I’m at the morning worship and I’m told that all the foreigners that work or volunteer in the hospital are called to see the highest local government official, the prefet, this morning. We are also suppose to bring our passports. After living in Cameroon, this sounds fishy to me. No explanation is given, just the order to show up at 9. I’ve NEVER had to give my passport to any local officials while in a country, just at the entry to that country. So I know something is up, but don’t know what yet. We all gather and pile into the truck and head over there. After waiting outside about 5 minutes we are ushered into his presence. There are chairs around the room for all of us and he sits on a couch. He greets Olen as the head of the hospital and recognizes the rest of us. Small talk is then made about how each others families are doing. Coming down to business it is said that not all of us have been presented to him as the local authority, and that he needs to know who is in his domain so as to keep us safe. I don’t feel unsafe, and am still skeptical as to what this really means. He asks for each of our documents, and we present our passports. He hands them off to another in the room who starts to glance through them. They say they will need time to go through them and assure that all is in order, then they will call us to pick them up later. I feel uneasy about leaving my passport anywhere, much less here. But as there is no other option, we leave and get back to work at the hospital.

Later in the day Olen is called back to the office and each passport was shown with it’s deficiencies, a lack of visa or lack of stamp… He had to find the recent visa or stamp for each one and that all was in order. Then the person said that the hospital needed to pay for the stamps and evaluation of the passports. They were declined. Then he was asked to give money for pens for the office, he offered the pen in his pocket. Eventually after a bit of back and forth, Olen was given all but 4 of the passports. Mine was in those that remained. (In a couple days I got mine back as well). So in the end it seemed to be a method to try to get some money from the hospital, frustrating!

Back at the hospital after leaving the above meeting, I change back into scrubs and head back to the OR. There are still about 8 people waiting for their surgery today. Each day we try to get through as many as we can and then quit about 5 or 6 and the rest are allowed to then eat and wait till tomorrow. We do two different guys with inguinal hernias and do a hydrocele. A hydrocele is when there is a lot of fluid around a testicle. One I did yesterday had a liter of fluid I drew off as I opened it. After these three there was a woman who was seen in the ultrasound room that Rollin had seen with a positive pregnancy test without any baby in the uterus. So it is likely this represented an ectopic pregnancy (pregnancy outside the uterus). This is important as usually they present to the hospital with bleeding inside their abdomen. So Rollin and I took her to the operating room. The spinal is placed, the patient prepped and draped. And the incision is made. Getting into the abdomen all is stuck in the pelvis. With a lot of difficult and uncertainty about identifying structures with all the inflammation, we eventually identify a teratoma. This is one of the strange things that occurs. It is a tumor with different tissue types inside of it. It often has hair, muscle, bone, or teeth inside. With a lot of effort we eventually got the teratoma out and closed up the abdomen.

Next we did a hysterectomy and then another hernia. And head out about 6 or 7 PM. About 5 in the morning I hear a voice outside my window. Christian is there to say he was called and would like my help. I get dressed in scrubs and head in to the OR. During the night he had gotten up to do a C- section and now there is another woman in the ER that was stabbed twice in the abdomen. The story I hear is that her father stabbed her. Apparently he has stabbed and killed her husband in the past and may have been in jail a short time frame. I pull the covering back and look at her abdomen. There is about a 1.5 inch wound on her right flank and also another in her right upper abdomen. Her abdomen is rigid and tender- peritonitis. For those who don’t know, a stab wound can hurt nearly anything in the chest or abdomen. It all depends on the direction and the length of the knife. This rule is confirmed again during this operation. She get’s a spinal like everyone else, a little strange to me as it doesn’t work in the upper abdomen, but it does provide some relaxation that wouldn’t be there otherwise. She gets some ketamine as well. She is prepped with betadine from chest to thighs, and a urine catheter placed. I pray out loud over her, as I do for all my patients I operate on. I ask for Gods guidance as I operate, for wisdom to make good decisions, for her not to have any complications afterwards, and most of all for her to know God in a meaningful way. I cut open along the upper midline. As soon as I enter the inside of the abdomen there is intestinal contents everywhere. The first thing I see is a small liver laceration, it’s not bleeding any more so I continue looking. I find a hole in the front of the stomach. I fix this, then we open up the space to the back of the stomach. As expected there is a hole back there too. We close that. Looking down and toward the middle there is a slice in the pancreas as well. Looking further, a hole is found in the duodenum (small intestine). After fixing that I dissect out the other side and find a hold in the other side at the mesentery (vessels of the intestine). We fix that and find four more holes in the intestine where the knife poked through two segments. Then on the left side where the kidney is there is a non-expanding hematoma. This means there was bleeding but didn’t appear to be bleeding any more. We look through the rest of the intestines and don’t see any more holes. Next I go back the the flank stab. I put a clamp into it and try to feel the area from the inside. I can’t so, I dissect and pull the right colon to the middle of the abdomen taking the duodenum with it. I can see them well and there is not holes. I probe the spot again and can now see it went to the right kidney and there is no expansion there either. We wash out the belly with a lot of fluid and then close the inside of the stab wound and close the midline incision. Most intestinal leaks occur within the first 5 days after a intestinal repair. So I will be worried about her for at least the next 5-7 days. I say another internal prayer, for God’s healing for her. No ICU and vitals wont be taken except once a day. Even the drain that I place near the pancreas, has no bulb as we used up the two we had, they were already reused on other patients and will be reused again once they’re available again. Again for most of you reading my letters, you are fortunate to have been born in a first world country and have good medical care. A place you could have ICU care if needed, get a full complement of medications and tests whenever was needed. You may not like your medical care system, but you can get care. People come here from literally ALL OVER Chad to be taken care of. Look at a map and see how large Chad is compared to your section of the US or Europe. No highways to travel 60mph on and they come. The medical system here may work some in the two large cities, but not in the whole rest of the country. Though I don’t like many things done in my own country, I am still grateful to have been born there.

Shanksteps (of faith) Bere 2017 #9

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