We arrived in the afternoon yesterday. We unpacked and then prayer walked around the hospital. We prayed that God use us to reach people here that don’t yet know Him who are ready to hear. Also that Gods angels guard around us and the hospital and protect us from the enemy (satan) and that Gods will be done in us, through us, and in this hospital. In the evening, the lady who is cooking us food, dropped it by. We had rice with one sauce that was peanut based with vegetables and another peanut based with maringa leaves (tastes a bit like spinach but much smaller leaves from a tree). As we were ready to go to bed a stiff wind started blowing and we heard thunder and saw lightning. And it cooled off to about 70. Having slept very little on the airplanes, we fell fast asleep till morning. That is after killing about 15 mosquitos in our room with an electric fly swatter. Invaluable here. We had forgotten to bring one, but there was a working one in the guest house we are staying in. Yay! We kept the door shut to our room and got no more bites overnight. We definitely are taking our malaria prophylaxis.
In the morning we headed to the hospital in time for 8am worship with the staff and were introduced. Next the surgeon (the only doctor here today) took us on his rounds and showed us around the hospital. There were a variety of patients, and Ill guess about 17 patients. They were here for malaria, body aches, open fractures that were in traction or in various stages of granulation, those who had had skin grafts, and those fractures who had been fixed with a SIGN intramedulary nail. (A great system of giving fixation that doesn’t require a C_arm for placement.
After that it was a clinic day. So as we started there were somewhere about 40 patients waiting when be began about 10am. Audrey and I decided to see patients in one room while the surgeon saw patients in his office. We took the new ones and him the follow ups for previous hospitalizations, and some new. We saw patients till about 6;30 PM before finishing. The nurse translator would bring the patient in and take their vitals and then ask what their symptoms were and why they had come to see us. Many with body aches and headache, and many with articular pain. We would speculate about a diagnosis then see if there was a test here that was remotely useful for that disease. If there was a test, then we would order it and they would go off to get those labs or x-rays. Late in the day when we finished all the new patients, we started re-seeing all those we had ordered labs and x-rays on to see their results and decide on a treatment. Some we had to admit to the hospital most were treated as outpatients.
One we admitted was a 12 year old with right lower quadrant (RLQ) pain. She had been treated at a clinic a week ago and her pain persisted and so she came here. She had no documents as to what happened there nor what she was treated with. I was concerned about appendicitis or typhoid. So after she did tests I saw her back for an ultrasound. I attached my butterfly ultrasound to my phone and looked around her RLQ. Im not great about finding an appendix on ultrasound, so I didn’t see one. But there was some haziness where I wouldn’t expect it so figured it could be. But she also already had survived a week without apparently bursting. So I decided to treat with antibiotics. That would cover typhoid and appendicitis. It’s sometimes hard to know when to operate here unless there is peritonitis. No CT scans or the variety of labs we use in the US. Later on I went to see her as we left- and she feels much better. So I’m praying that trend continues.
Another we admitted was a man with a history of a gastric ulcer treated in the capital a number of months past. He even had an upper endoscopy report with him that said he had an ulcer at that time. He continues to be anemic (low blood count) and keeps getting transfused. He felt weak so came here to see what we could offer him. His hemoglobin was 3 (normal >13). So we ordered 2 transfusions of blood and will see how he does tomorrow after the second one.
Another memorable one was a 13 year old by with body aches and weakness. The translating nurse thought we should check him for sickle cell disease. His symptoms didn’t match that real well- but Ive learned over time that when I think of something or in a case like this when someone else thinks of something- I order it. It is often Gods Holy Spirit prompting (the still small voice) to do what is needed. And yes he did have sickle cell disease. His hemoglobin was 6, but we looked it up and they typically shouldn’t be transfused till 5 so we gave him some iron with folate tablets
Other patients tested positive for malaria, rheumatic fever, suspected typhoid (not typhoid test here), broken ankle the woman walked in on that said it hurt (yep!!) Medial and lateral malleolar fractures.
