Aud’s in Bere, Chad
So, I am writing my first note from Bere at 1am on Wednesday night/Thursday morning. Why at 1am you might ask. Well, this is the first time I have had to sit and reflect on my journey here.
I left my house in OR around 2pm on Sunday afternoon after my sweet kiddo made me an awesome lunch. I drove to Eugene to hit Costco for some last minute goodies to bring to our friends here in Africa. I suppose it was a funny site in the parking lot of Costco as people drove by watching me weigh and re-weigh my trunks so they wouldn’t exceed the 50lb weight limit. 2 people offered to help me get them in the car, not realizing that I had picked those trunks up dozens of times already to max out the space. Finally happy with the weights, I started driving to Portland. I got to the parking area and again had to lug the trunks from he car, to the shuttle, to the checkin. I was so happy when they finally disappeared with tags for N’Djamena, Chad.
My flights were uneventful. Ovenight from Portland to Chicago; 15 hrs Chicago to Ethiopea; then on to NDJ Chad. I was able to get through customs with no hassel at all- a first for me coming into a West African airport. The only glitch in my travel was the miscommunication of landing time, so I had to wait at the airport for awhile. It was extremely hot, especially after coming from 50 degree Oregon, and I didn’t have a phone to call, or a contact number for my ride. I finally borrowed a phone to call Greg, who called our friends that were to give me a ride. I met up with Gabriel, Dr Sarah’s fiancé and Sarah Appel and went on to Sarah A’s house on the farm.
I spent a nice afternoon at her place, walking around and taking the best cold shower I’ve ever experienced. We ate at 6pm and by the end of dinner I was almost falling asleep on my plate, so went right to bed, sleeping deeply until I had to wake at 5:40 to eat and get to the bus terminal.
I got on the bus around 8am. Now, I wish I could show you pictures of this bus. Imagine a grayhound bus, with curtains, and window decorations, and tassels, and streamers. (Last year’s bus even had beachballs hanging from the ceiling). Now add lots of people and kids in all shapes and sizes, with all of their individual smells- some amazingly sweet, others not as pleasant. Plus the luggage. There were largs sacks of onions blocking the aisle of the bus, and everone was required to step over and around, no matter what kind of skirt or wrap you might be wearing. Fortunately on this trip we were not stopped by police or army to inspect, and re-inspect our travel documents. In the past we have had 3-7 stops just for police to try to extort money. Not so this time, a very pleasant surprise. The bus made numerous stops to pick up and let off passengers. We stopped in the middle of nowhere and everyone started getting off. I soon realized it was a potty break-just stand next to the bus and do your business… The next stop was Bangor. This was the only major “city” on the route. It was also a good place to get crackers, soda, water etc. So, I got some “roadside meat” which was delicious, and yes, I tried fried crickets. Pretty good mixed with hot pepper spice. Finally off we went to my final stop of Kelo where Greg was there to meet me.
Greg had decided to not repeat his trip into Bere with getting the truck stuck, so he came to get me on a motorcycle. We hired a 2nd “clandoman” (moto driver) to bring my two 50lb trunks and off we went. Fortunately it hadn’t rained for 2 days so the dirt roads weren’t slick mud, but were still covered wih huge puddles. I knew this would be an adventure when Greg said, “ok, with this puddle, you need to lift up your feet or you’ll get wet.” Sure enough, the water came up over the tires but we made it through. All in all, the 2 1/2 hr ride was very pleasant, getting in just 30 min after sundown (with a crummy headlight).
As soon as we arrived, Greg went in the hospital to see a woman who had been injured by a bull. For you squeamish types, this might be where you should stop reading. The old woman had been charged by a bull, slicing her throat with its horn. She was still alive and breathing when Greg got there. Dr Sarah thought it had gone through a small bit of her trachea and possibly esaphagus. He was then notified of a 2 yr old with a strangulated inguinal hernia. Greg called for me to come and do the surgery with him to repair the neck and then repair the hernia on the kid. When I saw the woman, I could feel air escaping her neck with every breath. Already a miracle that she was alive. We prepared for surgery. It should be known now, that there are no ventillators, no gasses to put people to sleep, no pain medicine stronger than Ibuprofen. She was put to “sleep” with Ketamine and then Greg started to explore the injury. The injury was just above the trachea in the soft tissues. Not great, because this area will swell up terribly if injured and will become easily infected. All this to say that soon she would not be able to breathe through her windpipe. We decided to do a tracheostomy below the injury so she would have a secure airway. “Do they have tracheostomy set up here?”, Greg asked. No! So he started to do a trach, inserting a endotrachael tube, getting it set, then cutting it shorter so it would‘t stick out so far. By the time we were doing this, she had stopped breathing so it became emergent. We had a very hard time keeping her oxygen normal. The nurse doing anesthesia was bagging her in attempt to bring up her saturations. Greg, meanwhile was trying to repair the bull induced injury of her neck. I finally broke scrub to listen to breath sounds finding them only on the right. When we pulled the tube back a bit, she was then able to breathe using both lungs. She was still only taking a breath irratically so Phillipe continued to bag her. With the neck repaired as well as could be expected, we now had the challenge of managing a tracheostomy in an old woman, with none of the nurses trained to do so, no respiratory therapy, no ICU. I stayed by the old woman trying to keep her oxygen level as close to normal as I could. Greg did the next surgery on the 2 year old boy with inguinal hernia with a sweet nurse from South America who has been working here for several years. Fortunately for the kid, his bowels were still healthy and so it was a quick surgery. Meanwhile, I was suctioning, intermittently bagging, and manually giving oxygen to the woman. Her breath sounds were becoming very wheezy and diminished so we gave her IM Salmeterol (like Albuterol), IV Dexamethasone, Epi down the trach, then injected. She finally started really breathing on ther own, but was still fairly unstable. After doing as much as we could, we left her with Dianna, the nurse who had done the hernia operation with Greg, and decided to come back to the house to have dinner. It was now midnight. We ate rice and beanballs (like meatballs but bean based) in a tomato sauce. Greg went back in to check on the old woman, and I took the second best cold shower of my life. So here I am, writing while Greg showers. An exciting first day in Bere.
Total travel: Sunday at 2pm to leave the house- arrive Bere Wednesday night around 7pm.
Update: Afte sleeping until almost noon today, I went in to find the old woman doing well, considering… She has not pulled out her trach. She is breathing comfortably. Her lungs finally sound good. If only her family would actually pay for the antibiotics she needs, she might just make it. She will probably need the tracheostomy for some time to allow her neck to heal. She is having a hard time understanding why she is breathing through a tube in her neck, but has finally accepted it and is not fighting it. With patients and cases like this, I have to give all the credit to an awesome God who loves us and her, as she really should not still be alive.