Cocky vs. confident on the Moto

I’ve made no claims to anyone that I am a good moto driver. In fact when people ask “Can I get a ride?”

Jessica had to indure my crazy driving.

I reply, “Do you want to live?”

I’ve always been safety first with my driving. It took me 2 weeks to get enough courage to shift out of 1^st gear and another 2 to make it to 4^th.  Even then I was all over the road. The sand and mud had its way with me and I was not pretty. I’ve run into bushes I even ran into a pile of logs with Carlie on the back. It’s kind of like running into a parked car. I was definitely not known for my great driving skills.

But with nothing left to lose why not go for it. All or nothing. Go big or go home.

Thats the face of confidence.

They probably should have gaven me training wheels to start out with but to late now. I’ve come to embrace the dusty sandy roads of Béré. I don’t exaggerate when I say that people scatter when they see me coming.

Recently I’ve decided to put all fear aside and just gun it. I fly over and through sandy pits and over a lot of objects that I should try to avoid but with these new found wings I cant seem to stop flying. When I see a dip I gun it and I hit that bump so hard I fly through the air like Mary Poppins with her umbrella but with a moto instead.

There is no more old lady driving for this girl. No more being passed and laughed at my Tchadian men.

It’s a good thing there are no traffic laws here.

Warning to my mom. Ill be asking for a black Vespa with flames down the sides for Christmas.

Skin… Who needs it?

Rash extends from my wrists to my shoulder.

March 14. It started in my left anterior area of my elbow. Just a simple reddened area. Logical answer would be heat rash. It blazing everyday and I’m constantly sweating. Just put a little baby powder on it for a couple of days and it will clear right up. Wrong. It spread and started to itch.

March 19. Gary and Wendy gave me some powder acid stuff encase it might be a fungal infection. Eww. On my arm. I start that right away. The last thing I want is fungus growing on my arm. It dry’s it out but it still itches and it’s expanding more.

I try fungal spray just to see if it helps Hydrocortisone cream and Benadryl Anti-itch cream. The itch is just to strong.

March 28. I try Calamine cream. The rash is now half way up my upper arm and half my forearm and is in my right arm now and expanding like my left.

March 31. I notice that my left knee and left upper thigh are itching. Olen prescribes Worm meds- Mebendazle, Prozequantil. If a worm starts crawling out of my skin I’m out of here.

Rash is red, raised and extremely itchy. Claw marks on
 the lateral side of my arm happen in my sleep.

April 1. Doxycycline is added to my growing medication list. That night I take a Sleep aid- Benadryl- I slept good and only woke a up couple times to scratch. In the morning when I got up I had claw marks all over my arms. Seems I can’t control my scratching in my sleep. Olen has bane me from scrubbing in on surgeries cause he doesn’t want me to contaminate any of the patients.

April 2. Over night it has jumped to my chest and neck and is creeping its way to my face. Dr. Rollin starts me on a steroid, prednisolone unfortunately there not the type that will make me bulk up.

April 3. I can take just sitting around at work scratching so I decide to take the day off and scratch at home instead. I take a walk and as soon as the sun its my skin it instantly starts to burn and itch. My sweat burns as it runs down my red, swollen, bleeding skin. I’m scanning every book I have trying to figure on what this is. And why nothing is helping. Everything I try makes it worse. That steal wool by the kitchen sink is starting to look pretty tempting but I can foresee it ending in more pain and a lot of blood and plus I need it for dishes so I refrain.

I found a bottle of Cooling Aloe sunburn relief…. You had me at cooling. I smeared half the bottle on my body and at first it stung with all my open wounds but then the cooling set in. Oh ya that’s good stuff.

Rash has reached my chest and neck.

April 24. The rash is still here. My arms are swollen but the hydrocortisone cream keeps the itch at bay. Now my legs from ankle to thigh have joined in. Claw marks that once plagued my arms are now infesting my legs.

April 28. Bronwyn thinks that I have and fungal problem and has given me a tube of fungal cream. Ewww Oh God please not all over my body. I take a shower daily how would I get a fungal infection? I guess ill try just about anything about now.  The itch is deep in my thighs. I have bruises all over cause I use so much force to scratch. I look like I’ve been beaten.

Swollen from scratching all night.

May 7. The itching redness and swelling is still present. Fungal cream didn’t do anything. Spent a couple of hours in the sun while at the river. Being in the sun exacerbates the itching so I’m still holding strong to pseudo-heat rash. I still wake in the night scratching, no clawing at myself. I’ve gone through 4 tubes of anti itch cream. Now I’ve moved onto lavender oil. Which seems to be working the best. Except for the bugs tend to stick even more to my sweaty oily body then usual.