We are very tired and headed to bed early. May God strengthen and guide you at each step, during this life journey He wants to have with you….!!!!
Have you ever had the experience where you are pretty certain what God has asked you to do, but then things aren’t working out in that direction until it seems way to late for anything to happen. Then suddenly things start working out that don’t seem possible and occur in very quick succession. And it becomes clear what God has wanted you to do. Well that’s happened just this past week.
For starters, we try to do a month of mission (sharing Jesus) humanitarian (free labor) work overseas, twice a year. So last year about October we made our schedule to be off the month of May to do this volunteer month. We anticipated visas would once again be authorized for US citizens to get Chadian visas by then. We come up to this past few months and realized that won’t happen. So in the past few months we offered to a few different hospitals our services. And the ones we contacted didn’t need us that month. So we guessed we would find a vacation spot and travel. Until….
Two weeks ago Audrey was at a urgent care continuing education conference. While there one of the presenters mentioned in his talk that he had done work in west Africa. So after the meeting she waited till he was available and asked him about where and when. He was a liaison for a rural mission evangelical hospital in Mamou Guinea. So they exchanged contact information. She and I had a crazy week after she returned. We got to emails last weekend and found he had written a letter that if we wanted to volunteer there to get a hold of him. So we said we were interested (and had time off in a week) and he created a zoom meeting last Sunday to meet the administrator and founders.
At the zoom meeting we met them and talked about their hospital and what we have had experiences doing. After two hours of talking, they decided it would be a good time for us to go there and thought we could do it in a week!
So last Sunday evening Audrey filled out our online visa applications and Monday she purchased airline tickets. Wednesday she realized there were documents that were supposed to go with the visa application but there wasn’t a way to send them clearly, so she hadn’t done that. So she tried to call their Washington DC embassy, without success of getting someone. That afternoon the e-visa came through for both of us anyway.
So here we are 6 days after our zoom meeting and everything has lined up and we leave for Guinea in the morning. WOW! God did it. Everything fell in line when He decided it was time for us to know and go. God is amazing! We look forward to however he will use these faulty vessels in His service. Lord help us to represent You well! Give us wisdom and may Your love flow through us to all that we meet. Amen
Please pray for us as we serve other in Jesus name.
I’m about to drift off to sleep, laying there wet and evaporating in the fan when I get a call. It’s difficult to hear what the nurse is saying as there is a lot of background noise on his end. I think he says someone can’t pee and has a catheter in and is in a lot of pain.
I had seen a man brought into the recovery area carried by his family members because he wasn’t peeing with a catheter in. One of the other docs was out there and I was trying to get to my next surgery so I walked away to my surgery figuring they would figure out what was going on. So as I get my self together and grab my bag of stuff (water, stethoscope, headlamp, butterfly ultrasound, kind bars, batteries for headlamp) and head to the hospital, I wonder if it is for that same man. Wondering if the foley balloon was blown up below the prostate, breaking the urethra and causing a stricture in the future…
I walk through the ER and adult wards looking for the patient. Not there. So I go to the surgical ward and he’s there. It is the same old man. Three women are fanning him with handheld fans- a sign that he is in distress. They fan when someone is after surgery and when they are really hurting or agitated. The man is grunting and I ask him what’s going on. He tells the nurse that he can’t pee and his abdomen hurts. There is only about 5cc of urine in the tubing not making it to the foley bag. And so I suspect it is misplaced in the urethra so I feel for a distended bladder. I don’t feel one. Hmmm. Same foley of earlier today? Yes. Same bag as earlier when you were in the OR? Yes. Is he not making urine?? I feel around his abdomen and he cries out in pain. Peritonitis. I get my Butterfly ultrasound and look for his bladder. I can barely see it for all the other fluid in his abdomen. So I attribute this to a leak from his intestine or stomach causing the peritonitis and lack of urine output. I see his CBC was ordered today by another doctor in clinic and they don’t have the paperwork but I can see on the computer his WBC is 20 and Hb- 17.1 So he’s very dehydrated, has peritonitis, not