Rise n Shine & A Day at the River

The next day Suzanne got up and ate porridge for breakfast. It was made of peanut butter, rice/rice milk and a touch of lime. It was quite good actually. I, on the other hand, had a glass of water and suddenly felt the desire to eat nothing else and go directly back to bed. That is, until they called for help to do anesthesia on an exploratory laporatomy for a large abdominal mass, combined with a hernia and hydrocele... so I got up anyway and skipped breakfast to go to work. It turned out that he had an obvious intrahepatic tumor (cancer in his liver) that likely had spread from somewhere else (who knew where), and might even already be studding his spleen (James could feel it with his hand). Bummer. The ultra sound done earlier hadn't seemed to be that bad, but now it was apparent that we were facing a bigger challenge than we had thought.

The tumor involved the entire left lobe of the liver, and a bleeding stink of a mess awaited us should James elect to attempt a partial liver resection (something usually only done by a liver transplant surgeon, and an anesthesiologist equipped with double central lines, 2 dozen units of blood and clotting factors, and pressurized infusion devices to overcome the blood loss as it occurs). We checked a hemaglobin. It was 7.0, the lowest you usually let a patient go before transfusing (and we handn't even begun to cut yet!). After talking with the family, the decision was made to close him up and let him have whatever quality of life he had left instead of risking him bleeding to death as we attempted to cut out this liver tumor. Unfortunately, I had hammered him with enough Ketamine to last several hours, so it would be awhile before he actually woke up to talk with his family.

Suzanne and I did some inventory of the anesthesia equipment and drugs as a way to start building a model by which a hospital wide system could be then implemented. Right now, there are 2 answers to the question of how much of any kind of drug or supply the hospital has. One is, "We have that." The other is, "We don't have any of that." For example, the other day administration was told by some of the workers, "We are having to fill the generator with fuel today, which completely empties our reserve tank." So you see, there is no mechanism by which to tell WHEN to order more of WHAT, and no one tracks the supplies that they use up to do anything. So, imagine discovering that you are out of something at the exact time that you need it most. This, my friends, is Africa!

We went to market to find me some flip-flops to walk around in so that I can get out of my closed shoes and socks... it's much cooler, and easier to change into your surgery pair of shoes quickly. So, we went to Bere market for the first time... alone. We spoke just a little French, and a few words of TChadian Arabic. We were so proud of ourselves and our little purchase. We'll try more advanced stuff next visit.

We've learned from the others who've been here long-term that the best way to stay cleaner and cooler is to shower off (without bothering to use soap... save that for when you REALLY mean business) every chance you get. You also have to watch out for little wounds on your hands and feet (since they get used a lot) because they can easily get infected with bizzare bacteria. And antibiotics can be hard to come by at times, so prevention is MUCH better than trying to get some cure. Which brings me to another point. If you have any weird allergies (ie. Suzanne who broke out on her arms), cortisone, tiger balm has no effect. :-(

Another things that has dawned on us is that cooking has to be done on an as-needed basis continually because there is no refrigeration. Thus, if you want to eat something other than fruit, bread/peanut butter... you're going to have to cook it (without electric stoves), and that assumes that you don't have to go out and buy it (you thought ahead enough to not need to go back to market). Cooking here is done over charcoal stoves that are either wire cone frames that sit on the ground, or stone/brick ovens that have a hole in them that the charcoal is loaded into and fired for the pot that goes on top. And this is NOT the charcoal you've seen in the states... it's charcoal made from trees, not fuel soaked briquettes. And let me tell you... they burn HOT! We realized during the last communal cooking spree (hosted on our 3 stone stoves and 2 wire charcoal burners) that one nice benefit of having concrete floors is that when you spill the hot coals all over the place... the house won't burn down.

Things you don't want to hear in the mission field: "It's not that bad really, except for those first 2 days. I've already had malaria TWICE since I got here!"

A Day at the River

The first Sabbath. Everyone slept in and woke up around 7:30 am. With the exception of nature's alarm RIGHT below our window, Mr. Speckles (aka. rooster). After a quick cold shower and breakfast that consisted of left over porridge, bananas, and bread......off to church we go! We showed up at 8:30 am at church located outside the compound (I should quickly add that when we say "compound," this should in no way be taken to represent anything like David Koresh lived in). It turns out that the first few hours or so are singing sermons. The songs all in French, the tunes memorized (there is no piano) and we were the only white people so far, other than a few college students. There were, however, a few drums, and Franklin was unceremoniously handed a mini tamborine that he had to learn how to play on the fly. It was difficult to follow much of anything, since the service was done in French and translated into the local dialect. The seats were 2 X 12 boards served as pews without backs or seat cushions. This made it harder to fall asleep in the sweltering heat.

After eating lunch, we went off the the river for a swim. This was to be a 2 mile walk/ride on horse back (Sarah, James' wife, has 2 horses... one of which Franklin did that lance/drainage job on earlier). Well, for those of you who followed the last trip, you already know that if you are told here that something is 2 miles away, or will take 1 hour to walk to... what that REALLY means is that it's closer to 3-4 miles, and will take nearly 2 hours to get there. This was the case again today. Franklin thought it'd be nice to ride for a while, but the horse wanted to gallop so much it was hard work keeping him from running out of control. The stirrups also dug into his legs, and to be honest, flip flops are not the best for riding horseback.

BUT... we will say it was kind of cool to swim in an African river. You know, always wondering if piranhas or something are going to start eating you (even though, honestly, you know piranhas are only in S America. Just the other side of the world). The current was quite strong, and it took a while for a smaller group to swim to the other side and jump out a tree overhanging the river. Climbing it was half the fun, and then after hitting the water you could just relax and let yourself get swept downstream and back across to the other bank with the others.

The hike back took until after dark. No small thing in a land with NO signs or directions available (why, oh WHY didn't I bring my GPS?!). Fortunately, the ONLY cell phone tower for hundreds of miles around is near the hospital, and after it's dark, and if you're close enough, you can see it in the distance and just walk towards it to find your way home at night. The whole trip left us with several blisters on our feet, and questions as to why we didn't bring any moleskin from Walgreen's, and why Franklin had settled for that european sized 43 set of flipflops instead of looking harder for some 41's.

Our futile attempts at connecting to the internet for email and blogging drained what little energy we had left. We listened to the shortwave radio for some glimpse into what's going on outside our small, remote world (didn't learn much), and then went on to bed. It's been cooler at night here in the south compared with N'djamena. It's actually comfortable from about 3-4 AM until 7:30 AM. Then, you might as well get up because it's going to get hot and sweaty soon anyway.

Things you don't want to hear in the mission field on rounds: "That guy doesn't look so good."