Bere 5/2025. #4

administrator Greg No Comments

Bere 5/2025  #4

I slept through the night- yay!  The missionaries here are amazing!  So much to do, so often little sleep.  Dr. Andrew was up 5-6 hours last night with a child who was dying.  So sad and so many advanced diseases.  I think I say that every time I’m here.  It’s always very hard and very good to be back.  All the missionaries here are amazing and have such a heart for God.  They are wonderful people to hang out with.

I went to morning worship at 7 then found out there were no meetings after that.  So I thought of starting rounds or operations right away.  Well no nurse on surgical ward, and no one except patients sitting around with IVs in their arms in the OR.  So I go wandering around looking for workers.  I found the anesthetist chatting with a surgical patient.  I told him I was ready when he was, so he headed to the OR.  Since it is the hot season most of the patients and families spend their days outside.  They have to be collected from out under the trees, to come inside to round.  So after about 15 minutes I was able to go to the OR and start a surgery.  

The first guy had what was suppose to be a hernia and possibly a hydrocele.  After his spinal I thought it was likely a hydrocele.  But in palpation I got the sense of a hernia too.  So after we prepped him and put the cloth drapes on- I made an incision for a hernia figuring if it were a hydrocele (fluid around the testicle) that I would just extend down to it on the scrotum.  I did the usual exposure down to the fibrous layer and then opened it.  Still couldn’t reduce anything.  Eventually I got a little to go back in.  But the scrotum was still at least grapefruit sized on one side.  I finally opened the sack and found what appeared to be omentum (fat) as well as intestine.  The omentum was stuck to the sack.  So I tied and cut through the omentum.  Then the area I was unsure of, the area that could be intestine still wasn’t clear.  So I slowly dissected it.  After a bit of work it was more omentum that was encapsulated, weird.  So I took off the hernia sack and repaired the hernia with a mesh patch.  It’s the first mesh I’ve ever used here.  I’ve always been worried about infection.  But they have been using mesh lately and said they’ve not had many hernia wound infections.  At least there was an indicator in the pack that showed this pack was sterile!  The rest of that surgery went smoothly.

I saw a patient or two in the consultation room, which is now in a separate building, while I waited for the next patient to be made ready for the operation.  The next was a guy with two suspected liver abscesses.  As I ultrasound his scaphoid (concave) abdomen, I find a smaller superficial abscess and a larger deep abscess.  I numbed up his abdomen and put a needle catheter into the more shallow one and pulled out 30 ml of thick pus that slowly rolled into the syringe.  I couldn’t reach the deeper one and didn’t want to use a sharp spinal needle to do it.  Fortunately my hospital had a few pigtail catheters that were post dates that I brought.  So I stabbed one of those into his liver and into the second deeper one.  I drew about 50 ml pus out of that one and left this drain in that one.  Did the pigtail and also sutured it into place.  

The 60 year old man had bilateral hydroceles,  one medium hydrocele and a large hydrocele on the other side.  This fluid around the testicle I think is related to the shistosomiasis here.  A disease you can get from being in the rivers or a lake.  The solution is to dissect out the sack, resect the excess and evert it over the testicle and cord.  As I dissected out the side where Zach was standing it suddenly burst splashing testicular fluid all over his front and his shoe.  He was a trooper and took it and kept working.  The larger side had I bet about 800ml of fluid in it.  Quite large.  I resected both sacks and everted them and then sutured the testicle back to the base of the scrotum and closed the skin.

I saw a consult or two and then Dr Andrew said he had another surgery for me.  One I hadn’t seen before but they’ve done here a few times.  A hippo bite.  I understand that Hippos can be very territorial and you don’t want to get near one in the water nor on land.   They are large but can run almost twice as fast as a human (unless you’re Husain Bolt).  This teen boy was bitten in the leg.  He had a gash at his knee, a number of smaller punctures and a gash on his calf.  He got a spinal then we prepped his leg with betadine after washing it with soap and water.  So between the river water and the hippo mouth, I’m sure there are plenty of bacteria in the wound!  I loosely closed it, intentionally leaving space between each suture for pus to come out if it were to get overtly infected.

This evening I had a wonderful conversation with a missionary who has been helping people become free from devil harassment and oppression.

God please continue to guide them and Lord, use me in any way you want to, to advance Your kingdom!  I want Gods will do be done on this earth as it is in heaven.  (i.e.- Gods will isn’t being done on earth- His will, was the garden of eden…) See. Genesis Chapter 1 and 2.

Bere 5/2025 # 3

administrator Uncatergorized No Comments

Bere 5/2025 #3

Ohhh power just went out as I start to write and get ready for bed.  I certainly hope they figure it out or me sleeping without a fan will be very difficult!!  Today was my second day of operating.

