Can you sing the fight song? We didn't have one
16. Who was/were your favorite teacher(s)? Mr. Mayhew
17. Where did you sit during lunch? The first two years wherever we chose, the last two we sat where the hostess placed us at each meal. So we tried to place ourselves in line to make sure we could sit with our fun friends.
17a. Who did you usually sit with? Tried to sit with Sue, Laura, Judy, Kerry, Sharon, Roy, Jeff, Ron, Derick
18. What was your school's full name? Kansas City Junior Academy, Sunnydale Academy
19. When did you graduate? Oh, please.
20. What was your school mascot? We had none
21. If you could go back and do it again, would you? We had a great time, but I would never want to repeat it.
22. Did you have fun at the Prom? We had banquets and I always had a good time
22a. What was the prom song? None
23. Do you still talk to the person you went to the Prom with? Nope
24. Are you planning on going to your next reunion? I only go when my good friends go as it is a long trip
25. Did you play any sports? I could barely pass P.E.
26. Did you have a senior class trip? That's what they called the bus ride to St. Louis and a visit to the planetarium. The bus broke down and we spent hours on the hot bus waiting. Sound like fun?
28. What were you voted Most Likely? Nothing official that I can remember.
Friday, January 9, 2009
Along with the eating we are to exercise an hour a day. Last night we headed out and I dragged myself through the city for an hour and was loving back safe in my house. That feeling was short lived when all of a sudden the house began to shake, there was a strong jolt and a loud "boom" noise. Usually I know where I want to be when an earthquake hits but the latest information says that you shouldn't get under things like we have been taught for the last 30 years, but be right next to a heavy object so the object doesn't crush you. Makes sense, but I just hadn't put any thought into how I would change my under the table safety plan. So...I just stood there with a panic stricken look searching for what looked like it matched the new "you'll be safe" model.
By the time I could get it all together, the shaking had stopped and only a few picture frames had fallen over. There were several other little aftershocks that we couldn't feel but there was one that set that panic feeling racing all over again. For now we are all safe and the nerves are calmed down and we're thankful we survived another earthquake in So Cal.
I had all these good intentions of writing each of you personal long
newsy emails before we sent and received this week. I didn't realize
that this lazy Tuesday afternoon would find me hooked up to another
IV, recovering from surgery.
I had an appendectomy last night, sometime around 9:00 pm. Dr. Bond,
a visting surgeon, tells me that surgeries come in threes. Last week
we did three emergency strangulated hernias, in a matter of three
days. And this week was appendix week. There were two Chadian women,
late Sunday night, one inflamed appendectomy after another. I would
have never guessed that the third would be me.
I had had a gnawing lower right abdominal pain for three days. I'd
wake up at night, nauseated and sweating. But it would go away. I
went horseback riding and watered my garden. Dr. Bond told me he
thought I had appendicitis, but I was in denial. "If it was
appendicitis, I would be hurting a lot more than this. Maybe I have
worms," I thought.
Finally, an elevated white blood count convinced him that waiting any
longer was just increasing my changes of rupture. We called my
parents, and, after a few biting-on-my-lip-to-hold-t
went to surgery. Kristin and Emily tied me down to the same table
that I had tied other patients to, just earlier that day. They hooked
me up to the monitors, and gave me shots of promethazine and diazepam.
I'm so thankful that they were there, in their masks and bright red
surgical caps, holding my hands. I'm thankful that I was able to have
a surgery performed at the best hospital in the whole country. Not
many people can say that.
I was given spinal anesthesia, so I could be awake during the
surgery, and skip the bad side effects of ketamine, the main general
anesthesia drug that we have here. Ketamine makes people crazy. They
talk, they sing, sometimes they drool excessively, they say all sorts
of weird things in different languages, they have awful dreams.
Ketamine is an old drug that isn't hardly even used in the States
anymore, and I've never wanted to know what it would be like to be on
it. Please no ketamine, I had told Dr. Bond before hand.
But the spinal didn't work. I could clearly feel him pinching my
abdomen with the forceps, right before he was about to cut. "Kristin,
give her 150 mg of Ketamine, now." I heard Dr. Bond say.
As I drifted off, Simeon, the Chadian nurse who assisted, leaned
over, sterile gloved hand on my tummy. "Ansley, God is so big," he
said softly in French, "He will take care of you, he will hold you."
It's twenty four hours post-op. I'm doing okay. I'm sore and tired.
I've slept all day long. I'm taking tylenol and getting pentazocine
injections for the pain. I am not allowed to eat or drink until tomorrow.
Emily said that the ketamine made me speak only in French, and that I
didn't say anything bad, or embarrassing. (I guess I'll never know
for sure). She told me that I kept asking, "Was it a good appendix,
or bad?" I was worried that the operation had been in vain, that my
appendix was fine, after all, and could have been left alone.
It was a bad appendix, all red and angry, ready to burst. We're all
glad that it is gone.
I love you all, and thank you for your prayers. God is so big, and he
does care for us.