After 4 weeks of looking through, cleaning, sorting, choosing, and selling, everything down to the last piece of paper has been taken care of at my parents home. It was an emotional and tiring journey and I am glad to be done. We thought that just two weeks would be enough to have it all done so it was a bit of a surprise to still be hanging around a month later. We had planned the garage sale a week earlier but the forecast predicted a day of rain due to Hurricane Ike so we postponed it a week and wouldn't you know, it turned out to be a beautiful sunny day anyway!
While I was here I thought there would be some time for sewing at least a little knit top but it looks as if I will be taking my patterns and material back home the same way that I got them from the store. The only sewing I did was to put new elastic in a garter so that my niece can wear her mothers garter when she marries in December - she was thrilled so I count that has productive sewing.
Saturday, September 27, 2008
Roadtrip
"I dont' know, I really want to pick you up in the airport, but it'd be hard now. It's pouring down rain, the roads are already bad, the car doesn't start, I'd have to go by motorcycle and public transport. I'd like to see you as soon as possible, but I'm exhausted, plus the extra expense...couldn't you just take a taxi from the airport and then come back on public transport?"
Sarah is supposed to arrive tomorrow in N'Djamena, but with the rainy season and all, I try to excuse myself. Deep down, I feel I should go to meet her though, but she doesn't have to know that!
I haven't decided for sure one way or another, but I get a text message from her later that evening telling me she understands and I should feel free to not come to pick her up, I'll just owe her a ton of back rubs later!
I call Ndilbe, our nursing student who has just finished his 3 month internship and is ready to go back to N'Djamena.
"We leave tomorrow at 5am. Can you arrange some motos for us?"
At 3am, Augustin knocks on my door.
"There's a kid in respiratory distress, can you come see him."
Sure. I haven't been able to sleep anyway thinking about surprising my wife at the airport.
The kid is grunting, wheezing, retracting and has nasal flaring. Severe asthma. I open my office and find a few vials of expired Xopenex that we put in the nebulizer. I tell Augustin to give him some Dexamethazone IM while I hook up the machine.
The kid suddenly comes alive and it's all the mom and I can do to hold him and the mask in close enough proximity for some of the medication to get in his lungs. Despite his best efforts, something must be getting in those tiny lungs as he starts to breath easier. I tell Augustin to start a Quinine drip for malaria, add some Ampicillin in case it's pneumonia that provoked the attack and return home.
I'm too wired now for sure to go back to sleep for a few minutes so I make some egg gravy and toast and finish packing my small backpack, a skirt and t-shirt for Sarah and an army duffle bag to bring back fresh vegetables from the N'Djamena market.
The predawn glow appears. It's cool and humid and a little haze rests across the African plain. Two old Nigerian motorcycles with dim headlights waxing and waning with the speed of the engine and spewing out white, burned-oil-smelling exhaust, limp up to the front gate.
Ndilbe wraps himself up in a turban and we strap on our bags to the back of the motos with old bicycle innertubes.
We're off, with the cool air whipping gritty humidity into our faces.
The road is one long series of mudpuddles with improvised footpaths around most of them extending sometimes into the rice fields. Often we have to just plow through green, muddy water up to midway on the tires. We cross the new bridge and down the other side where the gravel buttress has mostly fallen away with the rains leaving a small middle section carved up with a few metal beams tied together with steel cable barely holding things together. We're through the barrier at the bottom and pass through Tchoua on our way to the hippopotamus lake.
The elevated road through the lake with a central drainage pipe is pock marked with a million ruts carved out by heavy trucks and a billion ridges carved out by the draining rainwater. It's confounded by being made of clay, slickened by the rains making it a bumby slip and slide experience wondering when we'll just slide down into that wide open hippo mouth.
The last stretch before Kelo is completely submerged and we plow our way through and wind our way through the early morning mud streets lined with tiny mud brick shops just yawning a good morning to another day of fasting in this month of Ramadan. A few lonely robed figures stroll through the red tinged early morning fog as we finally hit the pavement and pull up to the "bus station" on the side of the road opposite the air compressor and rickety wooden tables lined with various shapes and sizes of glass bottles filled with an assorted variety and mixture of fuels.
Sarah is supposed to arrive tomorrow in N'Djamena, but with the rainy season and all, I try to excuse myself. Deep down, I feel I should go to meet her though, but she doesn't have to know that!
I haven't decided for sure one way or another, but I get a text message from her later that evening telling me she understands and I should feel free to not come to pick her up, I'll just owe her a ton of back rubs later!
I call Ndilbe, our nursing student who has just finished his 3 month internship and is ready to go back to N'Djamena.
"We leave tomorrow at 5am. Can you arrange some motos for us?"
At 3am, Augustin knocks on my door.
"There's a kid in respiratory distress, can you come see him."
Sure. I haven't been able to sleep anyway thinking about surprising my wife at the airport.