I woke up early and did the things of the last post.  At 7AM I went to morning worship and then soon there after the power went out.  I knew there was suppose to be a woman with a large thyroid to operate on this morning and that would take a while.  There were some texts going back and forth about what was happening with the generator so I went to try and find out.  I found a number of guys I don’t know.  I guess they were newer than when I was here last year.  One was the mechanic, who can fix about anything.  At least he listed off a bunch of things.  He told me that the generator stopped because the voltage was zero in the battery.  He shows me a panel.  It has numbers and digital readouts.  So I know it wasn’t zero!  He showed me where the panel said 0V, but it was under the heading generator.  So the generator was off- thus zero volts.  I asked him for a electrical multimeter.  He said they were bringing it.  I was around there another 15 minutes with lots of discussion.  Finally they purged the diesel system of air and got a car battery and started the motor.  It ran fine .  Then they changed back to the “old” battery while it was running, putting the other battery back into the car.  

I was suppose to round and the other surgeons operate.  Then the first surgery, a large thyroid goiter was hypertensive.  So the other surgeons cancelled her.  So I was up for removing a young girls bladder stone.  Phillipe the anesthetist put the patient to sleep with propofol and some inhalation isoflurane and bagged her with a mask.  Her sat dropped temporarily then back up.  I scrubbed and we prepped the skin and put on the cloth drapes.  The nurse David had filled the bladder so it was near the umbilicus and then as I go in I will get into bladder and not intestines.  She’s about an 11 year old girl so she’s quite petite.  I cut through the skin low in the abdomen.  Split the muscles and identify the bladder.  She desaturates again, low this time, 40’s. Phillipe doesn’t have suction ready and he takes a bit to get it together.  Im trying to let the anesthetist do his job but Im about to scrub out to help him when it starts slowly improving.  I have a nursing student call in Dr. Andrew to assist.  He’s doing consultations.  The oxygen saturation is pretty good when he arrives.  So I continue the operation.  Andrew leaves and shortly thereafter the power goes out.  I always wear a headlamp so I’m the only one in the room with light.  I immediately worry will the patient desaturate and die for lack of the oxygen machine and anesthesia machine?  I try to hurry up as I just ready to retrieve the bladder stone.  I get it out and it’s about the size of filbert nut.  The patient slowly starts to desaturate.  I try to work as quick as possible.  About the time she’s in the 80’s for saturation the power comes back on and she slowly climbs back up to normal in the mid 90’s.  Wow that was stressful surgery.  So many things out of my control and many can kill or make a bad outcome.  

I go to see what’s happening in the other OR.  I find a nurse doing a hernia repair with a nursing student.  No one doing anesthesia.  I asked him where is his anesthetist?  Well he had done the spinal then started the operation.  I told him I thought that was very unsafe, decided not to make further comments and tell the missionaries that are here. That way they can address it if they wish.  It is quite different being in charge of a hospital like I was in Cameroon, vs visiting and trying to asses how to help without ruffling feathers.

The next one was a young girl of about 12 who had a broken leg about 3 years before and keeps getting infections in her skin.  She has some right hip pain as well.  So she had had an X-ray so I went to look at it.  It shows and involucrum (a thickened irregular bone associated with boney infection) and likely a sequestrum- a piece of dead bone that is an infection source.  The other doctors think this is the source of her various infections around her body.  I have no other explanation and this definitely looks like it’s a likely source.  In the operating room I open the outside of her hip bone and eat away at the soft bone down to the marrow.  But the infection seems to have been replaced with normal marrow and not full of pus like is usually the case.  So I wonder if I have missed the part with pus inside.  So I open the skin down to the bone quite a bit lower on the femur.  Here the bone is hard and normal and I can’t even make a window into it by trying to nibble away at it.  I ask for the nurse to search for another missionary to come in and help with their thoughts.  Two come and after discussion I decide to close up and they will send this info to the ortho friends they have to see who has better ideas.

When Im done with that David has done the other hernia case and there are no other planned cases today.  2PM- wow I don’t think Ive ever been done at that time.  So plenty of time for emergencies to be taken care of.  Zach and I head back to our rooms and get more water to drink.  When we’ve cooled off a bit in front of a fan, we go to the small market area just outside the hospital and I show him the types of things you can get.  We get some Gato (kind of like large donut holes) and sugar for them and for kool-aid I brought.  We also get toothpaste, and some little things that look like kit kat bars.  Back at my room we eat these and enjoy them.  