making urine. He hasn’t had a set of vitals, and I know I need to take him to the OR. So I call in Phillipe and try to get the medical student Caleb on the phone to help me. Caleb doesn’t pick up with multiple calls. So I walk to his house, shine my light in his screen window at him and say his name louder and louder till he awakens. Then I head back to open the OR and get the patient over there. It is now midnight. The surgery ward nurses put in another IV – good job, without my thinking of asking. I ask them to bring the patient to the OR and go and start unlocking the OR and turning on lights and machines. They wheel him in on a stretcher. While I wait for Phillipe I hook him up the the anesthesia monitor and start the BP cuff. HR- 120 BP 70/30. I start pouring in the fluids. He’s very dehydrated, likely in shock. Phillipe and Caleb arrive and after a few liters of fluid his BP and HR are better. He’s also looking a little better though very sick. I wish I had an ICU for him. I open the OR pack, select my suture, scalpel blade, cloth sheath for the cautery, pack of the reused suction tubing, our sterile gloves, gauze, and get everything ready. I prep his abdomen with betadine then go scrub. I scrub with the brown bar of soap then go back in to the OR, dry my hands and put on my sterile cloth gown and gloves. I gown and glove Caleb. We pray for Gods guidance and keeping this man alive during and after the operation and we start. I cut through the skin and very small fat and into the fascia and abdomen. As soon as I enter the intestinal contents start flowing out. We suck all of it we can but it still pours all over getting our gowns (and us) wet. I start in the middle looking for a hole and then extend my incision top to bottom looking for it. I see a dark patch in the terminal ileum, but see no hole. AFter looking at all the bowel and stomach again, I come back to the dark patch. I now squeeze intestinal contents towards the area and sure enough, I see a small pinhole leaking. So this has been leaking a while to get all this into his abdomen! Phillipe says START CHEST COMPRESSIONS! What? He hasn’t told me the pressure has been real low and up and down the whole surgery thus far. I start compressions. I ask him questions. The patients BP has been between 80 and 40 systolic and now not registering. I reach in the abdomen and feel the heart still beating. He gives a slug of ephedrine into the side of the IV container and its running wide open. The SBP picks up to 40 then 60. I need to be done this operation as soon as possible. I wish I had staplers but I don’t. So I take out that section of intestine with clamps on either end. Phillipe is giving two units of blood. I think the patient may not need blood, but he does need a blood pressure and he tells me he’s given many more liters fo crystalloid already. I choose to oversew the distal end in the sake of time and bring out the other end as an ileostomy. I wash out the belly with multiple liters of fluid that goes all over. I close the fascia and the patient is still alive- barely. I put the stitches to form the ostomy and leave the skin open in the sake of time. Phillipe extubates him after about 30 min and he goes to the “recovery” room. Meaning he gets out to a room where there is a monitor and the family can come and see him. The women start fanning and everyone just stares at him wondering if he is alive and looking for breathing. I tell the family what we did and show them the piece of intestine we took out. I suspect it’s a typhoid perforation. It’s 4:30 and Phillipe says he’ll start with the patient. I head back to sleep. I get 3 hours before my alarm goes off to start today…
I am deep asleep but know I must get up. There are 6-8 patients scheduled for surgery today and no way to get through them if Im not operating. I go in and find that David is doing anesthesia and Phillipe hasn’t come in. Drs. Andrew and Steven are doing a thyroid that is huge soon and so I head to do rounds where I find my patient still alive, women standing at bedside fanning and the patient minimally responding to questions. Again I wish I had an ICU with ICU nurses, monitoring and meds…. Wish for so many things. My cow horn goring guy wants to go home. As I think another operation will just delay a day or two the inevitable, I agree and discharge him home. I pray with him asking for Gods miraculous healing and encourage him to keep his trust in God till the end.
I go to clinic and am there till my last patient is about 3PM. Phillipe isn’t coming in today so only on room can operate. The OB/GYN is getting ready to do a hysterectomy (take a uterus out) on a woman with a huge uterine fibroid. Her uterus is well above the umbilicus. I wait till her patient is intubated to make sure it goes well then I head to say goodbye to the other missionaries. Missionaries I rarely see because they are spouses of the doctors or others that don’t work in the hospital and I don’t run into often.