The kid is grunting, wheezing, retracting and has nasal flaring. Severe asthma. I open my office and find a few vials of expired Xopenex that we put in the nebulizer. I tell Augustin to give him some Dexamethazone IM while I hook up the machine.
The kid suddenly comes alive and it's all the mom and I can do to hold him and the mask in close enough proximity for some of the medication to get in his lungs. Despite his best efforts, something must be getting in those tiny lungs as he starts to breath easier. I tell Augustin to start a Quinine drip for malaria, add some Ampicillin in case it's pneumonia that provoked the attack and return home.
I'm too wired now for sure to go back to sleep for a few minutes so I make some egg gravy and toast and finish packing my small backpack, a skirt and t-shirt for Sarah and an army duffle bag to bring back fresh vegetables from the N'Djamena market.
The predawn glow appears. It's cool and humid and a little haze rests across the African plain. Two old Nigerian motorcycles with dim headlights waxing and waning with the speed of the engine and spewing out white, burned-oil-smelling exhaust, limp up to the front gate.
Ndilbe wraps himself up in a turban and we strap on our bags to the back of the motos with old bicycle innertubes.
We're off, with the cool air whipping gritty humidity into our faces.
The road is one long series of mudpuddles with improvised footpaths around most of them extending sometimes into the rice fields. Often we have to just plow through green, muddy water up to midway on the tires. We cross the new bridge and down the other side where the gravel buttress has mostly fallen away with the rains leaving a small middle section carved up with a few metal beams tied together with steel cable barely holding things together. We're through the barrier at the bottom and pass through Tchoua on our way to the hippopotamus lake.
The elevated road through the lake with a central drainage pipe is pock marked with a million ruts carved out by heavy trucks and a billion ridges carved out by the draining rainwater. It's confounded by being made of clay, slickened by the rains making it a bumby slip and slide experience wondering when we'll just slide down into that wide open hippo mouth.
The last stretch before Kelo is completely submerged and we plow our way through and wind our way through the early morning mud streets lined with tiny mud brick shops just yawning a good morning to another day of fasting in this month of Ramadan. A few lonely robed figures stroll through the red tinged early morning fog as we finally hit the pavement and pull up to the "bus station" on the side of the road opposite the air compressor and rickety wooden tables lined with various shapes and sizes of glass bottles filled with an assorted variety and mixture of fuels.
After paying the moto taxi-men and for our bus tickets, a young, turbaned man approaches and greets us. He is chewing on the typical Ramadan teeth cleaning stick. It's the son of the builder constructing our new junior high in Bere. He's on his way to Cameroon to study. I buy some bananas and then confirm his fasting by offering him one which he politely refuses.
We get on the bus and have two of the back four seats. Ndilbe takes one window and I take the other. Next to Ndilbe is another flowing robed, turbaned Muslim spitting occasionally out the window to keep from violating one of the Five Pillars by inadvertantly swallowing his saliva. A fully covered and veiled Muslim woman with dark gloves and stockings makes her way down the aile towards the back. A young Arab in front of me seems concerned that this obviously pious woman may be forced to sit by an obviously foreign and thus necessarily infidel white man. He shouts in Arabic to Ndilbe and the other man to move over which they do.
"Da bas adil" he responds nodding his approval as the deeply perfumed, modest example of virtue makes her way to the seat as far away from me as possible in the same row on a tiny bus. I'm relieved too.
The rest of the four hours passes quickly with a "Tale of Two Cities" and an occasional nap to keep me busy. We arrive without incident in the midst of a vusy market in N'Djamena.
I had planned to catch a taxi straight to the mission guest house, but decide to go with Ndilbe instead and try and arrange to see his nursing school and pay the school fees for the next year.
We walk down the crowded, noisy market street and turn the corner. We try and catch a taxi, but as we're putting our bags in the back, three people have got in the back seat and two in the front. There's only one space left. We start arguing as we have to travel together since I don't know how to get to Ndilbe's place. The woman in the back who'd stolen my spot doesn't budge and just smirks in reply. Finally, a young Muslim girl is kind enough to get out of the front seat leaving me crammed next to a very large woman occupying the other "half" of a tiny Peugot taxi passenger seat.
The trip is short and we take another road with a drainage ditch in the middle filled with small, bare-footed boys searching for something in the muck.
We open the gate to the house and enter the courtyard where we thankfully dump our bags under a shade tree and I thankfully relieve a very overworked bladder in the corner latrine.
The woman of the house, the wife of one of Chad's chief justices, generously lets me use her car which takes us on a bumby ride through the suburbs of N'Djamena to a Goudi looking three story structure where two secretaries sit doing their nails and gossiping in front of empty adminstration offices. Strike out!
