We are anxious about where we will work in the future. Anxious about who will come to cover the work here. Will the hospital fall again, as it had before we arrived? We have not yet heard of anyone willing or interested in coming! What lies ahead for us? What lies ahead for this hospital?

I spend periodic nights awake, mulling over things in my mind. I know we need to be back in the US, but there are so many uncertainties. We give the responsibility for the different things we have done to others as it is possible. I pray for Yves often (our administrator) who has been through many tough periods at the hospital. He is a missionary from the Southern part of Cameroon.

Life continues as it has for the past five years. But in the back of all our minds there are concerns for the future here and in the US. This is especially easy if we let ourselves focus on us! When we focus on God and His faithfulness, all worries diminish.

God has demonstrated He loves us. His ultimate sacrifice on the cross demonstrates that very clearly. If the God of our universe loves me, is interested in my life, is interested in this hospital and the lives of it’s workers; then I can sleep at night, knowing that He is in control if I allow Him to be in my life. He is in control of the hospital if He is allowed to be. And who better to be in control than our: all knowing, all understanding, all loving, compassionate God!

When I focus on Him, and not myself, I sleep, and am content in knowing that He is in charge, and despite of my inability to see my future or the future of the hospital, He IS love. And when I allow Him to take charge, He will do what is best for me, best for my future, best for my learning more about Him. Praise Him! Greg

Six days ago the workers emptied the water tank to patch and paint it. They scraped the insides, patched the holes with a tar compound, welded a few spots and then repainted it. This took about 4 days to complete. The fourth day the electricity went out. So we have been “functioning” without water in the hospital for many days now and with no electricity. Two days ago I wanted to do a hysterectomy on a woman that needed it and when we tried to start the large generator the batteries were dead. So without power I decided to put off the surgery till we have power again, and when my OR schedule is open, 3 weeks. So with all this we are out of power when this child is in need of oxygen.

We have started the small generator of the lab and decide to transport the patient into the lab waiting room so that we can use the electricity there to run an oxygen concentrator (there is no bottled oxygen here). After placing a bed in the waiting room and hooking him up he breaths slightly better but needs blood. The mother is the same blood group so she gives to her child. The day passes and it is time to turn off the generator for the lab. The child has received the blood but is still very hypoxic (low oxygen) without the oxygen. Should I run the generator over the weekend for him? How long will he need oxygen? Will the oxygen actually help him survive, or will he die anyway? Should I tell the family that since the generator is running only for their child they would have to pay for gas? If I say this will they refuse treatment? I ask Aud what she thinks. We decide to keep the generator going and not talk to the family about gas for fear that they will refuse treatment.

At midnight I am called because the generator is stopping every 45 minutes. Apparently it is plugging up with gunk in the lines and for air vacuum in the tank. Baya, the nurse who is in the ER, is somewhat mechanical. So I offer tools and ask him to try to fix it. I don’t get called for the rest of the night.

It is Sabbath (Saturday), I plan on sleeping in. I wake up at 7AM to the sound of chickens and immediately think of the child. I can’t sleep any longer because I continue to think of him. I get up and head into the hospital. He is still alive! I have prayed for him a number of times through the evening and night. I am thankful God has spared his life. The generator worked all night after Baya tried a few things. I take him off oxygen and his oxygen stays above 92%. I transfer him to the ward. Our chaplain, papa Sidi, has just prayed for him again.

I see another girl that is 16 with severe headache and neck pain overnight. I do a lumbar tap (take spinal fluid) to evaluate for meningitis; I also treat her for cerebral malaria.

I leave the hospital hopeful for the child who has survived the night. Greg

My frustration know no end as I write this addendum. It is Saturday evening. The nurse on today did not observe my patient well. He calls me when the child is really dypnec (short of breath). They put him back on oxygen to late. He died.

So an old, very thin (likely between 80 and 90 lbs) sees me in the office. She is deaf and mute. Her son talks to her with gestures, which make no sense to me at all. He somehow has deduced that she has pain in her chest. He says that she has had this for about three months. She has not had a cough but just pain. I listen to her chest and hear breath sounds on the left but very muffled ones on the right. I tap and hear a dull sound, she is full of fluid. I request an x-ray, and they agree and go to pay the $7 to get it. She is lucky because this day we happen to have electricity. It has been out every day for 1-10 hours for the past 5 days. The chest shows a complete white out on one side. I do a tap with a needle and find dark yellow fluid that the lab says has some gram + cocci in it. Infection? Contamination of specimen? It is unclear. But the fluid needs to be drained.