About 6PM I get a call can I come help the OB/GYN in the OR. I hear there is bleeding and it’s a real tough case. It’s her first time in Bere and I wonder if it’s real hard or she she’s not used to the lack of equipment… I glance in the room before scrubbing. There is blood all over the abdomen and down the sides of drapes onto the floor. How could I doubt her! It looks bad. The patient is getting blood and a low BP but not life threatening low. I choose to forgo the plastic apron, because of it’s heat, and dawn the cloth gown. I later regret this decision. I take the place of the medical student and he becomes the scrub tech handing instruments to us. Which in this surgery is very helpful!! I pull hard on the uterus and it doesn’t budge. It is the size of at least a football, nearly a basketball. I pull to the side trying to expose for her and we get 1cm between it and the pelvic sidewall. OOHHH! This is terrible. No wonder she needed help. This is the worst I’ve seen for lack of visualization. We do our clamps, cut tie, down the sides further. ¼ in by ¼ in. Very small increments. We hug the uterus hoping we are not coming close to the ureters or iliac vessels. Usually as you go down the uterus becomes more and more mobile and comes up into the incision more and more exposing the next area to take. This one doesn’t move. We march down the sides with very little space to see anything, praying we don’t get into deep bleeding that would kill her before we could control it. As I work I soon realize the lack of the apron is making the patient blood soak through my gown, scrubs and underwear. I hate that feeling. Knowing I’m wet from someone else’s fluids… I mention maybe if wee took the posterior peritoneum, if we can get there, maybe we would get a little upwards movement. So she divides posterior and we are into the uterus next to the fibroid. It starts pealing out of the uterus. In 20 seconds we have the top of the uterus off with it’s huge fibroid and now we can see. We start controlling the bleeding and she packs some surgical and other hemostatic agents she brought into he area we just tore the fibroid out of. Now we start looking for the ureters. The left we don’t see and the right we find very distended and know it’s tied off. So we start taking down the ties, which causes more bleeding and eventually get off the tie that is on the ureter. We realize we have tied, cut and divided the ureter. This is terrible an neither of us have done this before nor encountered it before. But we have both read what is to be done in this situation. We need to either repair the two ends back together or implant the end we found into the bladder. Her bladder is large and easily reaches this area so we plan on that. We cut up the ureter a short distance to (spatulate) or make the opening larger so that our anastomosis will be larger and less likely to stricture with healing. Then using PDS we suture the ureter to the bladder. As we close we take a ureteral stent and put it through the abdominal wall, into the lower bladder, then up through our area of anastomosis. This will help it stay open while it heals. We are both spent. The patient has stabilized and our visualization is tough with the intestines pushing into the area. We search for the other one unsuccessfully and check that there is some urine in the foley bag so we decide to close. It’s about 8PM. I have handed my call phone off to Dr. Stephen so I know I won’t get called tonight. But I need to eat supper and pack. I leave at 5 AM on a Moto for Kelo to catch the first bus to Ndjamena. Dr. Leslie and Caleb, med student, start closing and I head out for supper at Dr. Andrew and Dr. Meghans house. Instead I head to my room for a shower, because I look like I had a circumcision in the village. (They use the pull the foreskin and cut, technique in the village). I have about a 2 foot circle of blood coving from my lower chest to thighs. Yuck! As expected, in the shower that same area has blood on my skin.
At supper, Dr. Leslie calls, there’s not more urine in the “recovery” room and she thinks we need to look again at the other side. She has flushed the foley and there is no blood clot obstructing it. We all decide it can wait till morning and I head back to my room to pack. It get done about midnight and sleep deeply till my alarm awake me at 4:30. After I’m dressed I take my bags out, see Rebecca is waiting to say good by, and my luggage is strapped to the back of the Moto and I and the driver load up and we are off for the 2 hour ride to Kelo as the sun comes up.
