Sunday, October 31, 2010
A week ago, the surgical team was invited to assist an 8 year old girl. She had chewed the end of a pen, and it went down her throat. The family had taken her to a local physician who "pushed it into the stomach." Later thst night, she started having coughing attacks. Three weeks later, the family brought her to Mbingo. We had a problem. We don't have a rigid bronchoscope, and the chest xray didn't show anything initially but then changed to a collapsed left lung. Dr Acha, the ENT surgeon, asked Dr Bardin, the internal medicine, pathologist, endoscopist, to bronch the kid, but the kid couldn't keep her oxygenation up during the bronchoscopy. What were we to do? After putting our heads together, we planned to proceed in the OR on Saturday morning with another attempt. The child had worsened with her left lung collapsed from being plugged by something. (remember that we don't have an ICU/ventilators/or suction on the wards) God was gracious to teach us some new techniques. I had thought that we could intubate carefully, use the flexible bronch with a wire kidney stone retrieval device first. We would then try the cystoscope (yes, what urologist use to look into the bladder). The child didn't tolerate the intubation-bronch attempts well and wouldn't saturate above 81% (normal >94%). We then extubated and changed the electronic towers (from Olympus to Storz) while we bagged (slang for ventilating with a mask over the nose and mouth with squeeze bag) the child. Once again, the oxygenation improved, and we then moved to rigid cystoscopic bronchoscopy. By the grace of God, we were able to grab the jagged edge of the plastic which had plugged the left bronchus. We win. Thank you for praying for us as these situations happen now and then where the instrumentation and situation don't fit our training.
Sunday, October 24, 2010
I realize that these pictures don't mean a whole bunch to you, but they stand for many different experiences in our lives these past few weeks. They represent getting earrings in the hospital by hand and needing "daddy" to replace them later. They represent eating at the Mr Ngam's house where the electricity went off during the meal so the rest of the meal was eaten with light from flashlights (the hospital area has a generator that comes on while the village area does not and we live around the hospital). A traditional Com wedding in the rain is interesting with a blessing and talk first by the pastor then the party begins. Most of the "ceremony" takes place in the kitchen (packed with people, of course) where the MC acts like a comedian makings sure all parties are having fun while moving through the rituals. As you can see, the food is less than sterile, but I found it quite good.
You know you’re in Africa when:
· You go to the kitchen and are surprised to see a large green insect on the kitchen counter. Standing next to the house helper you exclaim in surprise “Oh, what’s this…” She smilingly says, “Oh, that’s mine, I found it on the way here.” “Is it a snack I ask?” “Yes, for my children” she says as she grabs the live grasshopper by the legs and thrusts it under a small pink bowl.
· Every day you kill close to 25 spiders in your house, thousands of ants march on your patio and small flower bed, and at night hundreds of large flying termites swarm the lights, dropping their wings to leave a proliferate mess for the morning.
· Black and white crows wake you in the morning walking with their talons on the tin roof.
· You can stick just a clipping of a rose bush in the ground and it will grow.
· “Deep calls to deep in the roar of your waterfalls, all Your waves and breakers have swept over me” (Ps 41) means something to you, both figuratively and literally.
· Most of life happens in a 1 mile radius.
· Grocery shopping involves dodging bone fragments being hatched by the butcher on a cement block in an open air market.
· The personal daily gratitude for Western world resources (like available hot water, butter on toast, good books to read) intermingles with a stark realization of inequality as developing world poverty knocks daily on the door of your heart.
· You try to save the fat and grissle form meat to make homemade dog food but the house help keeps wanting it.
· Family is primarily together, not individually pursuing private interests.
· You smell something offensive and walk into the kitchen to find a shocking assortment of termite wings all of the floor and counters, with a house helper stirring a large pot of boiling termites.
My parents called today from Sumatra to say hello and reminded me that the blog has been under-utilized. I apologize. This last week has gone by fast; time seems to do that a lot. In the family front, Elsie is here helping out with homeschool. She is a single lady whose job it is to travel around to homeschool families and work with them for two weeks. She does the teaching and offers suggestions for improvement. We are very blessed to have her but must adjust to having another person in the house with us at all times. The big news in the surgical front was the visit of Dr MacFadyen and his wife Rosemarie along with Dr Thompson this past Thursday and Friday. They were visiting the two PAACS programs in Cameroon. Bruce MacFadyen is the president of CMDA, the head of the board for PAACS, and the surgical chairman and the Medical College of Georgia, Augusta. Dr Thompson is a long term surgical missionary in Gabon who helped start PAACS and is the Africa Director for PAACS. They were able to interact with the surgical residents and their families. I really enjoyed operating with Dr MacFadyen on a large inguinal hernia. He showed me how to do a true Shouldice repair. I have tried to do this in the past and succeeded to my knowledge, but he showed me some specifics which only someone doing the surgery with you could teach you. I was very blessed to get to interact with such leading servants of God and learn from them. Saturday, after dropping them off in Bamenda to catch a trip to Douala, I went to a traditional Com wedding in a local village. It felt like stepping back into my childhood in such a way that I feel so blessed to be here. I am continually reminded that I'm living my dream. I didn't get to stay for the whole long ceremony that was taking place in the rain but had to come back to help the residents do a case. This morning I was called to help them do a case on a 4 day old baby around 2 am. Church this morning was a joy to celebrate God's family around the world. The text was from 2 Cor 8: 1-8 as we are called to give ourselves to the Lord and then give generously or our possessions. We ate lunch with some SIL missionaries who are staying in the CBC guesthouse up the hill. Tonight we went to the Bardins, who are new long term medical (pathology/internal medicine) missionaries at Mbingo, to sing songs and pray. All in all, we are very blessed.