I just need to get out of this heat. Only 9 days and ill be freezing to death in England and wishing I was back in Tchad.

The Attack

May 5 2013

I’ve become sloppy with my mosquito net. It hangs loosely around my bed instead of anally tucked in vigorously with absolutely no means of entry. But after getting malaria 4 times I find it pointless to put so much effort into something that doesn’t help.

I toss and turn all night long trying to find a dry and comfortable position on my thin sunken in mattress.

The moon isn’t out tonight so it completely black out.  Which means the locals aren’t outside dancing in the moon light and pounding on their drums. It’s to quite and it’s making it harder to sleep. As if the heat and rivers of sweat weren’t bad enough.

I’m asleep but a wake enough to roll over again. When I do I feel a sharp poke and what feels like a electrical current in my shoulder. I sit up quickly sleepy and confused but in pain. I place my hands down on the mattress to push myself up and turn in the bed and I feel it again 2 more times in the palm of my hand. I rub it trying to sooth the pain but its not working. First thought is scorpion.

 Then I hear it.  Instantly I’m on high alert mode. I stop and focus my hearing. It buzzing. I cant see anything its too dark and I have only one good ear so it could be anywhere.

The one night I don’t have my torch by my bed is the one night I desperately need it.

Images of all kinds come to my mind but the one that frightens me the most is the African killer bee. I scramble out of bed and search for my headlamp. I locate the bee/hornet in the corner of my net. It not too big. How does something so small cause so much pain? I grab the thing closest to me, my flip-flops and turn them into a deadly weapon. Gotcha.

Now every time I roll over in bed I wait for the sting.

Typhoid Code

April 4, 2013

It happed so fast. I thought she was looking at me. Then I realized she was looking through me. I was watching her die and I didn’t even know it.

It was the end of a long day when Olen pokes his head into the Bloc and says “I had to search high and low but I think I found a case of appendicitis”. It had already been a long day with two thyroidectomies. But the thought of blood and pus gave me a second wind. Weird, I know.  

     

It took about 4 tries for the student nurse to finally get an IV started. The only information I had on the patient was that she had pain that started in her right lower quadrant yesterday and was now radiating throughout her entire abdomen. Looking at her abdomen it looked tight and swollen.

After Dr. Rollin exams her the diagnosis changes is ectopic.

1625 Simeon gave the spinal and we wheeled her into the OR. I hooked up the blood pressure cuff and the 02 monitors. Both read at 000. I open her fluids wide and start prepping her for surgery.

She was moaning in pain and I was praying the spinal would take her pain away.

Within the 5 minutes it took me to prep her I noticed that her stomach looked bigger. Blood? Gas? Poop? Pus?

Both monitor are still reading zero. Typical equipment here. Never works when I really need it too. She’s looking around and grimacing and talking so I disregard the monitor for now. Rollin and Jon (medical student from Loma Linda) come in and starting draping the patient. Monitors still reading zero. We pray and start the surgery.

1640 Once we reach the inside of the abdomen pus start spewing out. Suction! Pus is followed by a lot of poop.  Perforated Typhoid is the official diagnosis.

Finally the monitor starts reading BP 42/26, Pulse 49, 02 89. The fluids are all the way open. I cycle the machine and it comes up zero. I decide that a second line couldn’t hurt but I’m momentarily side tracked.

I’m holding the patient’s head still cause she keeps thrashing around. When suddenly she stops. She’s looking right at me eye wide open. I’m taken back by the intensity of her stare. I wave my hand in front of her eyes. Nothing. 

Madam! Sa’va?

1650 The O2 monitor starts beeping loud and fast. Ndilbe and I look at each other then to the monitor. 51%! Crap! We both react together. He gabs the Ambu bag while I thrust her head back and open her airway. I position the mask and he starts pumping. Olen walks in again “ Oh, that’s not good.” He takes over bagging and gives instructions. Surgery is stopped. Jon is starting chest compressions as I draw up medications.

Chest compressions.

“Pulse?”

“Weak”

“Atropine”

Simeon rotates in with chest compressions.

“Stop”

“Pulse?”

“Weak”

“Epinephrine”

Jon with compressions.

It continues….

1720 We call the family in to explain the situation. Right in the middle of telling the family that the patient was not responding and is not going to make it.

“Strong pulse!”

Olen stops talking to the family and tubes her. I check placement.

“It’s good.”

“Why is there fluid in the tube?”

The balloon broke. We tube her again. Pulse is gone

1730 time of death

We cover her with fabric. Place her on a metal stretcher and carry her through the hospital grounds, through the TB area and out the back of the hospital to a small building I’ve never seen before. I’ve never carried out a dead body.