When I first arrived at Koza there were no chest tubes here and I used a urine catheter for my first one. Today we have two sizes so the student missionary and I select the smaller size and numb up the area of insertion. We prep her side and hold her hands out of the way as she is contaminating the field demonstrating where her pain is again. Her son and another nurse hold her arms. We put the tube into her chest and get 1300ml of fluid. She coughs and appears worse for a little while. Maybe I should have let off the fluid a little more slowly.

Over the next few days she drains about 800ml a day. She is getting thinner by loosing all the protein every day in the fluid. Or I assume that’s what’s happening. So if I take out the tube all the fluid will reaccumulate and I don’t have anything for plurodesis (making the lung inflamed and stick to the chest wall, effectively stopping the fluid collection). So eventually I talk out the tube. She reaccumulates the fluid and I let her go home. I’ve treated her with broad spectrum of antibiotics; we are currently out of TB medications. The government supplies these for free but when we ordered them they said they had run out in the far north. So free TB meds doesn’t help when there are none. And since they are free none can be bought either, because there is no black market desire for them. So she reaccumulates her fluid and goes home in a day or two. Another dilemma unsolved.

The same thing happens in the room next to hers. There is a man with huge ascites. I drained off about 15 liters the other day. He had a tense belly for a month. I drained a lot off and he lost 9kg with the fluid extraction. His abdomen was large but then not tense. The peritoneal tap showed no bacteria. I treated him for schistosomiasis, TB, abd peritonitis, other worms, and a loop diuretic (water pill). He does not appear to be improving either. Is it cirrhosis from his long time millet wine usage? Possibly, but I can’t treat that other than, encouraging him not to drink. So another dilemma unsolved. I know these same dilemmas can happen in the US, but it is so much more frequent here. This is the frustrating reality of third world medicine. Greg

I walk into the ER and see an old woman holding the abdomen and back of the boy.  I ask Ibrahim (the boy) what is bothering him. He says that for two days now he has had sudden pain in his abdomen that then goes to his back.  Or it grabs his throat as if choking him.  As I am talking to him he cries out and grabs his throat with two hands.  About ten seconds later he appears fine.  I ask him about taking any drugs, or stuff others gave him, he hasn’t.  An uncle says that the day before this started he had a homosexual experience with another boy his age. The nurse starts making a clicking noise (surprise).  I remind the nurse to be professional, and that he should not display any reaction to things the patients tell us, whether we are surprised or not.  I give the boy water to drink and he gulps it down without problem.  I think of tetanus, rabies, meningitis, cerebral malaria, syphilis, and demon possession.  Doubt the last is on your differential in the USA, though maybe it should be!  Papa Sidi (our Chaplain) happens by and I ask him to pray with me for the boy.  The boy says he is Muslim and believes in Allah.  I tell him to trust in Allah and we are going to pray to God for help and healing.  The two of us, the nurse and student gather around the boy and we pray. Pray for healing and protection for this boy.  I look for some medications in the pharmacy to start his treatment for some of my differential diagnosis.  When I come back the boy is crying out and naming the names of sorcerers that he says are choking him.   The family decides that this must be his real problem.  They take him home to find a more powerful sorcerer to help him. I pray that God will protect him and that God’s name be glorified rather than a sorcerers.  Please pray for Ibrahim.
Trying to follow Him, Greg

Wednesday it was unbearably hot.  It was 113deg F in the shade as it has been but then it felt much hotter.  We had finished work and had gone home.  About 5 PM the wind kicked up.  It started really gusting.  Dust was thick in the air and we could not see across the soccer field in front of our house.  Even out to our own gate it was difficult to see.  We rapidly closed all the windows.  The power went out.  Wind with the power going out is usually a bad sign, it usually means that the power lines and poles are down somewhere between Mokolo and Koza.  This means that it will be many days before we get our power back.  It in fact is still out!  No power means no autoclave, no X-ray, even when our generator works.  It also means no water!