I then get a call from Babana Benzaki who has arrived from Nigeria. A former Muslim, originally from Tchad, who converted to Christianity while studying in Nigeria and who is in his last year of public health at Babcock University, Benzaki has come to get the financial support voted on by the last AHI committee. We have many very interesting conversations about health, life and God. In the meantime, Kaitama shows up to get the letter I brought from his brother and Dieudonne shows up from work so we can discuss how I'm going to take off the lipoma from his neck tomorrow and how maybe in return he can let me borrow his car to pick up Sarah from the airport.
It also happens to coincide with the birthday of the four year old son of the Chief Justice who's mom had prepared a birthday feast even though she had invited no one. With nothing but a couple of boiled eggs and some bananas in my stomach since 4:30am I am more than happy to be part of the celebration! We finish off with a deep red Jus d'Osei (Hibiscus flower tea) and some strong, cold homemade Ginger drink.
I finally head to the guest house in the judge's Toyota Four-runner for a few hours rest before the 9pm arrival of my Danish wife.
I stand patiently outside the barred entrance to the baggage claim as various "important" people are let through while others are kept out. Finally, they seem to be letting down their guard and I slip through with the next batch let in.
I wait in front of the door leading to the immigration booths. I had glanced in quickly to see if I saw Sarah's red head without her seeing me and I succeeded. Finally, after an eternity, she appears at the door and looks at me with a shocked look and then starts laughing and saying "no, no, no, I can't believe it." Unfortunately for me, it's not a pleasant surprise at seeing me that has brought on this reaction but shock at seeing my recently smoothly shaven scalp that makes her incredulous. She is very cute with her long red hair pulled up in back with a few ringlets of curls escaping to the sides to run down her cheeks and forehead. I give her a warm hug and breath in the fresh smell of her hear as I kiss her head. It's good to have her back and definitely worth it all!
Monday, September 15, 2008
Shocking!
From James:
I stand at the foot of her bed. Kristin and Augustin are the nurses on duty and the three nursing students, Ndilbe, Honoré and Innocent are gathered around, white coats spotless, notebooks and charts in hand.
The patient has just come out of surgery two days ago for a walled off, perforated appendicitis. At first glance, she seems to be doing fine. She's staring at me with understanding eyes and breathing rapidly but easily. Then, I notice beads of sweat all over her chest, face and arms. I pull off my stethescope from around my neck and press it against her thorax. The heart beat is rapid and irregular. She's mid thirties and shouldn't have heart disease. What is it?
I look at the chart. Her vital signs there are listed as normal. Then I notice that she's been still kept NPO (nothing to eat or drink) but hasn't got IV fluids in 24 hours. I quickly have the nurse put up some Ringer's lactate IV solution. I think maybe she's dehydrated and has some electrolyte imbalances. We can now at least check his potassium thanks to the Danes and I go ahead and give him a little expired Magnesium that I've been hording in my little stash in the pharmacy.
Then, I remember the heart monitor/defibrillators that our two young volunteers for the summer brought over. I go to the OR stock room and find one that still has a charged battery despite never being charged since arrival in Tchad three months ago.
I hook it up to the patient. The screen is so small and the heart beat so fast it's hard to tell for sure, but it looks like atrial fibrillation or atrial flutter.
I stand at the foot of her bed. Kristin and Augustin are the nurses on duty and the three nursing students, Ndilbe, Honoré and Innocent are gathered around, white coats spotless, notebooks and charts in hand.
The patient has just come out of surgery two days ago for a walled off, perforated appendicitis. At first glance, she seems to be doing fine. She's staring at me with understanding eyes and breathing rapidly but easily. Then, I notice beads of sweat all over her chest, face and arms. I pull off my stethescope from around my neck and press it against her thorax. The heart beat is rapid and irregular. She's mid thirties and shouldn't have heart disease. What is it?
I look at the chart. Her vital signs there are listed as normal. Then I notice that she's been still kept NPO (nothing to eat or drink) but hasn't got IV fluids in 24 hours. I quickly have the nurse put up some Ringer's lactate IV solution. I think maybe she's dehydrated and has some electrolyte imbalances. We can now at least check his potassium thanks to the Danes and I go ahead and give him a little expired Magnesium that I've been hording in my little stash in the pharmacy.
Then, I remember the heart monitor/defibrillators that our two young volunteers for the summer brought over. I go to the OR stock room and find one that still has a charged battery despite never being charged since arrival in Tchad three months ago.
I hook it up to the patient. The screen is so small and the heart beat so fast it's hard to tell for sure, but it looks like atrial fibrillation or atrial flutter.
She's gotten a couple liters of fluid and the magnesium and now the potassium comes back normal. She seems stable enough so I leave the monitor hooked up but turn it off to save battery and move on to the next patient. Maybe she'll come out of it on her own.
It's 9:30am.
After finishing rounds and seeing the first batch of ER patients I perform a hernia operation with mosquito net mesh and repair to my office for some ultrasounds.
Augustin knocks on the door.
"Ca ne va pas," he says "Bed 10 is in respiratory distress."
