Malaria Round Two-Carlie

I came down with malaria and round two was a lot worse than the first time.  I woke up around one in the morning because I was so cold.  I was shivering violently and have to get my sleeping bag out for added warmth but it didn’t help.  I checked my temperature which was 102.5 F.  I also had the worst body aches I have ever had.  I hurt everywhere.  I tried to take some Advil to bring my fever down but started dry heaving and couldn’t keep it down.  By three in the morning my fever had reached 104.4 F.  Saying I was miserable doesn’t describe how I felt.  I tried to take some Advil again at this point and succeeded in keeping it down. By six in the morning my fever had dropped to 102.2

Athens then talked to Jamie and he came and drove us to the hospital.  My malaria test came back positive with a result of 0.25% which was higher than my last case of malaria with a count of 0.05%.  Talking with doctor we decided to IV quinine since I was nauseated and having trouble keeping pills down.  Athens and Bronwyn took me over to Urgence to get and IV put in.  They ended up putting an infant catheter in because my veins were so small.  But by then they had stuck me about 3 times.

I was then brought back to the house where I laid in bed for the next three days while I was on IV quinine.  I don’t remember much for those three days because I was basically passed out in bed.  I would only get up to use the bathroom.  Athens would stay with me during the morning to monitor my IV drip then when she would go to work Bronwyn would come over and stay with me.  We had had to go down to the hospital twice because my IV infiltrated and we needed to get another one put in.  The only good thing about my IV infiltrating was that it prevented my veins from hardening from the quinine.  Quinine might help treat malaria but it is poison to your veins.  After finishing IV quinine your vein is tender and sometimes becomes hard.  You also develop temporary hearing loss.  You feel like you are underwater and are listing to people talking above you.  Your hearing returns once you finish taking the quinine.  It was frustrating not being able to hear. 

After my three days of quinine I was put on oral quinine.  By that time I was feeling a lot better.  My fever had gone down and my body aches were gone.  I just felt very tired. Malaria is hard on the body, and all you want to do is sleep.

 I hope that if I do develop malaria again while I am out here that I will be able to take Malarone for treatment.  Malarone does not have the side effects that quinine does, and treatment is only for three days.  But you have little choice on the matter if you are throwing up and can’t take oral pills.  That’s when you are put on the poison IV quinine. Se pa bon!!

Living the dream. The Missionary nursing dream that is.-Athens

                I’ve finally done it! I not only got to meet the man that inspired me with his book “Nasara” by to be a missionary I got to work with him for a whole four days.

 Dr. James Appel books was a huge influence on mine and my families decision on coming to Tchad. His book is inspiring in how he was able to learn and adapt to the eviorment around him and to see the problems that we there and try to fix them instead of looking passed them like many other before him had. He also had a great time while helping people in one of the most remote third world countries and he also found LOVE. Romance is always a winner in my book.

                Coming to Moundou I had no idea what he had in store for me. I just said I was willing to help in any way that he needed. So straight to the OR I went. I was able to watch him in action and ask questions along the way. I wasn’t expecting to get to involved cause I’ve never been a part of a surgical team before but what better way to learn then from a great teacher like Dr. James. Oh the excitement is almost too much. But I’m a grown women and a professional so I’m going to act like one. But inside a gitty teenager.

                The first surgery I was able to watch was a urethral stricture repair. His bladder was the size of a grape fruit and had a history of difficulty peeing for the last 6 months. When they opened him up and placed a catheter they found that there was no stricture but he did have puss gushing out from his ureter. So essentially he has an infection in his kidney. Why that caused him difficulty in urination I have no idea.

A lady with a Above the knee amputation had necrotizing facites. The wounds on her leg were bluish green with a rank smell. I watched has Dr. James cut off dread skin from the wound.

Then it was show time. He let me assisted him in amputating a man’s right testicle who had a hernia repair but developed internal bleeding and now had a hematoma in his scrotum. While he did the cutting I watched in Aww as this mans cantaloupe size scrotum poured out blood. Huge clots come and then came the kicker he took the scalpel and with  a few quick slices…. There was one.

Dilation and Curettage.  I’ve seen one of these in the states. It usually takes about 10 minutes to perform using the proper equipment. Here we do everything by hand. While I held the speculum in place and Dr. James scraped what was left behind from her miscarriage. If anything is left behind it can cause bleeding and infection. Blood was splattered all over my arms and feet. We spend almost 2 hours trying to get it all out.