So the wind is howling and dust is in the air.  Then it starts to rain.  We usually get one solitary rain in April then it waits till June to start the rainy season.  The wind is whipping trees back and forth.  Branches are falling all around.  The tin roof over our truck is now loose on one side and waiving wildly in the wind.  Hail starts to fall all around.  On the tin roof of the house it gives a deafening sound.  Water starts to drip though our ceiling at different places.  Some the same as last year, others different.  I try to catch some in buckets, moving things out of the way.  The rain pelts the ground for about half an hour. A small river is flowing through our yard and leaving under the gate, and through the chain-linked fence. After the rain we hear chopping. There are many downed branches and people are running from all over to claim a down limb and start chopping on it.  I guess after it is downed it is not considered stealing, but only when it is still up on the tree. So I decided to go to the hospital and see the damage.  After walking out of my house I see our power lines are going down to the ground. A large tree branch has fallen on them and the bear wires are pulled down to the ground.  Further on I see a large power pole down.  A building behind my house had half of its tin room blown off.  On other hospital buildings there are tin pieces pointing to the sky or gone.   Workers saunter by telling how either their house or neighbor’s houses had lost their roofs during the storm.  Some houses even fell down with the rain and wind.  I ask how the patients did, and everyone is fine.  The nurse was just getting ready to call me when the storm began, so he asks me to see two patients in the ER.
To the right as I walk in is an 11yo boy laying on his back very still. His left leg is shorter than his right and pointed off at an oblique angle.  I can immediately see a large gash on his left knee going around to the back of his leg more then 10inches long.  His right foot has a huge gash that has separated the skin of the sole of his foot from the foot itself in a huge flap connected at the heal.  He appeared as if he was in significant pain but didn’t make a sound until I examined the leg that was pointing off to the side.   He had a femur fracture too.  The uncle who brought this boy into the hospital said that the two were playing on a rock when it rolled and crushed their legs beneath it.
To the left was a 10 yo boy laying on his side moaning.  His foot was wrapped in a cloth.  As I unwrap the cloth his toes and sole of his foot hang, detached from the rest of the foot that is left.   A metatarsal (midfoot bone) sticks straight out from the top of his foot, as does the bone going to the smallest toe on the same foot.
Both the boys need to go to the operating room.  I send someone to call Ganava and Jacques.  I return home and change cloths and head back with the medical students currently here.  Ganava is not in town and Jacques is late in coming.  The students and I set up the two in different OR rooms and we start cleaning the injuries.  Since there is no electricity, and the generator will not start, we work by headlamp.  First each gets an IV, Valium, Ketamine, antibiotics.  Then the scrubbing begins.  One med student on each child and myself and another giving meds, going back and forth between each room.  Jacques arrives and helps Travis on the child with a femur fracture and large lacerations.  I help in the other room where Elisa is cleaning, Kalaza, the boy with the badly crushed foot. We complete the amputation about mid foot.  Taking off the bones that are sticking out.  In the other room the huge lacerations are closed with drains.  I then go back in there and place a pin in his tibia (lower leg bone) to put him in Perkins traction for his femur fracture. Both boys are taken to the pediatric ward and the bed adjusted to accommodate traction.  Meaning, bricks put under the foot of the bed, weights placed with a string to the tibial pin, and the framework holding up the mattress let down so the leg is flexed at the knee.  We head home in the darkness, watching intently for scorpions.  It is their season now and I don’t want to experience one again.
It’s about 9:30PM and the temperature has cooled off to about 97degF.  It makes for difficult sleeping conditions. I shower, don’t dry off, and drip my way to bed.  I lay trying to not have any part of my body touch another part.  I drift to sleep before drying.  I awake a couple of hours later drenched in sweat and repeat the shower process to sleep again.  It makes me very thankful for electricity and water when they do come back.  We are now five days after the power has gone out and still no sign of the electric repairmen.  We are praying for repairmen.  Greg

There was hushed sounds in front of the OR doors.  I turned on my headlamp.  A group of about 15 people are huddled around a gurney.  On the gurney is a 30 year old man, speaking in a hoarse voice.  At each word blood bubbles from the side of his neck.  He is conscious and responding appropriately.  Blood also bubbles from his nose and mouth.  A pool of blood is under the head of the gurney. His blood pressure is low and this pulse high.  He is from a village about a half hour away by motorcycle.  He had a stab wound entering the left lateral neck and exiting the right anterior neck.  So the medical students and I took him to the operating room.

He was bleeding more after being moved.  I opened his neck along the midline, low near his sternum.  Dissected down to the trachea, and made a window into the trachea.  A large tracheostomy tube was inserted and sewn in place.  He was now breathing better, but still bleeding when we let up pressure on his neck.  Along his left sternoclidomastoid (SCM) we opened the skin.  I dissected down to the internal jugular vein and noted that it was nearly transected.  His blood pressure was quite low by now and we waited for him to get more fluid so that his pressure came up.  We also were waiting for Kanas (the lab tech) to come in and do a groupage sanguine (blood typing).  The vagus nerve was dissected from the vein leaving it towards the carotid artery.  We controlled the bleeding and then explored the area.  It seemed that the knife had traversed the thyroid cartilage and exited the other side of his neck.  I could not identify any other injuries so I left a drain in his neck, closed the SCM, and closed the area that I had opened leaving the stab wound open.