I hurry over to the ward, worried that she's already dead (which is what "ca ne va pas" usually means coming out of a nurse's mouth). Fortunately, not only is she still alive, but she's consious and not really in respiratory distress. However, as I turn on the monitor, I see that her heart beat is still 150-160 and irregular. I feel I should do something but it's been a long time since I've had to deal with cardiac patients and I'm not exactly in the best equipped place to deal with it.
I hurry back my office to look up my little "cheat sheet" on electrical cardioversion. It tells me I should sedate the patient first if possible, put the defibrillator on "sync" and start with 100J. Ok, I feel a little better, it's starting to come back.
I hook up the defibrillator pads, give her some Valium IV, turn on "sync" and see the little dots appear over the QRS complexes on the EKG, turn the knob to 100J and hit charge. I hear the whirring of the charge and then it's ready. But now, I don't know how to make it decharge. I look all over and see nothing. Great.
I turn everything off, take off the pads and return to the OR where I find the paddles with their large, curly-cue phone cable like cords. I hook it into the defibrillator, check out the little buttons and place one over her sternum and the other on her left side under her armpit.
"Everyone back," I announce. "Don't touch the bed or anything!"
She's still staring up at me wondering what the heck I'm doing (as do I). I see that everything is well sync'ed. I hit the charge button and then the two "shock" buttons. Just like in the movies or on TV she bounces a little off the bed, her head thrown back, and then flops back down. The EKG makes a big wave, a brief flat-line and then a normal rhythm of 110 beats per minute starts to play across the little green screen.
I almost can't believe it. I know it's supposed to work according to all I've read and been told in my ACLS courses, but come to think of it, even in the US I don't think I've ever been present for a synchronized cardioversion.
My heart is full with thanks to God for bringing everything together to make it possible for us to save this woman's life first with the operation and then with what I had considered mostly useless defibrillator monitors.
Shocking!
Friday, September 5, 2008
Update
So sorry that I haven't been able to post anything. I drove to Texas to help my father go through all of the things left in his house since my mother died a little over a year ago. Although he remarried in February of this year he had kept his house that he shared with my mom until now. So it has been a little of an emotional roller coaster going through the things and dividing them up and making a stack for a garage sale.
I am staying at his old house where he has disconnected the internet so I am going through a withdrawal from reading all of my sewing blogs! My sister lives just down the street, so I have hit the computer while waiting for lunch to cook.
My dad and sister left early last night so I did cut the pattern out of Burda # 7764 and am hoping that this next week they will need to quit working early so I can actually get the muslin cut out and stitched up.
As I look at all of the things that were so precious to my mom - and really not to anyone else but my sister and me - I am so thankful for the humble home that I was born into and for the strong foundation that they took the time to build in us kids and for the great sacrifices they made in our behalf. I would say that it is one of those things that VISA really cannot buy.
I am staying at his old house where he has disconnected the internet so I am going through a withdrawal from reading all of my sewing blogs! My sister lives just down the street, so I have hit the computer while waiting for lunch to cook.
My dad and sister left early last night so I did cut the pattern out of Burda # 7764 and am hoping that this next week they will need to quit working early so I can actually get the muslin cut out and stitched up.
As I look at all of the things that were so precious to my mom - and really not to anyone else but my sister and me - I am so thankful for the humble home that I was born into and for the strong foundation that they took the time to build in us kids and for the great sacrifices they made in our behalf. I would say that it is one of those things that VISA really cannot buy.
FIXIN DA BONE
From James:
After transferring him from the OR to his bed and attaching the sand bag, I do the final manoeuver, I put two empty Ceftriaxone vials over the sharp edges of the pin, make sure the legs are the same length and go home.
Considering I'd only done it once before in my life, it's hard to believe that this is the third time this month I'm slicing open a thigh. This one should be the hardest one to date.
Abel helps me stretch a sticky, yellow plastic covering over the thigh where we'll cut to try and get to the unhealed femur. As I poise with the scalpel over the now yellow window of thigh in the surgical field the first two cases flash through my mind.
The first was a large man hit by a motorcycle two years ago. His twin brother came to our hospital for some other reason and then asked me if I could do anything for his brother whose leg had healed badly leaving him crippled hobbling around with the aid of a crutch thanks to his now shortened right leg. Surprisingly, the traditional method of bone setting hadn't worked leaving him only with a circomferential scar where they had attached a cord too tightly.
Maybe it was the twin angle, but I told him to have his brother see me when I'd be in N'Djamena next. Sure enough he showed up with several sets of xrays showing his femur shortened by 4 cm and angled at about 25 degrees. It was well healed though. When he came to Bere I was able to break the two fragments apart and then put him in traction to pull it out to length. He's been here for a month now.
