Shanksteps Bere 2017-3

I awake from a relative unrestful sleep- because of jet lag. It is 3:45 in the morning. There are dog barking, insects chirping. I lay there in the heat and toss and turn. I went to bed wet last night, and hoped to sleep before I evaporated. The desert cooled off and I felt cold in the middle of the night. At about 4:20 I hear the familiar Allahu akbar (God is greatest)x4

Ashhadu anna l ila ill Allah (I testify that there is no God but Allah)x2

Ashhadu anna Muhammadan rasul Allah (I testify that Mohammed is God’s Prophet)x2

Hayya alas salah (Come to prayer)x2

Hayya alai falah (Come to security/salvation)x2

Allahu akbar (God is greatest)x2

La ilah ill Allah (there is no God but Allah)

Assalatu khayrum minan naum (Prayer is better than sleep)

This intonation goes on for about 3 minutes (can be heard online if your interested). I feel at home in West Africa again. I lay awake unable to sleep and have my special time with God. I am also reading a book called “The Bondage Breaker”. Within an hour the sun is coming up and the sound of chickens and dogs increase. It is Friday. We have decided to halt our progress to Bere to stay with some friends in Ndjamena (the Appels).

We all eat an oatmeal breakfast and James and I head to the hospital. It is a mission hospital that James volunteers at here in Ndjamena. We go to see an old man who needs a debridement of his foot. It’s a holiday and the hospital has two nurses on and we can’t find either one. Finally we find one in the “ER” (two bed small room with a curtain in between them). We go to see the man with the foot that’s been infected and draining for many months. He is eating bouii (pourage), meat, and other things for breakfast while he was ordered NPO (nothing by mouth). So it is unsafe to give him sedation and do the debridement. So we tell him not to eat anymore and we will work on him in the afternoon.

We go and find the covering Chadian doctor and do rounds with him. During rounds we see a 10 year old girl that has been treated for myositis (muscle infection) of her upper leg. She lays on the bed very stoic. The antibiotics seem to not be working as her upper leg remains swollen and very tender to touch. There are little healed cut marks on the thigh, which I interpret as the place of most pain. (In Cameroon these cuts were made to let out he bad blood or pus by someone at home with a razor blade). She had an ultrasound 4 days ago and no abscess was seen. Her leg had been wrapped in a gauze and the nurses put alcohol on the gauze. The patient thinks that it may be a little better. We talk to her and her mom and grandma who are at the bedside. I wonder if there isn’t an abscess now, as it isn’t better. So we tell the family we will be doing another ultrasound. The mother wants to wait for the father to make the decision, and we convince them not to wait. She is taken to the ultrasound room. She is lifted onto the exam table with eyes ready to pour forth tears. She doesn’t know what we are doing. Her grandma is there encouraging her. As James looks around her thigh- we find what appears to be a pocket of fluid that seems to be lateral on the leg. After explaining to the mother and grandmother what we’ve found we convince them to let us take her to the operating room for sedation and to open her leg.

In the operating room she is given a shot of ketamine and we wait. She is eventually staring off into space with unconscious eyes. I incise the side of her leg and spread into the muscles. Spreading around I start to wonder if we really saw an abscess. James spreads around to and pus flows out. We put a finger in and break up the loculations all around the femur. We get about 300ml of pus, and the space is about half of her lower thigh. We wash it out with dakins solution and pack it with gauze. I am now content that she will get better.

We are called to the ER again to see a guy with a strangulated inguinal hernia. An old man lies on the bed. His hernia has hurt for 4 days. And yesterday he started to vomit and has been unable to pass stool since yesterday. His abdomen is very bloated. We ask for the operating room crew to be called in for an emergency hernia repair. In about an hour we are in the operating room.

He is given a spinal anesthetic and we start. I incise the skin and I think, either this skin is tough or this blade is dull. I make a number of passes with the knife and am finally through the skin. The hernia is large and firm all the way down to the bottom of the scrotum. Slowly we dissect out the hernia sac. We open the sac and find his colon and omentum(a fat layer it the abdomen) in it. The colon does not look good. I open the hernia site larger and with more space, blood starts to change the color of the colon back towards normal. I’m able then to reduce the colon and omentum back into the abdomen. Within minutes we hear diarrhea coming between his legs. The blockage has been relieved and the odor of success is permeating the room. We close up the hernia site and close the skin.

Later we debrede the infection off the foot of the old man.

After each operation the staff take whatever has been removed out to show the family and they nod and make comments about whatever they see. I’m often curious what they are saying. Especially about the pus from the girl, because there were a lot of facial expressions and talking.

We went back home and ate some rice and beans. It is 95 and dry. We spend the afternoon talking and swinging in hammocks. Night falls and it finally starts to cool off. I’m am very grateful for cooler nights. I’m also grateful for the ability to serve others with trips like this. Seeing other cultures always reminds me of the blessings I have that many others do not have, purely because I was born in a 1st world country.

Shanksteps Bere 2017-3

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