Le Weekend

From James:

Boy, am I glad I went to bed early Friday night!

It was still dark and sticky when I woke up around 4am thanks to the pitter
patter of little rat feet running back and forth directly over my head as I
lay in a profound sleep.  Now, I can't go back to sleep.  Every time I'm
about to find dreamland again I hear the scurrying or the flapping of a bat
outside my screen window.  I give up and get up.

I put on a headlamp so I don't wake Sarah with the overhead light and go out
to the kitchen table.  I grab my French Bible and finish preparing the
sermon I'll give in church later on this morning.  At 5am I'm finally able
to catch a few more winks before the pink early morning light filters in the
windows accompanied by the ever vigilant roosters.

I eat a simple breakfast of local peanut butter on toast with guava sauce.
Meanwhile, Sarah has gone out to feed the horses and locked me in!  I stare
out the bedroom window waiting for someone to come within calling range.
Kitty hops up to the window sill to join me in my quiet contemplation of the
African dawn.  Some purple, pipe-cleaner type flowers have shot up just
outside the screen and a zebra looking bee is buzzing merrily amongst the
bristles.  Everything is green and the guavas are getting bigger and bigger
although they're still very green.

Finally, I spot Emily, a volunteer just arrived yesterday who responds to my
pleas for freedom and unbolts the outside latch on the front door.  I pack
up my books in a tiny bag and hoist my heavy, hollowed out tree trunk drum
to my shoulder and head off to the church.

The ancient French hymns sung off key that come wafting out of the church
are soon replaced by a more African rendering as Allah, our new nurse
Augustin's 10 year old son, starts pounding out some rhythms on the drum
accompanied by my little tambourine.

I have a very interesting discussion with a bunch of young people interested
in finding out what Christianity is about.  We talk about the Bible and how
it came about and who wrote it and why it's important because it's a
collection of stories telling us how God interacts with people despite all
their warts and wrinkles.

Then I preach my sermon in French with Nangjere translation.  Afterwards,
Simeon is waiting for me outside.

"There are a couple of patients you should come see."

I hurry home, change into scrubs and mosey off to the hospital.

Our friend, Polycarpe, the child with the bleeding disorder we've been
transfusing almost every week for the last few months is having severe
abdominal pain.  He also had some bloody diarrhea.  I'd been saving the
plasma part of other people's blood transfusions by storing them in the
kerosene freezer.  Yesterday, they were supposed to thaw it out, let any
remaining red blood cells filter out and give Polycarpe the plasma.  It
hadn't been done.  I quickly hook him up to the plasma and give him some
malaria treatment.  I hope to avoid another transfusion.

A three year old child with a hemoglobin of 4.3 g/dl still hasn't got a
blood transfusion.  Seven family members have been tested with no one who
can give her the blood she needs.  Her blood type is B-, the same as me.  I
just gave blood last week, but what the heck.  I tell Simeon to call the lab
guy, find an IV and I'll be back.

I figure I'd better eat something first.  I go home and Sarah has heated up
yesterday's eggplant spaghetti sauce.  We eat and then I drink another liter
of water and head back to the hospital.

Mathieu is waiting for me.  I lie down on the examining table in my office
as Mathieu prepares the blood bag, wraps a tourniquet around my arm, uses
alcohol soaked cotton to wipe off the skin over the big vein in the middle
of my arm and slides in a huge needle effortlessly into the vein.  I pump my
fist to make the blood go out faster and I've quickly filled up the 450ml
bag.  Mathieu takes out the needle and puts a cotton ball over the puncture
wound.  I flod my arm up, sit up and get ready to go.

"Already?"  Mathieu asks, astonished.  "Aren't you dizzy?"

"No, I just ate and drank a bunch so I'm fine."

I head out the door and meet Sarah at the house where she's already saddled
my horse, Bob.  Sarah takes off on her horse, Pepper, while the volunteers
follow on foot.  I change into jeans, grab some water bottles and jump on
Bob.  Allah, my drumming friend from this morning is coming with me.  I
swing him up by his arm into the saddle behind me and we take off at a trot.
Allah bounces around and we have to stop and walk often but eventually we
catch up with the others.

The rice fields are completely swamped and the path is nothing but a swath
of still water meandering amongst the rice stalks already starting to bend
at the neck from the weight of their kernels.

It's blazing hot and the water splashing up from Bob's hooves is a welcome,
mild relief from the sweltering heat.