The second was an 8 year old girl referred by the first patient. In fact, she was his niece or something, also with a right femur fracture 3 months old due to a motorcycle hitting her. Basically the same procedure and she's been here for a couple weeks now. She also ended up with malaria needing a blood transfusion. She is stoic and looks me directly in the eyes every time I do rounds lifting out her hand solemnly for the obligatory greeting and exchange of "Ca va's". I look forward to seeing her every day.
As I slice through the yellow plastic, the black skin and the light yellow fat turning quickly red with blood, I think again that this one won't be as easy...
Again another call came to me while I was in N'Djamena last week saying he also had heard that we'd operated successfully on two of his relatives with right femur fractures and he hoped we could do the same for him who had the same problem. Yep, the right femur broken by a motorcycle hitting him while he was riding a bicycle.
As I held up the xrays in the faint rays of light filtering through the slats of the ER windows I could tell instantly that this was complicated. The two fragments of the femur were separated by about 4-5 cms with a separate fragment also to the side and no evidence of any type of callous or new bone formation anywhere. It was a year already after the accident. His fracture had also been an open fracture with a draining would for 3 months before it closed. As I looked again at the thigh I saw the healed scars from where the bone shard had pierced the skin. As I picked up his leg I found he had an extra joint mid-thigh. I could move his lower leg in all for directions without his hip moving at all. Not good!
I cut through the fascia and the red muscle wells up into the wound as Abel retracts. As I continue down through the muscle, I see the fibers twitch and retract. I hit some nice arteries and scramble to clamp them off. I call for a suture and tie off the bleeders. I can feel the proximal fragment of bone with a muscle spilling over it down into a cavity where the other bone has to be somewhere. I keep digging until I find the distal part of the femur. There is about 2 inches of muscle and a ton of scar tissue all around. I try to free it up with various instruments: scalpel, scissors, periosteal elevators and various others. I get into part of the scar tissue that has walled off some yellow inflammatory liquid like a cyst. It is clear though and happily doesn't look infected. The distal part just doesn't want to free itself.
I'm kind of a little nervous as I know somewhere around the back or medial side of that deep bone are the big arteries and veins that supply the leg. I don't want to have to resort to a Celox miracle again.
I have the scar tissue freed up superiorly, medially and laterally, but behind the bone I just can't seem to get to it. Finally, I find some dangerous looking pincher-like instrument and manage to grasp the fragment and pull it up enough to cut off the scar tissue keeping it from moving.
I then grab some Rongeurs and start ripping and tearing and biting and cracking off pieces of calloused bone over the two unhealed ends. Finally, I'm down to pretty fresh, raw, bleeding bone. Klevin and Gabrielle have been taking turns putting some traction on the foot and now I really have them tug with all they've got. The bones are still overlapped by a centimeter. I wedge in a chisel and with my prying and the boys' pulling the distal part finally slips over the proximal and meshes together with all the sharp edges left after my gnawing at them.
As Klevin and Gabrielle maintain tension on the leg I suture closed the fascias and the skin and place a sterile dressing.
I then take out a sterile, threaded pin about 20cm long and put one end into a very not sterile cordless drill. I make a small incision on the skin over the tibia and pull the trigger. The pin barely moves, the battery is weak. It makes it a few millimeters into the bone before conking out completely. I ask for the other battery. It is even deader since the charger hasn't been plugged in. I try an old rusty hand drill. Doesn't move at all. Finally, I send Gabrielle to my house to get another cordless drill. After a long five minutes he's back and I drill through the bone, nick the skin on the other side and let the pin work it's way halfway through before detaching the drill. I then attach a U-shaped wire onto it so we can attach a bag of sand to work as traction to keep the leg out to length.
Abel helps me stretch a sticky, yellow plastic covering over the thigh where we'll cut to try and get to the unhealed femur. As I poise with the scalpel over the now yellow window of thigh in the surgical field the first two cases flash through my mind.
The first was a large man hit by a motorcycle two years ago. His twin brother came to our hospital for some other reason and then asked me if I could do anything for his brother whose leg had healed badly leaving him crippled hobbling around with the aid of a crutch thanks to his now shortened right leg. Surprisingly, the traditional method of bone setting hadn't worked leaving him only with a circomferential scar where they had attached a cord too tightly.
Maybe it was the twin angle, but I told him to have his brother see me when I'd be in N'Djamena next. Sure enough he showed up with several sets of xrays showing his femur shortened by 4 cm and angled at about 25 degrees. It was well healed though. When he came to Bere I was able to break the two fragments apart and then put him in traction to pull it out to length. He's been here for a month now.
The second was an 8 year old girl referred by the first patient. In fact, she was his niece or something, also with a right femur fracture 3 months old due to a motorcycle hitting her. Basically the same procedure and she's been here for a couple weeks now. She also ended up with malaria needing a blood transfusion. She is stoic and looks me directly in the eyes every time I do rounds lifting out her hand solemnly for the obligatory greeting and exchange of "Ca va's". I look forward to seeing her every day.
