Sunday, July 22, 2012

Same old thing 22 July 12

     Some times you get used to certain things so that they seem like the same old things monotonous or ho hum but then you may miss things that are interesting to others.  Sometimes you think things are understood but maybe they are not. The diet may be rice and beans and sometimes beans and rice but in actuality Dolores does a great job of putting variety in the diet.  We had lots of mangoes for a while which the season is now gone but guavas are coming on now and tomatoes beginning to come to market.  Occasionally we get a coconut, papaya, banana, okra, some greens such as spinach or lettuce, or avocado so we are not starving even though we have lost weight which we sort of needed to lose. We are healthy with a little less fat. We had no refrigerator past month or so but we managed to purchase one about size or one in our camper this past week.        Before we had to be sure we ate everything as soon as it was cooked because it would spoil in this warm humid weather but now we can keep some fruit or tomatoes or bread for a few days.
     It rains frequently but that provides some beautiful clouds for photography and one day even a rainbow.  What was brown everywhere is now green and the grass thatch houses look sort of pretty with the greenery and clouds and occ dark clouds for background which make it very beautiful. Yes, I do occasionally get out and take a few pictures which I wish I could share but maybe when we come home on annual leave which probably will be next June and July. Our oldest grand daughter, Rachel, will be in Ubon, Thailand this coming school year.  We hope to be able to visit there as we come home and maybe do a little sight seeing such as Angkor Wat, Cambodia or maybe see the Great Wall and the Forbidden city of China. We don’t know yet. Ubon is close to the border of Laos.  Maybe next year we will miss out on some of the mud and heavy rains here.  Apparently the western US would like to have some heavy rains.  Maybe it is too late for the corn and soybeans already. 
They raise lots of peanuts here in this sandy soil so we eat lots of peanut butter which is not very expensive.  
     We try to do everything with nothing it seems sometimes. How do you take care of preecclampsia or ecclampsia with only diazepam, nifedapine, atenolol. They may need rapid delivery but the nifedapine for decreasing blood pressure may also cause uterine atony. Danae is a great Ob-Gyn. Patients may not get their meds because they didn’t buy them, or the nurses did not give them, or maybe the “pharmacie” was out and no one told you so one has to check these things besides seeing if the patient is getting better or worse when one makes rounds. Our usual Friday eve or weekend urgent surgery was Fri  eve with perforated intestine probably from typhoid. We had to repair the hole. We also had a case of Gangrene, probably Clostridium of the neck with gas in tissue and terrific foul odor with small amount of purulence and clots when we opened the neck. Thankfully both are looking better today ( Sunday).  A lot of our instruments do not function very well especially scissors.  If anyone ever says in the OR that some instrument is not working as it should so “give it to Jesus and send it to Africa” please knock them out.  Actually we need better instruments because we are not as “expert” and work under worse conditions.  How do you take care of a diabetic ketoacidosis with almost no lab and minimal medicine.  Perhaps some insulin that is not consistant because it has been kept cool and some glyburide only. (Olen does a great job taking care of such things and the peds).  Or various ones that need antibiotics or blood pressure meds but say “I don’t have any money to buy food or meds”. There are lots of various abcesses anywhere from top of head to toes and at any age.  Pediatrics is very busy now with mostly malaria and lots of malnutrition.  Sometimes there are as many as 10-12 admits of little ones per day. Our peds ward is not big enough (only 30 beds).
     Sometimes 2-3 die in a day as some get there and die before meds have time to help and of course sometimes we don’t know the problem.  We had an intussusseption and perforation (apparently from typhoid) in the same patient (a little 8 year old girl) and had to resect a portion of small intestine about 2 weeks ago.  She did well and has gone home.  A few days ago we had a necrosed (dead) testicle apparently torsion (twisted and shut off blood supply) and he had a small hernia also on the same side. 
     Sometimes one thinks that the patient or nurse have understood what you have instructed and they have not or have chosen to ignore so that what was clear to you did not get done. I still have some language barrier also although it is improving a little. The language problem is not just my lack of French but many that don’t know French and speak only Arabic or one of several local languages.  All hospital employees speak at least 2 or 3 languages and some know many more.  Sometimes I think I am linguisticly stupid. 
     Zane had a fever 1 day so he has been started on quinine and seems to be doing ok.  Some have caught colds in these “cold” nights when it is down to below 75.  We are all in relatively good health.

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Our address is: Hopital Adventiste de Bere, 52 Boite Postale, Kelo, Tchad, Afrique
Love, Rollin and Dolores

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