Ikea showroom headquarters--Central Africa? Oct 24,2014

I'm sharing an email response I just sent some missionary friends in Ghana. It's a decent recap/update on our life here in Chad, Africa. 

-M

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Hello to you both!

We are excited to read you email. I really appreciate you reaching out and offering encouragement. 

Bere, Tchad is probably a lot like you remembered it. Rich with hope but materially impoverished, mostly HOT, and terrible roads (nearly impassible in rainy season). We really do love many things here and we've been touched by the people and their generosity and kindness. Obviously it is a challenging environment and the transition has been difficult at times for the entire family. 

I believe we live in the little one bedroom "apartment" attached to the house you lived in. We stuck a bed in the living room for Kim & I but the girls share the real bedroom. It's small but we have water and electricity so that is a blessing. 

We are just about to move into a new building on the compound.  It will be amazing to have a little breathing room but its actually making me feel embarrassed. In a country where nearly everyone struggles in poverty, we are getting a brand new home that is filled with furnishings that just arrived on a container this week from the United States.  Equipment for Bere, Moundou, and Abeche was shipped here and they gave us some room for beds and tables, etc so we bought some stuff and had it sent over. It feels too extravagant and now I'm self conscious. The girls and Kim deserve it but it doesn't diminish some feeling of guilt for all the new abundance. In the U.S., the home would be considered a small metal warehouse or garage but here it's a 2 bedroom palace with Ikea furniture. 

The hospital compound would be unrecognizable to you. 

Maybe you have seen the One Day churches that are made of corrugated metal? Bere hospital received a large donation of these structures and this place has grown HUGE. AHI has really worked hard to improve Bere. There are mostly empty metal buildings everywhere but they are connected by actual concrete sidewalks.  Eventually we will have new hospital buildings from the same materials. New maternity ward, 2 new operating rooms, post op wards, etc. perhaps in the next 2-3years. It depends on money and manpower-- just like most things in this world. God has provided everything we need so we just have to remember to be patient. 

Kim has been busy keeping a malnutrition program open until the new director arrived. It was a labor of love and cost a lot emotionally and financially but it was time well spent. She also works with the local school-- she spends time nearly everyday with finances and student registration and she is also struggling to get teachers and administrators to work from a realistic budget. That's nearly impossible and pretty frustrating but its worth it to help the local kids get access to a better education.  This school is considered one of the best around, partly because they limit class size to ~60 students per classroom! That would be at least twice the normal size back in the U.S. 

I came here to give anesthesia and teach others to be anesthetists (as much as that is possible for them). I ended up doing that PLUS overseeing pediatrics.  That has been particularly challenging to round on pediatrics in the morning and get to the OR for a reasonable starting time for surgery. Add to that-- I'm not a pediatrician but fortunately God put enough people around me to get me back up to speed. I haven't focused solely on pediatrics since 1994-96 and I never studied much detail of tropical disease management. The re-learning curve was steep but I began to feel more confident after a month or two. Dealing with poverty (& parents inability to buy medicines) and the too "frequent" death of children from preventable/avoidable diseases has been difficult and I spent more than a few nights crying. Like most things, it gets easier as you adapt to stress but its sad to deal with the things that just don't exist in modernized countries. I may not be able to continue with Peds once we get really busy in Dec-Mar when we try to do 8 surgeries/day in one OR. Time will tell.

Our daughters were always homeschooled but after much discussion, we decided to enroll them in the local school. We realized that the academics would be lacking but we felt it was important for the girls to make friends and learn the many languages. It's been rocky and difficult for them but they are persisting. I would love it if you could remember Grace and Emmie in your prayers. And pray for our family to rely on God and stay close together. I know you remember the stress of raising a family here. We are managing fine but its much different compared to the United States. 

You can already guess our menu: rice with sauces; pasta with sauces; we've had goat a few times; I just received a chicken for a "thank you" gift so we ate it yesterday. I eat mostly vegetarian but not exclusively so we graciously ate the food that likely was a big sacrifice for a local family to give away. 