As I slice through the yellow plastic, the black skin and the light yellow fat turning quickly red with blood, I think again that this one won't be as easy...
Again another call came to me while I was in N'Djamena last week saying he also had heard that we'd operated successfully on two of his relatives with right femur fractures and he hoped we could do the same for him who had the same problem. Yep, the right femur broken by a motorcycle hitting him while he was riding a bicycle.
As I held up the xrays in the faint rays of light filtering through the slats of the ER windows I could tell instantly that this was complicated. The two fragments of the femur were separated by about 4-5 cms with a separate fragment also to the side and no evidence of any type of callous or new bone formation anywhere. It was a year already after the accident. His fracture had also been an open fracture with a draining would for 3 months before it closed. As I looked again at the thigh I saw the healed scars from where the bone shard had pierced the skin. As I picked up his leg I found he had an extra joint mid-thigh. I could move his lower leg in all for directions without his hip moving at all. Not good!
I cut through the fascia and the red muscle wells up into the wound as Abel retracts. As I continue down through the muscle, I see the fibers twitch and retract. I hit some nice arteries and scramble to clamp them off. I call for a suture and tie off the bleeders. I can feel the proximal fragment of bone with a muscle spilling over it down into a cavity where the other bone has to be somewhere. I keep digging until I find the distal part of the femur. There is about 2 inches of muscle and a ton of scar tissue all around. I try to free it up with various instruments: scalpel, scissors, periosteal elevators and various others. I get into part of the scar tissue that has walled off some yellow inflammatory liquid like a cyst. It is clear though and happily doesn't look infected. The distal part just doesn't want to free itself.
I'm kind of a little nervous as I know somewhere around the back or medial side of that deep bone are the big arteries and veins that supply the leg. I don't want to have to resort to a Celox miracle again.
I have the scar tissue freed up superiorly, medially and laterally, but behind the bone I just can't seem to get to it. Finally, I find some dangerous looking pincher-like instrument and manage to grasp the fragment and pull it up enough to cut off the scar tissue keeping it from moving.
I then grab some Rongeurs and start ripping and tearing and biting and cracking off pieces of calloused bone over the two unhealed ends. Finally, I'm down to pretty fresh, raw, bleeding bone. Klevin and Gabrielle have been taking turns putting some traction on the foot and now I really have them tug with all they've got. The bones are still overlapped by a centimeter. I wedge in a chisel and with my prying and the boys' pulling the distal part finally slips over the proximal and meshes together with all the sharp edges left after my gnawing at them.
As Klevin and Gabrielle maintain tension on the leg I suture closed the fascias and the skin and place a sterile dressing.
I then take out a sterile, threaded pin about 20cm long and put one end into a very not sterile cordless drill. I make a small incision on the skin over the tibia and pull the trigger. The pin barely moves, the battery is weak. It makes it a few millimeters into the bone before conking out completely. I ask for the other battery. It is even deader since the charger hasn't been plugged in. I try an old rusty hand drill. Doesn't move at all. Finally, I send Gabrielle to my house to get another cordless drill. After a long five minutes he's back and I drill through the bone, nick the skin on the other side and let the pin work it's way halfway through before detaching the drill. I then attach a U-shaped wire onto it so we can attach a bag of sand to work as traction to keep the leg out to length.
After transferring him from the OR to his bed and attaching the sand bag, I do the final manoeuver, I put two empty Ceftriaxone vials over the sharp edges of the pin, make sure the legs are the same length and go home.
Friday, August 22, 2008
Little Gwame and Bob the Horse
A young boy with twisted legs. An old horse with a twisted
pelvis. Neither was expected to walk again. But their story has a twist of its own.
From James:
I was riding my horse Bob when I came to Gwame's house. Bob was an old horse who had been slightly handicapped by trying to jump over a six-foot-high fence. He didn't make it but hit the top of the chain link and flipped over. His knee popped out of joint and his pelvis was twisted. Somehow, he recovered enough to not only walk, but trot and gallop. The accident also made him gentler. Every once in a while, though, Bob still thinks he's a young stallion and he wants to race.
Today was one of those days.
I'd finished work early at the hospital and took Bob out to the river. We rode across the African plain at a slow gallop. There are no giraffes, elephants, zebras or lions. The local villagers hunted them all down years ago. The only dangerous animals are snakes and hippos.
After arriving at the river, I carefully looked up and down to make sure there were no hippos and then took a long swim. The day was hot and the water felt cool. I got out and got back on Bob. Bob had just eaten the only green grass to be found in the dry season here in Chad so he had a lot of energy. He took off at a mad pace. The wind was whipping in my hair and I was holding on for dear life.
