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Bere 5/2025 #10

A MIRACLE! Thank you God!!!!  

I attend the morning worship and concentrate on listening to the one translating into French.  He reads a worship thought from a book called the Desire of Ages, a book about Jesus.  At least that’s I think what he’s reading from.  All the book covers here look different than ours so I’m not sure.  As I listen to the worship thought, daily life is going on past me on the other side of the fence that is around the hospital.  Horse and cow drawn single axle carts go by.  A small pack of dogs bicker with each other.  A young man appears to be harassing a woman who then picks up a small switch and goes after the young man.  Everyone is laughing except the woman who must at least be insulted.  A moto taxi pulls up with a couple people on it, bringing them to the hospital.  I find it hard to concentrate on the message as my brain is all over the place.  

After worship there isn’t any meeting so I go to the OR and tell them Im ready to work.  I do this to help them get going, otherwise they linger and do whatever else they do in the morning.  Like talk to a patient that is a friend and gab a while.  I also go by the surgical ward and tell them Im ready to round.  This gets both locations going.  But I just stand around waiting in the surgical ward.  So they get going.  The dressing cart is prepared faster and Emma changes from his street cloths into his scrubs and we start.  I see all the patients Ive already told you about.  The guy that was gored by a cow horn is better but is complaining of pain on his side where he was gored.  Some pus is coming out the drain I left.  But as I look with a flashlight at his dark skin, I realize he has some dead looking skin on his flank.  It looks like he was burned.  I asked the family and they decline knowing anything about it.  They’ve been very attentive to this man.  There are at least two people fanning him day and night.  It’s nice to see them so engaged.  I’m not sure what to make of it.  I wish I had a CT scan…… and so many other things to diagnose him further.  He’s still eating some boui (porridge) and pooped yesterday.  Great signs. I’ll keep an eye on that spot.  I leave most of the dressing changes for the nurse to do.  The next one is a woman who is a sister to Emma.  She had a thyroidectomy and we are certain the recurrent laryngeal nerve was cut which was repaired and would make a person hoarse.  She seemed hoarse the first day and now her is clear!   It’s a miracle!!!!  I’m excited to share this with the one who did the operation.  It has been many stress filled days of knowing this woman will be hoarse for months or permanently.  BUT SHE IS HEALED!!! We have been praying for that.  Thank  you God!!!!  We pray for so many people to be healed of physical or spiritual things and I don’t understand why it happens like this some times and other times it doesn’t.  But I’m so grateful to see healing when I do.  Later that day I share it with the surgeon and we just sit in the moment of relief and thanks to God!

Back to the OR and they aren’t ready yet.  Phillipe is concerned that we are starting a long difficult abdominal surgery and since the generators have been cutting in and out the last many days- is it safe to do this surgery.  He mentions that there is a generator specifically for the OR that hasn’t been started in about a year.  Could we make sure that one is functional first.  I think that’s a good idea.  So I ask Dr. Andrew how to arrange that, he makes a call then goes off to find out.  As always, missionaries, have so many different tasks to manage, and are pulled in so many ways.  It would be so much less stressful, if we were able to only stick to what we know- medicine….  So we prepare another patient in the second OR.  This one is a TURP (transurethral resection of the prostate).  We figure if the power goes out we can stop that surgery in the middle if we have to.  He is also known to have a large stone in his bladder too.  So the first patient waits all day and we never do get the go ahead from a generator standpoint.  So he is postponed till the next day.  The prostate is slowly shaved off using that same method I described in my last email.  Only this time each movement I make is bumping against a bladder stone.  If feels large, but then again, everything is magnified in this cystoscopic image.  It takes us a few hours to complete the resection of enough prostate so he should pee well.  We search many times for the ureters and never find them.  Thats a crucial part of the surgery.  So we are continuously bothered by that.  We need to see them and protect them.  But the stone has created so much inflammation we can’t identify them.  So we stay more in the middle where we know they aren’t.  After we decide we’ve done enough for the exposure we have. Then we transition to the surgery on the abdomen to remove the stone.  After going through all the layers of the abdomen and bladder, I try to grab and pull out the stone.  It is large and I have to enlarge my bladder incision twice before I can pull it out.  It is about 2.5inches wide and black with lumps all over it.  Each bladder stone is different and this is unique in it’s color and shape.  Wow, that must hurt being in there, and have been in there a long time.