Three days after the surgery he was looking much better.  The facial swelling that had been present after surgery had subsided and I let him start to drink water.  The day was busy.  I made rounds on the surgical/maternity ward with about 20 patients.  Then saw about 10 patients in clinic, treating their pneumonia, typhoid, malaria, rash, skin infection…  I then started the ventral hernia repair.  While in this surgery, the nurse came to tell me that Matakon (the man who had been stabbed in the neck) had liquid coming from his neck.  I tried to determine, by his description, if it was pus, water, or what kind of fluid.  I was unclear after discussing it.  So after the surgery I went back to see him again.  I asked Matakon if the water he drank came out his neck, he said yes.  So I ask him to demonstrate.  He took a big gulp of water, and out the left side of his neck gushed the water he swallowed! I returned to clinic sad for this man.  I saw another 6 patients that were waiting and headed home that evening.  I tried to look up neck wound in the ENT book and Trauma books that I had and all they said for esophageal perforation was repair it and put a  muscle flap in between esophagus and trachea.

The next day we took him back to the operating room.  I reopened his neck, identifying the vagus and recurrent laryngeal nerves.  Going next to the carotid artery and the trachea and behind to the esophagus.  After quite some time of tedious dissection I found the hole in his esophagus.  I closed the hole, then placed a sternohyoid muscle onto the repair.  Next we placed a gastrostomy tube (stomach feeding tube) into the abdomen.

He is now 4 days after that surgery.  We are often doing his tracheostomy care as the nurses are getting used to it.  Fortunately this one has an inner canula.  This can be taken out and cleaned then reentered to its position.  We are feeding him via the G-tube.  With many days of IV fluids and antibiotics and surgeries his bill has become huge, around $380.  The one who stabbed him in the neck is in jail, his older brother!  Please help him by praying for his recovery and healing of his extensive injuries.  Greg

Day 1: It is Friday evening. Greg was called away to a meeting Monday- Wednesday so I was left to “hold down the fort”. It truly wasn’t too bad; there were no surgeries; I was able to sleep for 8 hours during the 3 days. I took Thursday off to “recuperate”, so why do I feel sooooo tired. MALARIA. And I thought my stomach hurt because I was drinking too much coffee. Again: MALARIA. That dizzy spell I had on Monday in the middle of clinic that I thought was due to not drinking enough water. MALARIA. The nightmares and difficulty sleeping – could it be due to stress or…MALARIA. I mentioned something to Eliza today and she said that I ought to get tested. Afterall, the test is free and the lab was on my way from the Peds ward to the Clinic. So, after telling the lab tech to take my blood, but not expect to find anything, was I surprised to find MALARIA. So, that’s why I’ve been feeling to crummy lately.

Since I feel like I’m going to die every time I take Quinine, Greg thought it would be educational (entertaining) if I kept a malaria journal for the next 7 days and explained to all of you what I was experiencing. So, welcome to my world of malaria and quinine.

Day 2: Saturday morning. I’ve only taken 2 doses of Quinine and already I feel like my brains have been replaced with cotton balls. Quinine causes cinchonism – or in non-medical terms, “buzzing” in the ears. In some ways this is a blessing. I sleep better with “white noise” (ya know: waves crashing, birds singing, fan turning etc), so the quinine has given me an involuntary, never-ending “white noise”. However, it also gives me nightmares (none too serious yet), and dizziness. I experienced the latter on the way to the bathroom. Good thing our hallway is not too wide as I used both sides to steady myself. I must have looked like I drank a little too much millet wine last night…

Some people have PTSD (Post Traumatic Stress Disorder) after experiencing a terrible event. I am sure I have PQSD – Post Quinine Stress Disorder. Every time I take Quinine, I feel like I’m going to die, or wish I already had. Fortunately, this is only the 4th time I’ve taken it in the 5 years we’ve been here. So, this morning I prepared my stomach for the assault. I ate egg gravy and toast to thoroughly coat my stomach with something resembling paste, as I am convinced that each and every quinine particle has a razor edge, or maybe teeth, in which to eat through my stomach. So far so good. My stomach is still hanging in for the fight. My tongue is another matter altogether. When the quinine tablet hits the back of the tongue, it is a gentle reminder to the rest of the body of what is to come. Quinine is terribly bitter – much more so than sucking on Aspirin. Once the quinine has infiltrated the body, all food and drink tastes a bit like quinine – and it gets stronger each day. YUM!

