Chad is in the heart of
Africa and can be described in a few words: poor, hot, dry, and flat.
Though French is the official language, nearly 200 native dialects are spoken.
Here in Bere, which is in southern
Chad, we hear French, Nangere, Arabic, and a little English.
English is taught in the school, so many of the children speak a little English and are anxious to try it out on you.
The most commonly heard phrase is, “How are you?”
There is a rainy season in southern
Chad that usually extends from May through August.
It was late beginning this year with no rain falling until the middle of June.
When it rains the roads, which are unpaved, can become impassable.
Most of the autos here (and there are only a few) are of the 4-wheel drive variety.
Well it’s been three weeks to the day since I arrived at
Bere Adventist Hospital in
Chad,
Africa.
The second day here I asked to observe a hernia repair and was invited to scrub-in.
Got to clamp bleeding blood vessels, mop up blood, retract obscuring tissue, and cut stitches.
The surgery was performed by Samedi, a 54 yr old Chadian who began his career as a janitor at the hospital.
(Google “Samedi
Bere” and I’m sure you’ll find his story on the web.)
The abdominal muscle had separated at the site of a previous C-section, producing a large hernia from the belly button to the pubic area.
Samedi opened up the abdomen, cut away the excess tissue, stitched the abdominal muscle together, and inserted a mesh to strengthen the abd wall at the site of the incision.
All went well, and though she’s going to have an ugly scar, the hernia was repaired successfully.
The next day a young man was brought in who had been in a fight with three other men. He had three stab wounds, two in the back and one in the abdomen. The two in the back had been deflected by the ribs and were superficial (He was lucky). The abdominal wound was more serious as the intestines had been perforated. Again, I was given the opportunity to scrub-in, but declined, as I was not sure I had enough stamina to last thru the operation. Samedi opened him up, piled his small intestines on his abdomen, and began stitching up holes. After examining every inch of the intestine that might have been damaged and repairing each hole, his abdomen was thoroughly rinsed with bleach water and he was closed up. The defensive knife wounds on his right hand and one cut in his scalp were stitched up and he was moved to the surgery ward. A few days later he went home.
The next week I was assigned to work in the ER. An old man showed up with a very infected finger. He was taken to the Bloc for surgery and I followed along to observe. Samedi had hopes of saving the finger, but as he cut away more and more dead flesh, it became obvious that there was nothing there to save, and eventyally the finger was amputated.
The first week here Heather Haynes, a recent graduate of Southern Adventist University, showed me the ropes. We visited the different departments and met the staff. The departments are:
Urgency (ER)
Medicine
Bloc (Operating Room)
Maternity
Surgery (Recovery)
Pediatrics
TB
Cholera (An outbreak of cholera brought over a dozen patients to the hospital, one died.)
The Urgency (ER) is operated like a clinic. Each patient carries a little booklet, called a carnet, which contains his medical history.
At about 8 AM the sick come into the compound and present their carnet to the receiving nurse in the ER.
The patients are seen on a first come, first served basis.
There are exceptions of course; emergencies, being a VIP, being a member of the hospital stall, or being the friend of one of the ER nurses. The receiving nurse takes their vital signs, weights them, records this information in their carna, and gives the carna to the consulting nurse.
The consulting nurse, who functions like a nurse practioner in a clinic in the
US, examines the patients and writes orders for labs where necessary.
After considering the complaint, the labs, the exam findings, the consulting nurse makes a diagnosis and writes orders for medications and treatments.
The patient then takes the orders to the cashier, pays for the drugs, medical supplies, or service, and then picks up the drugs or medical supplies at the pharmacy next door.
(By the way, the charges for medication and services are very low.
For example, the cost of a consultation and exam is $2.22 US, while an ultrasound exam is $10.
And if the patient can not pay, the government will pay for treatment if the disease or injury is life threatening.)
The patient returns to the ER with his medications and supplies where a nurse follows through with the consulting nurse’s orders.
IV’s are started and medications administered.
If the patient is admitted, he or she is assigned a bed in medicine, maternity, pediatrics, TB, or taken to surgery in the bloc.
After surgery the patient recovers in the surgery ward.
This hospital keeps patient cost low by having the family care for the patient’s personal needs. They bathe and clothe the patient, prepare and serve food, provide bed pans, and clean up any spilled body fluids. The nurses give medications and perform nursing procedures, but they don’t do personal patient care.