I thank you each for your prayers and for your interest in the mission work God has been giving me over these many years. I pray for His continued Guidance in my life on a daily basis.
If you want to support Bere Adventist Hospital this is a link you can use for financial support:
If you want to volunteer your abilities, time, and talents and whatever God has given you knowledge of- contact me via phone or email. All different abilities are needed.
God bless you as you serve Him wherever He leads you!
Bere 5/2025 #15. I had a number of surgeries today. But the one that I enjoyed the most was also the most stressful. It was the last one of the day and I started about 4:30. He had a wound on his leg about 3 months ago, and his family put scalding water on it and burnt his leg. This created a chronic wound and a significant knee contracture. I enjoy releasing contractors as it changes someone life significantly. It is stressful because anatomical structures can be pulled into the scar tissue and arteries and nerves can be in the wrong place and be injured. I have friends that have worked in burn centers and Im sure are much better at dealing with this than I am. But this patient has me. I’ve done some before in Cameroon and here, but I still have angst until it’s released and I haven’t injured anything and they have function after.
His knee is bent almost 90 deg. And can’t straighten. We prep the leg all over and also prepare his thigh for taking a skin graft. I use cautery to cut into the scar going across it so that it opens up longer. It is really thick. I cut about ¾ inch deep and still in scar tissue. Im starting to worry about popliteal vessels and nerve when I hit some bleeding. I suture the small vessel. I go to a different areal and continue. I get in a good plane and head towards the area where I got bleeding. I find his pedal pulse and then compress this vessel. It isn’t the popliteal as his pulse remains strong. So I cut across it and realize Im still a far bit away. I get to an area where my cautery is making his leg twitch. So there is a nerve near by. I slowly dissect and find a small cutaneous nerve. I have gotten about 30 degrees of extension with this cut. So I move higher an make another. And also do one lower. As I take these deeper I get more and more extension. After I get full extension Im able to relax a little. Now I realize if I put skin graft on it like it is. He will have thick and thin areas giving the back of his leg a very bizarre appearance. So I cut off a lot of scar tissue and this evens it out some. Using the dermatome I shave off a half layer of thigh skin in two swaths. Then Caleb (med student) and I start the long process of sewing these to the site we just opened. It has to stay put because if the skin graft shifts on the wound bed, it then dies. So it has to stay in one place. After suturing about an hour, we put xeroform dressing and build a plaster splint to help hold his leg straight and then attach everything before the plaster dries. I hold the leg straight about 15 min, till the plaster is very hard.
Another I had that day was an older man who was about 60 and had been in a Moto accident about 3 months ago. He had a patellar fracture and the two halves of his patella were separated by about 1.5 inches. I walked with a cane and could flex his leg about 30 degrees. I had seen him in clinic and told him that I could repair the patella but he would require a splint or a cast afterwards and would likely not be able to flex his leg in the future without much physical therapy (which is now available at the hospital). I’m skeptical that fixing his patella will give him any more mobility at this point and may make his leg straight forever. After discussion all this with him, he still wants it fixed. So in the OR I cut down to his knee. The scar tissue is thick and hard to remove. I remove it from the ends of the bones too and rongour the edges to get fresh bone exposed. I free up to get mobility of the upper segment so that it can move back down to where it belongs, as the muscles have pulled it up and away from the bottom half. I don’t have screws to put the halves back together so I use what I have- suture. I suture the halves back together. I fount a huge 5 suture with a sharp needle so this one I go through the bone with too and after about 6 different sutures I get the halves about ¼ in. apart. I then cut down on his side over the pelvic bone. I expose the rim of the pelvis and nibble away pieces of this to place in the gap that will be new bone to encourage new growth. After filling the gap with these pieces, I suture the skin back together in layers.
It’s been a long day and Im tired. One more day to go. I shower and go to bed wet, with a fan blowing on me. I hope to sleep before I finish evaporating. I’m just falling asleep when I get a call. A man can’t pee and he’s moving in pain. At least that’s what I think I hear. So I go in.