Well, it’s 9am and I’m off to take a nap – my first of many for the day. Only 18 more doses to go. Talk to ya again tomorrowJ

Aud

If any of you would like a similar experience, please come and visit any time…

Since I feel like I’m going to die every time I take Quinine, Greg thought it would be educational (funny) if I kept a malaria journal for the next 7 days and explained to all of you what I was experiencing. So, welcome to my world of malaria and quinine.

As you already know, life here is far from boring. Three days ago I got a message from the health district that there was a meeting two days later lasting three days. This meeting was in Maroua, three hours away. Well I had not scheduled any surgeries for two of those days so I decided to go all but the one day. This meeting involves all the hospitals and health districts for the far North of Cameroon. I planned on going the first day and due to circumstances waited till the second day to go.
This morning I get up at 5:30 to the alarm. I get out of bed, it’s still dark. Get my things together, put on my helmet and head out the door. I’ve decided to take the motorcycle because it costs to much to take the car to Maroua ($50) and I have nothing else to bring back, so it would have been an empty trip. I just replaced the rear brake pads on the motorcycle yesterday. They seems to be working well. The sun is just coming up as I crest the top of the hill leaving Koza. It’s a beautiful morning. All along the road there are women and girls with clay pots on their shoulders, heading for the wells, to fill the pots with water. Unlike other heavy objects which are carried on their heads, these pots are carried on the back of the shoulder when full. Dogs scurry past as I round a corner. Three boys, one with only a shirt on, one naked, and the other with pants and shirt, all run out to the road, waving and yelling “nassara!” I wave and smile to myself thinking of
how little boys all over the world are the same. They would rather be naked and dirty then any other way.
After 45 minutes I make it to Mokolo. This is where the pavement begins. I’m making good time. I pass many high school students in their blue uniforms walking along the road toward school. I try to honk and then remember I do not have a functional battery so the horn doesn’t work. In a few spots where children are crossing the road in front of me I rev my engine to make my presence known. I get about 15 miles out of Maroua and my engine looses power. I rev again but it keeps loosing and then the engine locks up. I am near a little village. I push the motorcycle to the little market area. Moto mechanics eye me with glee. White guy + big moto = big money! I leave my moto and walk away. I try to call the guy who repairs my moto in Maroua without success. I walk over to some old guys sitting in front of a little shop. After questioning they indicate a man who could watch my moto. He is an older man front of another shop. My motorcycle is larger (600cc) and more
expensive than others here so I prefer not to leave it with people for fear it will get stolen. I have no choice. He pushes it inside his little storage building along side the sacs of millet and corn. I then ask him how to get to Maroua. He says he will take me. He places a little cushion on the back rack of his small 90cc moto and off we head toward Maroua. We get there at 8:30 when my meeting is to start.
Near the bridge, under some trees, is a area that motorcycles are repaired. This is obvious by black sand under the trees. Black from all the oil changes emptied out on the ground. My mechanic is not their yet. The guy who’s driving me lets some guy who knows the mechanics house use his moto, so this other guy and I head off for the mechanics house. We arrive and he is just leaving. I explain the situation. He says he will take care of it. I give him the key and go to my meeting.
At 11;30 on our first break I go to the same trees and see my moto there. They took a moto and with an outstretched foot, pushed it all the way back to Maroua, one rider on each. He says I ran out of oil and the engine seized up. Oh how stupid! It never used to burn oil, so I stopped checking it. He says he’ll take it apart tomorrow, put a battery in it, fix the muffler too and bring it back to me in Koza. I’m sure it will be costly, but the service is great. I head back to my meeting.
They have cut the meeting to two days, so this was the last day. I ask for a ride with someone else returning to Koza. While driving from Maroua to Mokolo we hit a pothole and a battery light comes on. The truck continues running so we continue. Arriving in Mokolo we drop off one person. The truck will not start. Under the hood we see that the alternator is loose and the fan belt is so loose that it is not turning anything. The owner of the vehicle goes to find a mechanic at his home, to repair it and get a push start. I grab a passing moto. He takes me to the market where I look for a moto to take me home. I tell them the price I am willing to pay. He takes me to a group of motos and dicker about the price. They give him 500F and I leave with that person. He is from Koza and gave the guy the 500 ($1) for finding him a client.
We roll through the night with a headlight pointed at the stars. He does not have a battery. This is apparent by the fact that when the RPM of the moto drops down the headlight dims to nothing. So its with constant revving the engine that we can see and slowly make it back the rocky road to Koza. 12 miles in 1.5 hours. We arrive safely at my house and I pay him 2000F ($4) for the trip.
I’m thankful for Gods protection of this day. Greg