Monday, January 5, 2015


It does not seem possible that we are starting a new year.  Here the main cadeau (gift) giving is at New Year's, also asking for cadeaus.  There was not anyone at our door like last year singing then asking for cadeau.  Most o your good resolutions are already broken probably by now that we often make to begin the new year.  But we can still read our Bible daily and maybe I should be studying French more diligently. 

Our total surgeries for December was down compared to last year 145 to 128 but it seems we had more big cases including several bowel resections for various reasons.  Our last week had a spleenectomy in a 3 yr old for a ruptured spleen from a motor accident.  He also had head trauma but after giving blood to him and doing the surgery he is doing ok.  Also had a ruptured appendix that had abcess under the liver with his cecum there but incidentally his right kidney was down in the right lower abdomen feeling to palpation like a mass maybe a walled off appendiceal abcess.  We also had one with urinary retention with large prostate and another with urethra stricture.  Another little boy had a large stone in his proximal urethra which we were able to push back with difficulty into his bladder where we had opened it and removed the stone.  We also did a fasciotomy on the leg of a baby that had been severely burned.  Initially the foot appeared white and dead but after a few leg splitting incisions and one in his foot, the foot pinked up some and had a small amount of bleeding so hopefully save his foot although may lose his toes.  We had a bowel obstruction of the very end of the terminal ilium with a band that required a plasty to open the obstruction.  The little girl with arm amputation at the shoulder for cancer of the humerus is doing ok now.  We had a patient die from rabies that had been bitten by a cat a month before.  Cats don't normally carry rabies.

Our total census has been past full lately.  In fact on 30 Dec we had almost 90 in the hospital but bed spaces for less than 70 but we add beds to the veranda and they sleep on mats which some of them prefer.  We also have beds in the building that eventually is to be pharmacy and lab.  The new maternity is not open because it is not finished with electricity and plumbing which would add some bed spaces.  The new private wards have the same problem.  There was a run in maternity with 14 deliveries in one day.  Every service had lots of patients but today the census is down somewhat. 
We are heading into the usual busiest time of the year especially for surgeries.  Last year we had 200+ surgeries for Jan.  We have a new Chadian doctor here with us that is sort like an intern.  He needs lots of experience and guidance yet.  Hopefully eventually he can do a lot of the care.  He is supposed to be eventually in Abeche with Dr. Appel. 

Dolores is resting up a bit after her marathon sewing of all the choir robes for the church.  Now she is "just taking care" of the grandkids.  Danae has been very busy with maternity lately.  We are all healthy presently. 

We are almost out of medicines for malaria especially the pills and there is none to be found in the entire country.  We still have some injectable quinine, injectable artemeter, and fansidar.  The head of the central pharmacy for the country probably did not order it in time from whereever and yet they won't let hospitals order or import meds on their own schedule.  There are almost no meds for hypertension except atenolol and HCTZ.  We have no ivermectin for filaria and some other parasites now either.  We do have lots of albendazole.  Different anesthetic agents are hard to get or impossible to obtain so we work with what we can get. 

The "harmattan" dust has really moved in with the north winds.  The visibility is less than a kilometer but it shields out some of the sun so it is cooler with only about 80F for high and in the 50's for lows.  One can wipe the dust off something and it will be covered again in not very many hours.

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Kelo, Tandjile,  Chad,  Afrique