I'll try to catch-up this week by telling about our meal with the head administrator, Mr Ngam and the many other things. Hadiah had a time getting her new earrings as the lady in the maternity ward placed the first set which was asymmetric. It then fell to me to place them again the next day in better positions. We all lived through the experience.
Saturday, October 9, 2010
the compound a little. From this perspective, you may notice the entrance circle in the lower central aspect of the picture. The "driveway" to the road extends to the right. On the left are the hospital buildings. The patient first enters through what is the octagon grey building where the "screeners" see the patient and triage the patient sending them to the right outpatient clinic or consulting the medical/surgical services. If you can imagine the buildings representing the spokes of a wheel, then the first spoke moving in a clockwise direction from the circle entrance is a long grey building and is the maternity/prenatal clinic. Next is A ward which is the orthopaedic/trauma ward. The building next in the wheel has a two tone roof and is the surgical theatre with the newer roof representing the two new ORs for the orthopaedic surgeon, Dr Nana. The back of this building has clotheslines which are going to be removed for an expansion of the PACU. Next on the wheel is the surgical ward which houses gyn/gen surg/ophtalmology patients. The small building closer to the hub and next to the surgical ward which is bigger and a "T" is "B" ward, the men's ward. You've now reached the end of the spokes at the children's ward "C." This ward starts a series of linear buildings that extend in a sloping curve away from the "hub." The radiology department is in line with the children's ward. Then comes the "ulcer ward" which is actually two long rooms with people waiting for debridements/skin grafts. They stay for quite a while as their wounds heal as they often live where they can't get any wound care, ie no gauze or any other supplies. Still proceeding down the line of buildings, which was the backbone for this hospital 50 years ago as a leprosy hospital, you come to "F" ward, the women's ward. After this comes the physical therapy dept, library, shoe making dept, and then the hostel. At the end of this row is Drs Dennis and Nancy Palmer's house. Beyond that is some residents' housing, the church with the slanted roof on the left, then the school for the deaf, some "quarters", the primary school on the hill to the left and as you take a right sits the Sparks' house all to itself. There you have it. I need to take some pictures inside the complex so you can get a feel of how it looks from inside that jumble of buildings. May God bless. We ate tonight at the Bergers who are heading back to Switzerland for a few weeks before they start some time at Kijabe in Kenya. We found out from preacher who was there also that the sermon is on the tenth leper who returned to give thanks. Remember, God wants our thanks. dasen
Thursday, October 7, 2010
To illustrate the weekend, I've posted some pictures. You might notice a happy Elle, a mother who has decided that the rainy, slippery river banks are just too much to push on, Miriam riding by the "shack" that sheltered us and a dead crow used as a scarecrow for the fields, and cold girls waiting out the storm.
I just finished The Professor and the Madman about the writing of the Oxford English Dictionary. Besides being a great book, I got to read one more story about a missionary kid. Many years ago, Naomi (Liles) Crouse sent out a “Rights of Missionary Kids” list. It was a tongue-in-cheek list that started, if I remember correctly, with “Missionary kids have the right to be normal.” I took comfort in the list which purported to debunk the general view that missionary kids, now called third culture kids in a politically correct world, were strange in an unhealthy way. My experience, however, backs up the general stereotype. Yes, missionary kids are quirky and sinful needing God’s grace. I have also noted that single, second, fourth, and fifth culture kids are unique and sinful needing God’s grace. I am so happy to have the story given to me by my parents of living in another culture growing up a “stranger.” Without my purposeful decisions, I have learned to enjoy foods and life out of the ordinary. I still don’t like snakes, though.