I was able to scrub in a cesarean birth on a woman with twins who had preeclampsia. What!? Me!? scrub in…um YES Please!!! I’m looking all professional all gowned and gloved standing opposite Dr. James. He had to give me a stool to stand on so I could see the top of the table. It happen so fast cut….fluid rush….baby one out….Suction…..baby two out…. Suction…..placenta out…..clear out blood and clots…..close….Done. WOW! Rush!

When I wasn’t watching or assisting in the OR I tried to find other ways to be helpful. I worked with the laboratory and helped with blood typing, HIV and Hepatitis B testing and placing IVs.

When surgeries were completed early and there was nothing else to do I decided to have an adventure so took a leisurely 2 mile walk from the clinic into town to the market. I was so excited to see a paved road and actual building. Probably not the best idea being a lone female and not knowing much French but I don’t like to sit still and this town is so much bigger then Béré so I had to explore.

Friday came and as much as I loved the experience of working somewhere new  I was finally ready to go home to Béré. I was lucky enough that Augustine the Béré Hospital Administrator was in Moundou at the time and was able to give me a ride back. I had to take a cuando (moto taxi) to meet him and half a mile away from my destination the moto breaks down. Just my luck.  And of course everyone from a mile away wanted to come see the white person stranded. I had to push my way through the crowd to flag down another moto to take me the rest of the way.

The truck is a old rusted loading truck and is falling apart but it runs and that’s all I need. The road back is bumpy and hot. We get stuck 3 times!! The workers had to unloaded all the cement they were hauling each time to decrease the wait to we could push the truck. I probably didn’t help much but I like to show those Tchadian men that American women aren’t wimps. By 9:30pm its dark outside and we are 18 km away from our destination and I’m the only female and with 10 men. Thank God for Gary. He drove the distance to save me

Another African adventure but not the ride home I was hoping for but that’s just life in Tchad. I think God might have sent me here to test my patience.  

Merci- Carlie

I never thought I would see her again and didn’t want to. I wanted to forget that awful night in the OR, but it seemed that I wasn’t meant to forget. And I couldn’t seem to block the horrible memory’s that came rushing back when I looked into her eyes. She lay on a mat underneath a tree at the nutrition center.  I could hardly tell it was her, she was skin and bones with eyes so big they seemed to jump out of her face.  But in that those eyes I saw the pain, the sadness and the hopelessness that I know she feels.  I know how she feels because I was there two months ago in the OR, and felt her pain.

When I first got here I worked nights in maternity delivering babies.  It was exciting and scary experience. I don’t remember when she came in, but I remember it was soon after I got to work around 2100.  She came in after laboring at home for a couple days and not delivering.  We listened but couldn’t find a fetal heart rate, so the physician was called.  After confirming the baby was indeed dead it was decided that we would use the forceps to deliver the dead fetus.  What should have been a quick procedure turned into a couple of hours.

 I can’t and don’t really want to put to words what I saw.  It was a traumatic experience for everyone there. There were two physicians, two nurses, and a dentist in the room.  I was monitoring the IV and holding her left leg up.  The other nurse was holding her other leg while the dentist was handing out supplies while the two physicians tried to pull the dead fetus out.  But the fetus wouldn’t come.  No matter how much they pulled or tried to rotate the head the fetus would not move.  The head was too big for the birth canal, so it was decided that the fetus head would have to get smaller.  The only way to do that was to make an incision into the fetus head and drain out some of the fluid and brain tissue.  There was so much blood.  After the incision was made I watched as white particles I can only guess that was brain matter start to mix with the blood splattered on the cement floor.   Even after the fetus head was made smaller, it was difficult getting the fetus out.  It was a hot and sticky night, but standing under the bright lights of the OR made us all sweat profusely.  Soon we were all drenched in our own sweat.  I am not one to become squeamish from the sight of blood, but I had never seen so much blood.  It covered the cement floor at the end of the operating table.  Blood covered the physicians’ feet and was soon splattered on mine. I began to feel light headed and nauseated.  I was so hot and sweaty.  Sweat was running down my face and neck. When I couldn’t take the sight of all the blood, I would turn and look at her face as she lay there on the table.  I could tell she was sad, exhausted and in pain, both physically and emotionally.  With one had holding her leg up I reached up and grabbed her hand.  I wanted her to know how sorry I was, and that she wasn’t alone. I tried to share that all by holding her hand in mine.