We finally slowed down as we entered the village of Béré. Gwame's house is just on the outskirts. His house is made of mud bricks with long bundles of straw tied together for a roof. Around the house is a mud brick wall surrounding a courtyard. In the courtyard a bunch of chickens run around. There are also a few goats, two cows and a horse tied up to a pole. The horse stares at Bob wondering what it must be like to be free. There is also a round mud brick storage bin with what looks like a chimney coming out the top. It has been placed three feet off the ground on piles of sticks. That's so the rats can't eat the grain stored inside.
There they cut one of Gwame's bones in each leg and twisted his legs back into the right position. Then they put both legs in a heavy plaster cast for two months. Gwame came back after one month. He had eaten a lot of food in Kenya and now was a chubby little dude.
Six weeks after he came back, we took off his casts. He was scared and cried a lot. We tried to get him to walk but he was weak and frightened. He wobbled a few steps and then had to be carried home by his mom. Maybe the surgery didn’t work.
But today, a few months later, as I ride up to Gwame's house on my horse, Bob, Gwame comes running out to meet me with a huge smile on his face. There is no limp. His eyes are bright. He holds his arm high above his head with anticipation all over his face. I lean down holding my hand out and he slaps it a big "five".
Tuesday, August 19, 2008
FUTBOL
From James:
We quickly divide into "us" versus "them" as they are intent on preserving the national Chadian football honor on this warm, Friday afternoon. In fact, warm is an understatement as the humidity from last nights downpour hangs like a suffocating blanket over the ratty field as a cloudless sky lets a merciless African sun slowly broil us alive.
Needless to say, a few minutes into the match and my scrub bottoms are already soaking with sweat from the waist down and the top has long since been discarded. Along with our great Brazilian hope, Klevin, we are the only barefoot ones on our team. Stephan is our version of a gangbanger with his recently shaved-head-except-for-monstrous-sideburns look intimidating the opposition almost as much as his bare bear chest and cleats. Gabriel and Bond also are wearing scrubs and tennis shoes. Our opposition is lean and mean wearing only shirts and the occasional t-shirt along with bare feet and/or flip flops of various sorts.
We score first, a beautiful pass from Klevin after some footwork only a Brazilian could imagine setting up Stephan for a nifty tap in. Second blood is a breakdown in passing on my part setting up an easily intercepted ball across the middle and an easy angle shot off the bricks. From there on out it's back-and-forth with the Chadians controlling the ball the majority of the time before losing it through too much dribbling and not enough passing. We on the other hand make the most of our few opportunities and are soon up 3 to 1.
A loud thunder from the East makes me look up to see angry clouds forming quickly casting a slight shadow over the millet jungle that Bere has become and sending a cool breeze across our sweaty bodies. A perfect rainbow encircles the encroaching storm and as brilliant footwork and sometimes stellar passes continue beneath the now menacing sky, small pellets of water began to drop into the dry dust of the road making up the Western part of our playing field.
I quickly run over and put my Bible and songbook into the open doors of the church just to the Southeast, then grab my shoes and barely get them in before the downpour starts. We have not yet begun to play.
The game goes on.
We are drenched within minutes and passes start to get sloppy and slow down as the earth turns boggy. The rainbow has dissappeared but there is still clear sky to the West where the sun is almost changing color into sunset. The rain is coming down almost parallel to the ground drilling into our welcoming flesh from the East.
The western part of the field (formerly the road) is now almost unplayable as any pass hazarding into its slimy clutches is instantly stopped in a puddle of water and muddy sand. The chadians with flip flops are starting to slip and slide dangerously while the barefooted ones continue with no loss of traction. A huge grin splays across my face as Bond looks on from the eaves of the church having retreated there with the first of the downpour.
I haven't had this much fun in a long time.
Eventually, the Chadians say they are done. Down now 5 to 1 I don't blame them. They rub their tummies and give mournful looks as they say they haven't eaten since the morning...no strength. I mock them comparing our sagging bodies to their chiseled frames but they just laugh and insist. We finally agree to meet again sunday, slap hands all around and I head back over to the church as the torrent continues.
The noise inside the tin-roofed church is deafening. The only people who've made it for Friday evening prayer meeting are Lazare and a few kids who come around me as I sit in front of Lazare and say we should sing or something.
Shouting out loudly as we belt out songs in Nangjere I can tell that the kids are loving it, especially one-armed-boy. Finally after a few rounds of "Ka Ama Kouma Kwani Teri" and "Kela ka dane ma ei kera...dul kang ddi, Jesus, Jesus-Christi". I tell them the story of David and Goliath using Lazare to translate from French into Nangjere.
I end with teaching them "Only a Boy Named David" in Nangjere (Kware kusi ne David) by holding the songbook up to the last rays of light coming in the slit that serves as a window on the church. Then, one of the boys prays, Lazare locks up and I walk back slowly home through the mud and the mist.
Why did I choose to wear shoes? I thought it would protect my ankle which had been smashed by Jason last week forming a superficial blood clot leaving my left inner ankle and foot swollen and different shades of purple and green.