Im called to see a woman in labor who may need a C-section as the midwife says the baby is having some decelerations (heart slows down- a sign of fetal distress) with the moms contractions.  It’s this moms first child.  I go into the delivery room where there are rows of beds next to each other for delivering women.  There are two delivering women with many other women standing around.  The nurse tries to get the women to leave and some file out.  We ultrasound the one Im to look at.  The babies heart rate is good and its head down with the placenta not near the exit.  These are all good things.  But the baby isn’t coming out.  So I attach suction to the babies head which is right at the vaginal opening now.  With successive contractions I try and pull the baby with the suction attached to its head.  It doesn’t help much.  It seems the babies head is a little to large for the pelvis of the woman.  So the options are C-section or symphisiotomy (separating the pelvic bone symphysis to enlarge the pelvis).  I was taught symphisiotomy by an old OB/GYN while in Cameroon and this seems like an appropriate patient.  So I decide to do that.  Zach goes to the OR to collect a few things for me and the midwife gets some other things.  In between contractions, I place a foley (urine) catheter and then numb up the skin in front of the symphysis pubis (the connection of the front of the pelvic bone. I make a small incision in front of the bone and with the scalpel “feel” my way down to the ligament connection between the bone.  I put my finger in the vagina and push the foley catheter to one side so its not down the middle.  So with one finger inside the vagina and a scalpel cutting the ligaments I slowly divide the ligaments.  When it’s near the end I can feel the blade on the other side of the skin of my finger in the vagina.  If I go to deep I open the vagina and slice my own finger.  There is a pop and the bone opens about a fingers width.  The contractions keep coming and after the symphisiotomy the baby comes out in about two pushes.  Wonderful!  However the baby is floppy and there is meconium everywhere.  I pass the baby off to the midwife who takes him to the side table and starts suctioning his lungs and getting him breathing.  It takes about 10 minutes and more time on oxygen- but the baby appears to be doing well within about an hour with the midwife spending most of that hour with him.  While she helps the baby to live I sew up my small incision with a stitch and the nursing students clean up all the blood, placenta, meconium and mess.  I am always thankful to have a live baby – thank you Jesus!  Also thankful that this woman didn’t need a C-section- meaning a scar on her uterus, that gives her an increased risk of uterine rupture in the future.  Her pelvis will heal with a wider opening and her next delivery should be easier.

God help this baby to live and to grow to know You!  Give me strength for each day and wisdom for each patient I see.  Help me to support the missionaries here and help me to share Your love with all those around me.  Amen

Attached a picture of bladder stone.

Bere 5/2025 #2

administrator Greg No Comments

Bere 5/2025 #2

Sunday- second day in Bere.  Sundays are usually slower because we have no planned operations and don’t see surgical consults like every weekday.  I did rounds with Dr. Laurel on both the surgical ward as well as the maternity wards.  We saw the usual variety of patients.  One thing new here is Dr. Andrew has learned to do TURPs.  So basically rather than taking out the prostate to help old men pee better, he is able to ream our the inside with a hot loop and get them to pee better.  That’s exciting.  So we saw a patient who had had a TURP, some burn patients, a child with hirshprungs (disease where the nerves of the large intestine are absent and it doesn’t contract well) who had a colostomy a few days ago, a broken arm, post surgical wound infection, diabetic ulcers, osteomyelitis of a hip that needs debridement, and more and more.  Then on the maternity ward, there were many women who had delivered a normal baby and ready to go home, others who had a baby with an unknown infection that were there for antibiotics for the baby, and others with C-section and one after hysterectomy.  Many were frustrating because they didn’t have paperwork or it couldn’t be found to easily see why they were there or what meds they were getting.  We ended up looking at medications paid for and asked a lot of questions to figure out why they were there.

After rounds I took the call phone to start taking call.  When Im here I often bring insecticide to spare in all their houses, to help kill mosquitos.  It’s suppose to last 4-6 months, so it should help each family especially as the wet season is coming up.  So I sprayed about 7 houses today to kill flies, mosquitos, cockroaches, ants…. About mid way through I got the message that lunch was ready so I detoured for lunch before going back to spraying.