We come to a small brick building and we stop. All three men look at me and I know that this is not a building that I want to discover. That’s where they keep the dead bodies till their families can take them home.

Stories that make it all worthwhile

Moussa (Left) and his brother

Moussa Mahamat and Ahmat Mahamat are brothers from the village of Abeché. One of the northern villages next to Sudan.

Moussa the younger of the two brothers was a bricklayer and was walking to work one morning when something stung him. He says he didn’t see what caused him the pain. A week later he was unable to walk. His brother described him as crawling around on the floor like a baby. 10 days after he was stung he went to the Adventist clinic in Abeché and an American Anesthetist who has been to Béré in the past referred him to our hospital.

So with all the money they had they began there 1,400 km journey to Béré.

When they arrived at our hospital on February 15^th the carnet said:

My first look.

13/2/13

10 days after right foot wound, progressed to dry gangrene. Loss of all function and sensation below right knee. Pain felt from knee to groin otherwise no complaints.

Dr. Rollin and Danae operated right away. They preformed a Above the knee amputation (AKA).  They described his leg as wood. They didn’t think that he was going to survive to make it back home.

Starting on 2/19/13 it became my responsibility to change Moussa’s dressing everyday.

My daily task.

I gave him 250mg of ketamine before each dressing change. The first time I unwrapped his band and removed the gauze that was packed into his leg I thought this is never going to improve.  There was dead tissue, pus and some sort of slime oozing out. I stood there for what seemed like forever trying to decide where to start. When the all-inspiring Olen gave me the gracious words of wisdom “Be aggressive”. Now that I can do. I got my forceps and scissors and went to town taking a little dead tissue off here and there. Flushing it with a bleach water solution and rubbing vigorously. I repacked it with a lot of bleach water compresses and a new band. Just in time for his ketamine to start wearing off. I was satisfied with the end result and but it was no where near where it needed to be.

So everyday I did the same thing and slowly the infection improved all the dead tissue was gone, It was beefy red and filling in. I don’t know if a open leg amputation can be pretty but from what it once was this amputation is hands down beautiful.

The finished product. Infection
free and ready to go home.

 On March 7^th we took him back into the operating room and closed him up and placed a Penrose drain.  And on March 28^th he was discharged.  Happy and healthy.

Zenabou (Middle) with her parents.

Zenabou Issa a 20 year women from Achaua which is about 200km north east of Béré on the opposite side of the country came to us on February 27^th. Her and her parents had traveled all over the country seeking help.

Sometime in January Zenabou went to a local trained by the Red Cross who go through a 3 month training course about health and medications and then are certified by the Red Cross to prescribe and give medications. She was sick so the medical man gave her a IM injection of Benzathine Benzylpenicillin in both arms. The dosage is unclear to me and what she was sick with is also unknown.

The next day her left arm was swollen and within 6 days it started affecting her left eye. They traveled north to a health center in Mafili where they stayed for 40 days and the only treatment she got was antibiotics (Flagyl, ampicillin, Gentamycin). Next they traveled southwest to a district hospital in Bangor which is just north of Béré. In Bangor they spent 10 days there. The local doctor there told her that he could only amputate her arm at the elbow even though the infection went all the way up to her shoulder. Any higher then that and she would die. So they headed back home to Achaua. When they arrived back with no success a friend of her fathers told them about the Béré Adventist Hospital and how good it was. So they made their way.

When I walked out of the Bloc to search for Zenabou Issa I had no idea who I was looking for. I didn’t know what I was expecting but after 15 minutes of calling out her name and people pointing me in all sorts of directions I finally came upon a frail women curled up in a ball on the ground under a tree. I took one look at her arm and wanted to cry. Her hand and forearm were black and it reminded me of a mummy her upper arm had no skin at all. It was pure muscle that was exposed. And by now she was completely blind in her left eye.

The surgery was quick. I assisted Dr. Rollin in disarticulating her shoulder joint and shutting off any bleeding. She was given PCM, IBU, tetracycline, cimetinine, cipro and Amoxicillin. For pain and infection

Dressing changes everyday.

Everyday she came to the bloc for dressing changes. Unlike Moussa she did not get ketamine. She endured the pain.

On March 25^th we did a skin graft. Taking two strips from her very thin left thigh.

10 day later the much anticipated reveling of the graft site is here. I’ve been praying constantly for the graft to take and it did.

The graft took!!!

Dr. Rollin and I "Meshing".
(Putting holes in the graft skin)

On April 14^th she was discharged.

Just giving Florence Nightingale a run for her money.