None of my children were born or have lived most of their life overseas, yet each of them is unique, sinful and in need of God’s grace. Hadiah just turned 12. She states that she is in her 13th year. Our weekend was wonderful, mainly due to my wife. She worked out four horses to rent for 10 dollars each. So Saturday, we jumped lithely on the horses and rode off with the bugles trumpeting. We do make quite a scene, but I’ll work on adding the bugles part. The only sad part was that Hannah got scared off right as we loaded up leading to her staying behind. As the story unfolded, she turned out to be smart. Miriam, Hadiah, and Rebecca on their horses and Elle and I on our horse enjoyed the sun and trip up into the hills. The sun turned into mist, then into a drizzle and then into a downpour. We had two umbrellas, but we learned a valuable lesson about ponchos. We found a shack on the “ranch” owned by the hospital where Rebecca tried to lead the girls through calisthenics to keep them warm, but the girls ended up cuddling with me on a bench where we all shivered. Every once in a while, Rebecca and I had to go out into the downpour to yell and shoo off a stallion running free who wanted to bother all our male horses. Our horses ate grass happily with their backs turned to the wind. Once the downpour turned to a drizzle we loaded up again and came down out of the hills. The Sparks have blessed us many times with their house, and once again the hot baths and showers fed by gas heaters was very nice for everyone. I hope I can always remember Elle signing her heart out on the way up into the hills between asking to “drive” the horse and wondering why we weren’t running. She would constantly make her clucking noises to get the horse going and really enjoyed our short canter. Trotting was doable but kinda hard with a little one in front, I found out. The horses were well trained, and I mostly let her “drive” while I took pictures. Sunday, we made fresh raised doughnuts for the first time. Our lemon bars didn’t have enough fresh lemon in them, but they tasted good. We followed Hadiah’s set schedule and were blessed. By Tuesday, Hadiah had read her 400 page book, The Mysterious Benedict Society, given to her by the Smearsolls. Rebecca and I have no way of keeping up with her on her reading as she reads fast and has many more hours to spend reading. Rebecca is reading Augustine's Confessions with her and going through study questions, and my job is to read the supplemental book The Nine Tailors by Dorothy Sayer. The good news is that I've got a head start as Hadiah isn't to the supplemental reading part yet.
Friday, October 1, 2010
Today, I left the OR early around noon to go with Rebecca to Bamenda. There are great things about residents in that they can continue doing fine surgery most of the time even without me around sometimes. I'm mainly around to whine at them that they need to learn to pass the hemostat a different way, use their finger to cinch down the knot instead of pull the tissue up to them, present their case to me more succinctly, and so on. In Bamenda, we stopped first to get meat. Rebecca's first statement is, "This makes me nauseous." We then moved to the fresh fruits and vegetables market, and I must admit that she interacts great with the many women calling out to her to buy from them. At one stand where she thought of buying a bucket of tomatoes, the lady said it was 1,000 cfa's. Rebecca smiled and said that was too much. The lady said that there were a lot of tomatoes. Rebecca agreed and said that she was also a white woman. That got a chuckle. At another stand the lady wanted three times the amount for bananas than should be paid. Rebecca just stood there shocked with a shocked look for awhile. She then asked again about the price because she was so shocked at the price she had heard. The lady dropped immediately to the right price. The back tire on the car was pretty low, and I started to change it. The spare was pretty flat so I asked the three men who had quickly become involved about the nearest tire place. To my great joy, the place was around the corner. We left the car and went on shopping. The only problem was the afternoon downpour. I found out that you can put inner tubes in tubeless radials. I placed that tire as the spare and the spare just needed air. We won all the way around. We ate at a hotel, but this time found that the bar had a balcony overlooking the city. Rebecca finagled us into getting a table out on the balcony. Bamenda can almost look pretty from above the fray. I still would emphasize the "almost," however. We found out that there is a traffic jam leaving the city at sunset. The two lane road becomes two lanes then three lanes and then four lanes, if you count cars as lane definers. If you use motorcycles, then the "lane" gets muddled because the directions are nearly infinite as to movement or velocity vectors. Rebecca and I both chuckle that this isn't really stressful for me when compared with driving around downtown USA looking for parking lots. I kind of enjoy blocking many lanes of traffic as I pull crooked and back up into a little parking space in front of a store. The traffic just kind of "flows" around the car as it meanders.
You might wonder about the girls and Sarah back at home base while we were away. We lock all the doors. We tell them to shut all the curtains, don't let any strangers know they are in the house, we set the alarm, and notify the security. Just kidding--that is what people do in America. In Mbingo, Hannah went to a visit a resident's wife for an hour and then walked home. Miriam, Hadiah, and Elle went with Ellen Shotanus to the Cameroonian school library. Sarah stayed at home and watched a movie. Debbie Bardin came over mid-afternoon to check on the girls and played with them at the school playground. This evening the girls ate left-overs and watched, "I Love Lucy" episodes which they all enjoy greatly.
Well it is time to say goodbye. Hadiah's birthday is Sunday. She keeps reminding me that this is the last .... that I'll do with my oldest 11 year old. She reminds me that I'm old. I remind her that I'm the best dad she has. She reminds me that I'm the only dad that she has. She is growing up. She now calls Rebecca, "little Mommy," sometimes, but honestly, Hadiah isn't taller than Rebecca quite yet. They are exactly the same height. Rebecca and her are now onto reading and discussing Augustine's Confessions after finishing her test on Eusibius. As far as the other girls, they are growing, also. Don't tell anyone, but Elle is now wearing Miriam's panties. With that note, I wish you all a good bye. dasen