Finally the dead fetus was delivered.  It was a little baby boy.  The father came in with a cardboard box and took the baby away.  The next hour was spent trying to stop the bleeding.  There was so much blood on the ground that it began to make a stream and flow into a drain in the cement floor.  At one point I had to step outside. I knew that if I stayed a moment longer I would either faint or star crying. I was so light headed, and even blinking furiously didn’t clear the moisture from my eyes. After five minutes I dried my eyes, splashed water onto my face and neck and walked back in.

The physicians got the blood stopped and she was moved to the maternity floor.  I always feel bad for the mothers who have lost their babies that are put on the open maternity floor.  There they lay in bed surrounded by other moms with babies in their arms when they have none.

I left work that next morning in a haze.  The scene in the OR running through my head, over and over again.   I couldn’t seem to stop the images that appeared or the look in her eyes as she lay on the operating table.  When I got back to the Roberts house everyone was eating breakfast.  I couldn’t eat, and instead went to take a shower and go to bed.  I couldn’t stop the tears from coming, and cried myself to sleep.  I didn’t even know her name, but I wanted to try and forget her.

But two months later here I was staring at the face of the women on the operating table. As she looks at me I briefly wonder if she recognizes me.  If she does she does she doesn’t show it.  Her name is Merci, which means “thank you” in French.  I am told that after her baby died, the horrible birth that I witnessed that she went home and didn’t eat.  No one knows if she chooses to not eat or if for some reason her family wouldn’t feed her.  But she was brought to the nutrition center to regain her weight.  She looks like a Holocaust victim, a skeleton brought to life.  As I help hold her head up while I feed her, I tell her in English how sorry I am and that I am praying for her. I know that she can’t understand me, but I feel better saying the words out loud.  I grab her hand and give it a squeeze, and once again my mind wonders back to that horrible night in the OR.  But this time I don’t block the memories, or try and forget. And that’s when I realize I wasn’t meant to forget, but in some small way contribute to helping her heal. I give her hand another squeeze wanting her to know that she is not alone, as we continue to sit together on the grass mat under the big tree enjoying the sun and the cool breeze.

The Amazing Properties of the Citron

We have eight citron (lime) trees on our property in Bendale.  Both Athens and I have begun to put lime in lots of our foods from curry, pancakes to popcorn. The Chadian people eat the limes like oranges but I have no desire to destroy the enamel on my teeth so I do not eat limes like the Chadians.

With eight trees we have more than enough citron, so one day I brought a bag of citron with me to work to give to the other nurses.  I was working with Hamadu that week in Urgence and when I offered him some citron he took only one.  I tried to convince him that I had plenty and to take more but he only wanted one.  I asked him if he didn’t like citron and he replied that he did but he only could have one a week. Por que? (why) I asked him.  And he told me that he could only have one citron a week because citron killed sperm.  Do you know how hard it is to keep a straight face when someone tells you something like that!! Holding in laughter hurts!!  He seemed oblivious to the fact that I was about one second away from laughing in his face and he continued to explain to me why he could only take one citron.  He told me when he was young and he didn’t love a woman he could eat many citron.  But now that he is married and loves a woman he must only eat one citron a week. 

Well I didn’t want to prevent him from having the 12 kids he wanted so I didn’t force another citron on him.  I didn’t want to be labeled as a sperm killer either.  After this very education talk from Hamadu of the dangers of eating too many citron I had to step outside.  I am proud to say that I made all the way to the dentist office where some of the SMs were hanging out before I dissolved into laughter.  It took me a few minutes to get my laugher under control so that I tell the SMs why I was laughing so hard.  Where did Hamadu get his information from!!??  I could have stayed there and tried to tell him the truth, but decided against it.  He probably wouldn’t believe me anyway.  And I don’t think I could get through telling him he was wrong about citron killing sperm without laughing.  If the Chadians are using citron as birth control it’s no surprise that they have so many kids.  It’s obvious that the birth control method is not working, or maybe the men are not eating enough citron per week!!

Discouraged- Carlie

 I am a nurse in the Béré Adventist Hospital in Chad Africa.  But there are days where I don’t feel like a nurse and I just want to give up.   I want to scream and yell at the parents of my patients, then walk out the door without looking back. I want to take their child from them, and tell them they are unfit to be a parent.  But if I did that for every child, soon I would be running an orphanage.  And really could I do much better than them with what they’ve been given?

Chad Africa is a hard place to live.  With death being so common, “survival of the fittest” is underlining attitude here.  Parents have lots of children because many of their children will die before reaching the age of two.  More children means more mouths to feed, but also means more help in the fields.