When I was about done with spraying, I got the message that there was a woman who was to have her first baby who was footling breach (butt first).  So they recommended that I do a C-section.  She had had a previous C-section and wasn’t dilating with usual measures. (Usual measures like a foley catheter put through the cervix and balloon inflated to get the cervix to dilate).  So I took her to the OR for the C-section.  My nephew Zach would assist me.  She got about 1500ml of fluids than a spinal anesthetic by David.  I cut across the lower abdomen through the skin, fat, then to the fascia (like gristle).  Opened the fascia and separated it from the muscles.  Then opened down to the peritoneum exposing the uterus.  I incised the uterus and took the bladder out of the way.  Then I continued opening the uterus until I got a small about of amniotic fluid.  Sticking my hand in the uterus I felt around for a part of the baby to grab.  I found the butt.  I pulled on either hip and delivered the child out butt first.  The head stuck a little, as it’s the largest part of the baby.  But with a little twist and maneuvering the head came out.  The baby was floppy, but the new (she’s been here 2 weeks) midwife was at the OR bedside to take the baby so I clamped and cut the umbilical cord and passed off the little boy to her.  As I sewed up the bleeding uterus, I started to hear the baby cry with the midwifes help getting the baby going.  It is always a wonderful sound to hear the newborn cry!!  Happy Birthday!  Thank you Jesus for another live baby!  After closing the uterus and putting the bladder back into place, the rest of the layers were closed leaving a barely visible scar.

I head back to my room and get a text asking if I saw the kid with a facial laceration?  I heard they were at the pediatric department so I went there to look at him.  I called David to stay around till I found out wether it could be repaired under local or not, but he was already home.  The kid and family had gone to the lab to get bloodwork drawn.  I got out my headlamp and looked at him.  He was a boy of about 5 years old, with a gaping hole and cut on his upper left lip and cheek. I could see muscle and some loose teeth.  He had been kicked by a donkey in the face.  The blood work looked good and I took him to the OR.  Two of the pediatric nurses and Zach came with me.  I called David so he would come back in to do anesthesia.  The pediatric nurses rummaged around to find the supplies to get an IV.  Eventually one was in.  Then it blew the vein, so another one had to be placed.  Finally another was in and we started.  Under ketamine he did pretty well until he started vomiting food.  The fatter told us he had eaten 8 hours earlier but that didn’t appear to be the case.  Fortunately he didn’t appear to aspirate the food so he continued breathing well as I worked on his face.  I discovered that 4 teeth were loose.  Loose from the bone and also a maxillary fracture.  I asked for arch bars for the maxilla, and they didn’t have any.  But David could find wire.  So I wired a bad tooth on each Side to the good tooth next to it.  Not really stable but better than just leaving that peice move as it would.  Then for the laceration on his lip and face.  I took off the dead tissue and then brought the obicularis muscle back together.  Then I reapproximated the remaining muscles and tissue.  I closed the skin and the boy woke enough to go to the ward with his father.  I checked with the maternity and there were no concerns there.  I went by the surgical ward and they were concerned about the swelling of the abdomen on the kid with Hirshprungs disease.  His belly was distended but not very tender and his colostomy looked good.  So I reassured the family and headed home.  After writing to you, I showered and went to bed dripping wet, in hopes of falling asleep before I got too hot.  I dried out but was able  to sleep.

Somewhere around 4AM Im called to see two patients in maternity.  So I walk over there with my bag containing my ultrasound and other stuff.  It goes with me everywhere here.  The first patient the nurse shows me is a woman who has her 10th pregnancy and is at term and dilated cervix to 4cm.  The nurse can’t find the heart rate and the mother hasn’t felt the baby move since yesterday.  She’s having some contractions but hasn’t lost her amniotic fluid yet.  So I get out my ultrasound to see if the baby is still alive.  As I look around I can’t find any movement.  Then I see what looks like a still heart.  The baby is cephalic presentation (head first) which is good.  I tell the woman and the father my findings.  They remain stoic.  The nurse tells her to start walking around to help stimulate the cervix to dilate more and we will check her later to see how she is progressing.

The next woman she shows me is a young appearing woman who was in bed under her mosquito net.  She heard a commotion and when she opened her eyes a cobra was under her net in front of her and spit venom in her eyes.  Her husband killed the cobra and brought it in, in a sack.  They washed her eyes and face with water and came in here.  Apparently their cat had been stalking the cobra to kill it when it went into her mosquito net.  I haven’t encountered this before so I was able to have a good enough cell signal to look it up.  So I irrigated her eyes with Ringers Lactate solution until her eye no longer hurt much.  About 20 minutes.  Then I gave her antibiotic ointment and will check on her later today.  I asked the husband to show me the snake so he dumped out the pieces on the floor.  Im guessing if I put the pieces back together it would have been 3 feet long.

Now the sun is up and so am I.  I usually can’t fall asleep again when I go in, in the night anyway.  So I sit here in the cool of my fan, not sweating yet, to write you.

Please pray that God give me wisdom and strength for each patient I see while I’m here and that He give me the words to speak His love to each of them.  And that the devil is blocked from influencing or harassing me in this work.  Thank you!!!!