The next patient needs a foot debridement.  No one in the room really understands her language.  So what I hear is she was normal 4 days ago then she an infection started.  I take off the cloth she has wrapped around her foot and the whole top of her foot is dead.  Dead skin and pus everywhere. (I’ll attach pictures).  Zach and I use scissors to cut away all the dead stuff till we get to bleeding, live tissue.  It smells awful!. We chip away at the dead stuff till it looks much cleaner but I’d be surprised if she doesn’t need a foot amputation.  I bathe the food in Dakins solution and then put wet dressing.  Ill check on her in the AM to make sure her infection isn’t getting worse or one of the rapidly progressing necrotizing infections.  Later in the night I’m in seeing another patient, and I see her leg is already less swollen than it was at the time of surgery…improvement.  I’m grateful!  Thank you God for the improvements I see in our patients.  The others are so hard to see and it’s great to see the good ones.  God give me strength for the bad outcomes too.   Amen

Bere 5/2025 #9

Monday is usually a busy day.  I’m called to see a woman at 2AM who isn’t progressing in labor.  It’s the nurse I don’t have confidence  in so I’m not sure if I should start Oxytocin or not.  Unfortunately I awaken Dr. Staci and ask her.  She thinks it’s less risky to just wait till morning.    At 7AM I’m in worship when the nurse finds me again and says I need to see the same woman after worship.  I go there and nothing has changed.  Dr. Staci comes in and we decide after watching her contractions and how the babies heart slows down with each contraction and takes a little while to improve- that we should do a C-section.  So we find the husband who is avoiding us, because he doesn’t want to pay for anything, to go and get the lab work paid for and so we can proceed.  We keep telling the woman not to push because it hasn’t made a difference all night.  She can’t or won’t stop.  Looking between her legs suddenly the baby head has dropped down and is on its way out.  With another push the child is on the bed and crying.  Yay! She didn’t need a C-section after all.  Thank you God!

One of the first operations today is a TURP- transurethral resection of the prostate.  I’ve always done Friers prostatectomy.  Andrew was learned to do TURP and so I watched him set up the complicated thing then using the TURP wire, it it a loop of wire, it shaves off a little trench in the prostate and then the same loop cauterizes. Then another trench of tissue and cautery of the bleeding.  He showed me the landmarks to use and had me do quite a few.  It is a neat way to take care of excess prostate.  But I think I’ll need some more training on landmarks to be certain where to do it and where is deep enough.  We worked on shaving off pieces for a few hours.  When we were done it seemed like a bloodless field and we left a foley catheter in place.

There were many clinic patients to see so I headed over to the next building.  Now a day later, can I remember what I saw? Only some of them.  I saw the teen with drainage coming from a previous fracture site only in the rainy season- 8 months ago, maybe a sequestrum, but definitely not obvious.  I could see something on the X-ray.  Told him if it starts draining again, to come back then.  Rain started and it was a downpour.  Rained for a while and cooled everything off, even through the evening.  Another patient in clinic was an older woman with body aches, saw a few with bladder stones on ultrasound who couldn’t pee well and were set up with orders for a stone removal surgery and sent to the pharmacy to pay the equivalent of about $40 for the surgery.  By the way, some of you sent me with some money to use here.  They have an indigent care fund, and that is what the money went towards. Other patients I saw were a kid with a huge splenic cancer I could see on ultrasound.  Another was a pastors wife with one of the largest spleens I’ve ever seen.  Covered her whole abdomen, except for a small portion of the right lower quadrant.  Spent the whole afternoon in clinic.  When I was done and walked out of the building- what a refreshing feel.  It was a cool 75 and smelled like it had just rained.  Other than being awakened by a call at 3 AM, I slept quite well that night!

Bere 5/2025 #8

Sabbath was a peaceful day.  Dr. Andrew took his kids to the “monkey forest”  and they saw monkeys pretty close early in the morning.  I had a peaceful morning and then rode the big motorcycle to church with Zach on the back.  I went to the same church as last week.  It was unbearably hot with rain clouds all around but no rain at potluck.  Some people went to the river again and that was what I was hoping would happen.  I was cooler than the air and lovely to lay in the shallow brown cow poop shistosoma filled water.  In the evening I hung out with some missionaries and talked.

Sunday AM I am awakened about 5AM for a woman who has had 5 babies and all of them died during labor.  Her last one ruptured the uterus.  This one doesn’t seem to be progressing.  So I go in thinking she likely needs a C-section.  This nurse I remember I haven’t had much confidence in, in the past.  I see that the babies head doesn’t descend much during a contraction and I ultrasound the baby.  As I watch another contraction I see the heart rate slow down and it stays slow after the contraction.  Fetal distress.  I call in the team for an emergent C-section.  The maternity nurse brings the patient to the OR and we get her ready as Phillipe gets there.  It seems to move along faster than normal.  She has a previous scar on her lower abdomen from the uterus repair before.  It seems like a keloid (thick and large and hard), so I excise the previous scar.  Her scar tissue is pretty dense. After opening the muscles I find the bladder quite stuck and I can’t even drop it down out of the way.  I imagine this is because of the previous site of rupture and scaring.  So I have to make a higher transverse incision on the uterus than normal.  I reach into the uterus to grab babies head and it is wedged into the pelvis.  I work my fingers hard to try to get around the head to pull it back up.  It’s real hard to get my fingers around it then the suction of the pelvis holds my hand there, finally a bit of air goes around my hand and the suction is broken and Im able to pull up the head.  The baby is floppy.  And since I don’t trust the nurse I keep the baby on the wound in front of me for a little bit and get him breathing before handing him off to her.  The closure of the abdomen is uneventful and after about 5 minutes her and the anesthetist working on the baby, he’s breathing well.