Working at the nutrition center and seeing so many malnourished children I couldn’t understand why they were not feeding their kids.  The parents didn’t seem to be lacking in food when you looked at them, but their child was skin and bones or plum with edema from lack of protein.  It’s so hard not to jump to conclusions and judge these people.  The kids could be getting food, but because of parasites they might not be getting the nutrition they need.  Also malaria can cause kids to lose a lot of weight and they might not be able to gain the weight back after having malaria.  But we also had a ten year old child at the nutrition center that weighed 8 kilograms and was so malnourished he couldn’t walk; all because his mom wouldn’t feed him.  Apparently she was mad that her husband for loving his second wife more and took her anger out on her son.  How can a mother do that to her child?  How skinny does the child have to get before they seek help?  What is stopping them from getting the help they need, especially when the help is free?  I just don’t understand.  I can’t describe the feelings of holding a child who is so skinny I can see all his bones, and knowing he is going to die and there is nothing I can do.  Though yelling at the parent might make me feel better it accomplishes nothing.  So I accept the death of yet another child.

The other day when I was working in Urgence we had a 5 year old child come in with his parent, and the child was diagnosed with malaria.  He had a temperature of 40 degrees Celsius and a malaria count of 0.25%.  Even after knowing this the parents wanted to leave.  We told the parents that the child would die if he left the hospital and didn’t get the treatment he needed.  His high fever would cause convulsions and most likely his malaria would turn into cerebral malaria without treatment.  But still they wanted to leave.  Thinking that money was the issue we obtained a free form for them so that their entire hospital bill would be paid for but even then they still wanted to leave.  It took us a good half an hour to convince them to stay so that their child could live. What is wrong with these people?  Why did I have to convince the parents to stay in the hospital so their child could live?  I was so angry at those parents.  At one point I left the parents with Alexis (the Chadian nurse I was working with) because I was so angry I was afraid I would start screaming at the parents, or burst into tears.  You shouldn’t have to convince parent to let their child live.  They didn’t deserve their child and shouldn’t be parents.  I just don’t understand, isn’t life precious? How can you live with yourself knowing because you did nothing your child is dead?

I had a family bring in a boy who ten years old and unconscious into Urgence.  The parents had come in on October 4^th because the boy had a high fever and wasn’t eating.  He was diagnosed with malaria with a count of 0.40%, which is high.  The parents left the hospital, taking their child home without getting him treatment.  Now four days later on October 8^th they return with him, and he is unconscious having developed cerebral malaria.  The family around the child’s bed looks at me like I am going to save their child. As if I, Carlie Munroe have the power to cure him of his malaria. They don’t realize that he probably won’t make it through the night.  They are crying holding his hand, but all I want to do is yell at them.  I have so much anger; I know the minute I start yelling I won’t stop.  So I hold it in and say nothing.  Why didn’t they get him the treatment he needed on the 4^th when he was diagnosed with malaria? Why are they here now four days later?! They act so sad, but this is their entire fault!  Their child will die because they didn’t get him treatment when he was diagnosed.  I want to yell at them and tell them how he will die because they didn’t get him treatment. I want them to realize that this could have been prevented!  But I don’t say anything; I hold my anger in check.  Instead I put an IV in and start his malaria treatment; knowing that it will not help.  He will be dead by tomorrow.

I am a nurse in the Bere Hospital in Chad Africa.  But I feel so useless at times.  I realize I can’t save them all, but it doesn’t make it any easier.  I have lost count of how may children I have seen die, how may I have held I my arms knowing death is inevitable.  Death is like a shadow here in Africa, always right behind you, and it is wearing me down.  I am so weary and my soul feels tired.  I have long since stopped crying over all the death I see; my tears have all dried up; there is none left.  I pray that God will soften my heart, but I feel like my heart has turned to stone.  I know if I let myself cry, that I won’t be able to stop.  So instead I pray to God for the strength to go one for another day, and remind myself that God’s heart is not made of stone.  That I might not be able to cry, but God does, and cares for every child in Africa even if the parents don’t.

I am a nurse in the Bere Hospital in Chad Africa.  At times I am discouraged, but the good moments far out way the bad ones. God brought me here to serve his children and I am trying to the best of my ability.  As I recheck the quinine drip on my unconscious child I let go of some of my anger towards his parents; and as I do my heart of stone starts to beat again.