The river has way overflown it's banks swallowing up all the familiar
landmarks except a few trees bravely sticking their branches up from the
swirling eddies.  We wade out towards the current through what used to be a
large field leading down to the cattle crossing.  Jason, Jacob and Nathaneal
have already almost reached the current as I start out and they are quickly
swept downstream.  I find the current and swiftly catch up to them where
they rest holding onto some branches sticking out of the water as the water
rushing by makes it sound like we're in a mountain stream rather than a flat
river winding through the African bush.


I'm vaguely scared of hippos, though they probably won't like the fast
current, and am again glad there are no longer crocs in these rivers.

After several bends we pull ourselves up the bank by grabbing onto piles of
tall grasses and follow the sketchy, grown paths through the bush on the
bank of the river trying to be as loud as possible to scare off vipers.

Back where Sarah and the others are playing with some of the Chadian kids,
the guys and I head up river just a tad where we see a tree coming out of
the river near the bank and then bending out conveniently at a right angle
where we can jump off.

After some jumps to test the depth, we dive and do back flips venturing ever
higher on ever thinner branches until we've exhausted the possibilities.

Heading home on Bob with Allah I have a hard time holding the horse back as
he smells his dried corn at home already!  Packs of mosquitos buzz along
with us in the twilight as the sun has gone down over half an hour ago.
Finally, Allah can't take any more so once we hit the first huts of the
village he gets off and I let Bob go rushing off through the approaching
night with the wind whipping around me leaving the mosquitos far behind.

I arrive in time to see Augustin returning from church.  He informs me that
Samedi is looking for me as there was a motorcycle accident.

I quickly pull off the muddy saddle and harness from Bob, open the door,
strip off my soaked jeans, take a fast shower and pull on scrubs to head
over to the hospital.

The ER is dimly lit by it's one flourescent bulb crowded with buzzing
insects.  A small pool of blood has formed at the foot of the bed where the
middle aged, portly woman lies with her left ankle at an impossible angle
like it's been shifted completely towards the middle.  A blood soaked gauze
pad is tied on tightly over the lateral ankle where I assume the bone came
poking out.  She has no other injuries.

They've also just brought in another elderly woman in a push cart who I can
tell needs an amputation just by the smell and the sight of the left foot
wrapped in dirty rags over a mud soaked gauze wrap.  Sure enough, cutting
off the rags and gauze reveals wet, blackened toes with the calloused skin
on the sole peeling off and a large, pus filled central wound on top
revealing the tendons and bones.


The guy driving the motorcycle that had fallen over causing the woman's
broken ankle has a swollen hand with probably some fractures.  As I wait for
the two women to pay for their surgeries, I quickly apply a combo plaster
and fiberglass cast to the man's hand and wrist, give him some Ibuprofen and
tell him to go to Moundou and get some x-rays.

The family of the woman with the broken ankle are having internal conflicts
as to who will pay so since the son of the woman with the rotten foot has
paid half and put his bicycle on as collateral, we start with her.

Hoping to do a midfoot amputation only I squeeze the blood out of her leg,
apply a blood pressure cuff as tourniquet and slice through the bottom of
her foot right into a pocket of pus.  Her foot is gone.  I quickly move up
to the middle of the lower leg and slice down to bone.  I scrape the tissue
off the bone as far up as I can then painfully and slowly saw through the
tibia and fibula with a tiny inch long saw that keeps clogging up with wet
bone paste.  Finally, I get the leg sawed off, identify the major vascular
bundles, clamp and tie them and close the muscles and skin over the stump.


The second woman has finally found a solution so we find an IV, give her
some Ketamine and Diazepam and I pull her foot down and out into position.
The fibula gets stuck on some tissue inside but with some manipulation I
free it up and get it into anatomical position.  The medial malleolus (the
part of the tibia that makes up the ankle joint) is crushed in several
pieces.  The fibula part of the ankle seems to have only one break, but it's
an open fracture.  Abel mixes up some diluted bleach solution and I wash it
out well.  I close the subcutaneous tissues, apply a dressing with Betadine
and while I try to hold the foot and ankle in as good a position as
possible, Jacob wraps the foot and leg up to the knee with web roll and then
applies a plaster cast.  I am able to mold the ankle some more and get the
foot in a good position.  The cast hardens and we take her out to her bed.

It's 11pm.

I go home.  I haven't eaten since lunch, since giving blood, since riding to
the river, since swimming and jumping off trees, since riding back and since
doing two operations.

I'm slightly hungry and am so grateful to find a skillet filled with fried
rice and eggs.  I devour it.  It's only later that Sarah informs me that was
supposed to be enough for supper and breakfast the next day.

I fall fast asleep until the rat wakes me up again at 5:30am this time.
Sarah and I get up, grab the shovels and pick and go out behind the church
to dig a latrine...a typical weekend is half over in Bere, Tchad...