The next patient we are suppose to do is a liver abscess but the power went out again.  This time I think they’re filling the generator.  They have two new generators that they say have oil cut off sensors that are bad?? Unlikely on a new generator.  More likely poor oil amount or quality.  So since I don’t have power I go to make rounds.  I take my headlamp and see all my patients in about an hour.

I go back to the OR and about then the power comes back on.  So they bring the patient in and I decide to ultrasound his liver to decide whether I’ll do it with a pigtail drain or open drainage.  There is no abscess.  I check the paperwork and it says a bladder stone on the ultrasound.  Is this the patient in bed 9 with the abscess?  Yes.  The anesthetist steps out to find out more.  They come back with the correct patient who’s been out under a tree so some other patient took that bed.  Ultrasounding the correct patient, I see there is a deep abscess in the posterior liver up near the diaphragm and heart.  OOOhhh.  If I miss the direction I could stab the heart and kill him.  I think about not draining it.  But it won’t get better without drainage and in the posterior liver, draining it with open surgery will be nearly impossible too.  So decide to put in a spinal needle in the direction I think I should go and watch on ultrasound.  I get right into it.  So I take the much larger pigtail catheter and feed it in till I see the tip in the middle of the abscess.  I withdraw about 80ml of pus.  I flush it with saline and attach a bulb for suction.  

The next woman is HIV positive and has had abscesses all over her chin and neck from tooth decay and infections.  She has a remaining hole just above her sternum that when she coughs or lifts something- pus drains down her chest from the hole.  I decided this must be a retrosternal collection.  So I numb her up and open the hole to probe it further.  I worry about wether the internal jugular vein has been pulled or displaced by scar tissue- will I get into significant bleeding that is difficult to manage.  I open a small amount at a time.  I probe the pocket with an instrument and feel that it’s not to big.  I had hoped to get my finger in, but I stop as Im not in bleeding and down want to cause it.  I put a piece of glove in as a drain and put a dressing.

There are not many cases scheduled on the weekend so we are done.  I head over to another missionaries house about 10 min drive away on a motorcycle. Unfortunately and fortunately they are just ready to have a late lunch.  So we are invited to eat.  We have a nice meal together and I spray the areas of their house they want sprayed with the insecticide I brought.

Back at the hospital I make it back in time to be a part of a party for one of the Cameroon missionaries here.  Two of the families here made cake- and they taste real good!  We take turns commenting on how we appreciate the person who’s birthday it is.  It think this is a nice way to party.

Just at the end of the party there is a call for a woman who isn’t progressing in labor and has a face presentation.  Normally the back of the head is the presentation part an this comes out easier.  The face is to broad and doesn’t deform like the rest of the head for a vaginal delivery.  We wait for the generator people to put in fuel as the power just went out.  Then she starts bleeding vaginally.  Now it’s an emergent C-section.  We pour in the fluids and get a spinal in the dark by headlamp.  We can’t wait for the power to come back on.  We must get the baby out as soon as possible.    She may have placental abruption (separation of placenta from uterus that will kill baby and make mom hemorrhage a lot).  As soon as the spinal has taken effect quickly cut into the abdomen, down to the fascia.  A quick cut and scissor of the fascia and separation from the rectus muscle.  Move the bladder down out of the way then open the uterus.  I immediately get some clots.  I reach in and fish the baby out.  He looks weak but starts little breaths.  The midwife is there to receive the baby and she takes her, and starts working to get the baby breathing well.  I close the uterus as fast as possible to help staunch the flow of blood mom is loosing.  Then tie off some other bleeders.  Mom is getting a transfusion at the same time.  God help this mom and baby!  I hear the baby start to cry- what a joyous sound!.  The power flickers back on for about 1 minute then fades out again.  Sweat is pouring in rivulets down my back and legs.  I slowly close up the different layers irrigating between each layer.  Mom has stabilized with more blood and all I feel now that my adrenaline is less- is HOT!!  After we are done and wheel the patient to maternity, the slight breeze outside is sooo refreshing.  The power takes a while to come back on.  More plastic bag in the generator fuel lines I hear.  Eventually the power comes back on and I’m able to sleep. Till 2AM when I’m called again.