Bere 5/2025 #1

admin Greg No Comments

Bere 5/2025 #1

I’m back in west Africa.  God and missionaries keep calling me back.  I came with my nephew Zach a nurse who is aiming for med school.  Audrey couldn’t come this time because she had  a recent knee replacement and is still recovering from that.  Not yet the time to run through airports to try and catch the next plane.  Also our dog, Tucker, is getting old and hobbling around and takes more care.  I have had a quite busy last month with Audreys surgery and a variety of things going on that I didn’t end up packing till the day before and day of my travel.  I signed out in the morning to my surgical partner and continued packing then left that evening for Portland to fly out that night.  All the flights were on time and I made all of them arriving in Ndjamena  mid day.  I stayed the night to meet Zach who came in on a flight later that evening.  We got the required police stamp with our taxi driver helping us.  We have used the same taxi guy since coming here at least 13 years ago.  He’s very dependable, drives a 1993 very beat up Corolla, and crams all our luggage under his hatchback that he has to tie down using the wiper blade as the attachment point up top.  I always find this humorous but it works.  We got on the bus to Kelo about 10:30 in the morning.  

Throughout the bus ride of 8 hours we watched the outside scenery go by and also watch the TV screen up front what showed African comedy, some Saudi music sung by very stoic women, and movies they showed like Delta Force. (Basically Americans killing muslims)  Still makes me feel a bit awkward as I don’t want to be associated with that.  I’m pretty sure Jesus came to save muslims too, and Buddhists, and Jews, agnostics, atheists, and you and me… I.e. everyone!! About 6 hours into the bus ride we stopped at the Bongor bus station.  Walked around about 15 minutes and looked at all the things the local vendors were selling.  To many things to mention, but ill list some: grilled chicken or beef, dates, apples, oranges, carrots, fried crickets, crackers, cookies, sodas, sandwiches, lettuce, onions, gum, sunglasses, belts, bananas, on and on…. The bus started honking it’s horn and we all got back on.  Traveled the last two hours then arrived in Kelo.  We pull off in Kelo and at the little bus station I point out the bags associated with Zach and I and also Dr. Eddie who’s bags hadn’t come a few days ago.  Then the taxi Moto guy finds me and we take all the bags to his motorcycle.  He negotiates the trip with two other motos and they load all our luggage onto two and Zach and I with the moto driver I knew.  It’s a two hour moto ride to get to Bere. About 40 minutes into the ride we realized one moto wasn’t with us.  So we stopped and waited, and waited.  Some passing motos said that he was back there fixing a flat.  Then others said he was going, then others say fixing a flat.  After about an hour of waiting our moto driver decided to go back and see what’s happening.  Apparently the roadside mechanic packed the tube.  He drove a short distance and a flat again.  Second time same thing happened.  The third time the mechanic removed the metal out of the tire when fixing the tube 🙂 then, surprise, it didn’t go flat again.  We made it to Bere about 8:30PM.  So traveling from my house Tuesday afternoon I arrive in Bere Friday night.  Long trip.  I ate supper at a missionaries house and we talked a while and I finally got to bed about 1AM.  I awoke at 5AM- jet lag…

Today was sabbath, the day I go to church (as Jesus did).  I wanted to go to the “mango tree church”  I like it because it’s under a mango tree and has lots of kids.  Well they have a new church building, so it wasn’t quite the same.  I got in the back of the truck with Zach and many others.  Held on to the roll bar and it took about 30 minutes to get there.  As we weave through the village we hear little groups of young children yelling “nasara” (white person) and waving.  I wave back.  Near our destination some run after us and jump on the back bumper to ride the last little bit to the church.  It’s a game to see if they can catch up and jump on- at least it appears like a game to them.

I joined the kids sabbath school singing songs under the mango tree and the adults were in the church.  We sang songs like, Father Abraham, God made the animals, and many more, most of which I knew.  After a talk about Jesus growing up and him being left accidentally in the temple by his parents.  We joined the adults for church.  I translated from French to English for Zach.  Church today was about Abraham and him being a man of faith in God.  And how he had lapses of faith when he went to Egypt calling his wife Sarah his sister and later on doing the same thing with the Philistines.  And how God made Sarah have a child even though she was in her 90’s.  And how God blessed Abraham when he chose to follow God even when God asked him to sacrifice the promised child Isaac.  Then God keeping him from doing that.  Summarized Genesis chapters ?8-15.  Was a thoughtful sermon.  This afternoon we had the potluck with all the missionaries and later spend some time at the river.  Had a great first day.  Tomorrow I plan on rounding with a surgeon and learning the patients, then likely start taking surgical and OB call.  Pray that I will do what each patient I see needs, and that God will show me what that is!