Kim and I are speaking French much better now and that is a relief, though I still miss out on a fair amount since they often speak quietly or too quickly :-)

Now I just need to learn Nangjere, Arabic, Malba, and Gumbay and I will be in great shape to chat with almost everyone. Communication is so important and so difficult here!

So overall we are doing well and learning from our successes and failures. 

If we are ever in Ghana we will drop in for tea or coffee :-)

Not sure what Internet is like for you but we have a blog you can read if you would like to:

whyweshouldgo.blogspot.com

Thanks again Peter & Esther. Your email was like a breath of fresh air. 

Blessings to you, your family, and your work in Ghana. 

With love,

Mason, Kim, Grace and Emmie

Our mailing address:

McDowell's

 L'hopital Adventiste de Bere

52 Boîte Postale

Kelo, Tchad, Afrique

I-Message & email info: mcdowellcrna@gmail.com

Sand in my mouth 10/9/2014

  In Chad we have had to get used to an extra crunch at meal time because we occasionally get sand in our food.  This afternoon I stood in the Operating Room and continually felt the crunch of sand in my mouth but I hadn't eaten a meal. 

  After administering a spinal anesthetic, I heard someone urgently shouting my name from Preop along with some rapidly spoken African French . I had to come quickly...My wife...Child...Emergency...Accident at school.  I told the surgeon they could start without me and had a nurse watch the patient.  

  I sprinted out into the African heat of midday and through the front gate of the hospital. The school isn't more than 1/2 mile down the dirt road.  I had no idea where exactly I was running and hoped it would be obvious. 

  I quickly found a crowd at the edge of the field by the school. Kim was there, hovering over a small child and she was grief stricken...the kid was motionless and wet. 

  I took a quick look and started CPR. This sweet 3yr old boy has fallen into a well.  No one could tell me how long he was under. Chest compressions, mouth to mouth resuscitation, pulse checks again and again.  Life support classes tell you what to do for pulseless & lifeless children but they don't describe what cold little lips feel like as you desperately try to breath life back into them.  His pupils told the story. Fixed & dilated. 

I pressed my ear against his wet shirt straining to hear anything. No pulses heard or felt.  As I shook my head, the wailing escalated. I confirmed what the crowd already knew. I pulled a cloth over his body, scooped him into my arms and stood to carry him home. Some friends of the family accepted his lifeless body and took him home. 

  I stood silently for a few moments trying to make sense of what just occurred and then walked back to the hospital to rejoin the surgery already underway. My scrubs were drenched and stuck to my body-- partly due to running in the heat, the adrenaline from the emergency, and the baby boy's wet clothes pressed against my body as I carried him. 

  The surgery that I had to rejoin went well. Unfortunately I spent much of the time thinking about the sand crunching in my teeth. 

I'm ok with a little sand in my teeth from poorly washed food. That's life in Chad. I'll never be ok with sand in my teeth after doing mouth to mouth on a drowned baby lying in a dusty field. But, that's life in Chad. 

Matthew 11:28

 Come to me, all who are weary and burdened. 

Prayers for Grace... 10/8/2014

  We had a sick baby arrive for consultation today. The mom walked up to the benches set out in the pediatric courtyard under the mango trees with her child in obvious distress. The nurses insisted that she go donate a unit of blood for the obviously distressed and anemic baby-- typically a result of severe malaria. 

  While the mother was donating blood, her sweet little baby died under those mango trees with the nurses.  She waited too late to seek treatment and the malaria was too severe. 

  My own daughter, Grace, has had a fever for 24 hours. We knew what to look for, what to worry about. We started malaria treatment last night when her fever spiked again only slightly-- no vomiting or rigor, just sleepy with fever that day. We tested her first thing this morning-- positive for malaria, just as we suspected. 

  I am truly thankful to have been born in a country where education, and money, and good health are accessible. 

  Thanks in advance for your kind thoughts and prayers for Grace for an uncomplicated recovery. Please also remember the many, many people who aren't in the same position. 

  -Mason, Kim, Grace & Emmie

10/6/2014 Worth the risk

I've had a sad 3yr old patient with abdominal pain for several days. He had already been to two other hospitals with no improvement. 