Now as I send the ball skimming back across the grass, in the general direction of where I want it to go, I feel some burning pains on the sides of both small toes.
As Bond, Gabriel, Klevin and Stephan continue to play with some of the neighbor hood kids I step behind the two broken bricks marking the goal posts and take off my shoes. Sure enough, blisters have already burst leaving raw flesh where the side of the toes should be. I jump back up from the ground and join back in the game. As I look up past the other goal defended so well by Bond things sort of go into movie mode as four well muscled, lean teenage Chadians stroll up slowly from past the end of the fence. I almost feel like things should go in slow motion with sinister music from some gang flick plays in the background. The brief moment is burst, however, as they flash large smiles and I recognize Koumakoy and Frederick's "little" brother along with some of the normal neighborhood soccer thugs.
Now as I send the ball skimming back across the grass, in the general direction of where I want it to go, I feel some burning pains on the sides of both small toes.
As Bond, Gabriel, Klevin and Stephan continue to play with some of the neighbor hood kids I step behind the two broken bricks marking the goal posts and take off my shoes. Sure enough, blisters have already burst leaving raw flesh where the side of the toes should be. I jump back up from the ground and join back in the game. As I look up past the other goal defended so well by Bond things sort of go into movie mode as four well muscled, lean teenage Chadians stroll up slowly from past the end of the fence. I almost feel like things should go in slow motion with sinister music from some gang flick plays in the background. The brief moment is burst, however, as they flash large smiles and I recognize Koumakoy and Frederick's "little" brother along with some of the normal neighborhood soccer thugs.
We quickly divide into "us" versus "them" as they are intent on preserving the national Chadian football honor on this warm, Friday afternoon. In fact, warm is an understatement as the humidity from last nights downpour hangs like a suffocating blanket over the ratty field as a cloudless sky lets a merciless African sun slowly broil us alive.
Needless to say, a few minutes into the match and my scrub bottoms are already soaking with sweat from the waist down and the top has long since been discarded. Along with our great Brazilian hope, Klevin, we are the only barefoot ones on our team. Stephan is our version of a gangbanger with his recently shaved-head-except-for-mon
We score first, a beautiful pass from Klevin after some footwork only a Brazilian could imagine setting up Stephan for a nifty tap in. Second blood is a breakdown in passing on my part setting up an easily intercepted ball across the middle and an easy angle shot off the bricks. From there on out it's back-and-forth with the Chadians controlling the ball the majority of the time before losing it through too much dribbling and not enough passing. We on the other hand make the most of our few opportunities and are soon up 3 to 1.
A loud thunder from the East makes me look up to see angry clouds forming quickly casting a slight shadow over the millet jungle that Bere has become and sending a cool breeze across our sweaty bodies. A perfect rainbow encircles the encroaching storm and as brilliant footwork and sometimes stellar passes continue beneath the now menacing sky, small pellets of water began to drop into the dry dust of the road making up the Western part of our playing field.
I quickly run over and put my Bible and songbook into the open doors of the church just to the Southeast, then grab my shoes and barely get them in before the downpour starts. We have not yet begun to play.
The game goes on.
We are drenched within minutes and passes start to get sloppy and slow down as the earth turns boggy. The rainbow has dissappeared but there is still clear sky to the West where the sun is almost changing color into sunset. The rain is coming down almost parallel to the ground drilling into our welcoming flesh from the East.
The western part of the field (formerly the road) is now almost unplayable as any pass hazarding into its slimy clutches is instantly stopped in a puddle of water and muddy sand. The chadians with flip flops are starting to slip and slide dangerously while the barefooted ones continue with no loss of traction. A huge grin splays across my face as Bond looks on from the eaves of the church having retreated there with the first of the downpour.
I haven't had this much fun in a long time.
Eventually, the Chadians say they are done. Down now 5 to 1 I don't blame them. They rub their tummies and give mournful looks as they say they haven't eaten since the morning...no strength. I mock them comparing our sagging bodies to their chiseled frames but they just laugh and insist. We finally agree to meet again sunday, slap hands all around and I head back over to the church as the torrent continues.
The noise inside the tin-roofed church is deafening. The only people who've made it for Friday evening prayer meeting are Lazare and a few kids who come around me as I sit in front of Lazare and say we should sing or something.
Shouting out loudly as we belt out songs in Nangjere I can tell that the kids are loving it, especially one-armed-boy. Finally after a few rounds of "Ka Ama Kouma Kwani Teri" and "Kela ka dane ma ei kera...dul kang ddi, Jesus, Jesus-Christi". I tell them the story of David and Goliath using Lazare to translate from French into Nangjere.
I end with teaching them "Only a Boy Named David" in Nangjere (Kware kusi ne David) by holding the songbook up to the last rays of light coming in the slit that serves as a window on the church. Then, one of the boys prays, Lazare locks up and I walk back slowly home through the mud and the mist.
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