He cried all the time and he never responded to our medical therapy. But he was eating food, no diarrhea, not vomiting, afebrile.  Abdominal physical exam wasn't conclusive. 

There is no CT scan or X-ray here... I finally took a chance this morning during my Pediatric rounds...

He was no better but no worse--  he just screamed off and on all night.  I told the parents not to let him eat or drink anything and I put him on the surgery schedule. It had to be a surgical problem, right?

I didn't feel good telling his parents "we need to operate-- but I don't exactly know why."

  I whispered a quick prayer as I induced anesthesia and we did a laparotomy. It turns out he had a big intussusception that we reduced before his bowel got ischemic. 

His anesthesia & surgery went great. (Thanks Dr. Rollin Bland for the flawless surgery). Praying for this little boy'a recovery. 

Chalk one up for the good guys 

:-)

-Mason

(Anesthesia nerds: IV ketamine 0.5mg/kg then Halothane inhalation induction,  Halothane maintenance, spontaneous respiration  +/- manual ventilation  assistance using Diamedica DPA02 draw over vaporizer).  No neuromuscular blockade. Monitors: Precordial stethoscope and earpiece I bought in 1998, cheap $30 Pulse oximeter I bought off Amazon & a mostly malfunctioning automatic BP cuff. No EKG, no expired CO2 or gas analysis--Yep, it's possible)

10/1/2014 first day of school

Remember that "first day of school feeling" you had when your kids first started kindergarten?  You were excited and worried for them? Kim and I experienced that for the first time today. Always homeschooled, our 11yr and 9yr old daughters dressed in uniforms and walked to a "real school" for the first time this morning. The school is 100% immersion in French language. Send up a prayer for our girlies.

Friday night lights 9/20/2014

Friday night lights 9/20/2014

  This is my first Autumn in 20 years that I won't experience the crisp air, steamy breath, crunchy leaves under my hiking boots, or the pumpkin pie that accompanies Fall. And even though I don't follow football like I did when I was young, I still associate the game with this season. 

  It's Friday night in late September and for many people that includes the "Friday night lights" of football season.  But things are different here in Chad. It's after midnight right now & I just returned from a walk. I couldn't sleep so I decided to look at my own Friday night lights.  Here in the bush in Africa it is pitch black dark and the sky is intensely illuminated by stars in a way that many people have never experienced because of city lighting. Honestly it's beyond extraordinary. 

  As I walked to the open field behind the hospital, I paused in front of the old church that is now the pediatric building. 

I stood quietly and listened for trouble that comes in the night. 

All the windows in this old building are open so its easy to hear any commotion if someone is doing badly...and too frequently someone is.  Peds is my responsibility and it is the most agonizingly rewarding place I have worked in many years.  I know we are making a difference for many of these kids.  I worry at night though. Last night a baby boy and a baby girl died in Peds from malaria. They were new arrivals in the middle of the night and didn't survive until morning. 

  I make rounds first thing each day before starting the surgery schedule. Today rounds began with that sad news: 2 admits in the night but both died within hours of arrival.  I don't know that there was a lesson learned from their deaths. Nothing was completely preventable. Kids are malnourished, they get very sick and arrive in desperate shape. Sometimes we can save them & sometimes we cannot. 

  I keep wondering about the

things some of these mothers may have been thinking or seeing. Imagine that its night and the baby has been getting sicker for a few days. They have no money. Can she wait until morning? The baby is burning with fever. Now she's breathing badly and finally convulsing. The mad scramble ensues as the mother walks 5, 10,or 20  kilometers in the dark through muddy paths and rutted dirt roads. Only to have the child die on arrival... Or maybe the baby survives because their are people here who care. 

  Despite all of the headaches, hassles, and heartaches, I believe in what we are doing.  Nearly every day a mother will come to our door or sit under the tree outside of our home asking for Kim and I to help a child.  Nearly everyday I provide anesthesia services for people who may have suffered without me. And nearly everyday we offer financial or physical or spiritual assistance to people in need. 

  So here I sit tonight under my Friday night starry lights asking myself questions. Why am I here? Am I making a difference? What's my purpose?  

I don't have all the answers but God knows I'm trying.