2015 Christmas Letter :-) 24Dec2015

Almost missed out on our annual letter... Here it is hot off the press:

There once was a family of four
who tried to do something more.
They sold off their stuff
and lived with no fluff
yet they grew like never before.

In an era of caution, extra insurance and even fear, we took a chance and answered God’s call to serve. Since June 2014, we have enjoyed some of the best and worst times of our lives in Chad, Africa. Even though we envisioned staying longer, a State Department recommendation to evacuate Chad ultimately capped our time. So now, we find ourselves living back in the United States and reflecting on lessons learned. 

Top 5 Things the McDowells learned in 2015:

#1. It is possible to live with less of everything. 
We survived in a smaller home with much less money, clothing and personal belongings (and no air conditioning). It really gave us a fresh perspective and helped reshape our expectations for life back in the United States. Unfortunately, we also lived with less and less body weight. Occasional disruptive illnesses were part of the package deal while serving in Chad. I even pooped in the bed once. Yes, really. I could live with less of that. Merry Christmas. 

#2. Friendships matter.
You know that new guy/girl that talks funny and doesn’t quite fit in? That was us (and maybe it’s still us?). Despite that, the very people we were serving were often times reaching out to serve us too. Before moving to Chad we were taught to “seek to understand before seeking to be understood.” We made friendships, first and foremost. Several of those friendships are able to persist even as we live back home thanks to (of all things) Facebook! Personally, I’m notorious for not feeding and watering my relationships and they can get spindly. We are now rekindling friendships here in America. If you are reading this, you are cordially invited to visit us. I will wash the sheets. (See #1)

#3. The internet is everywhere. 
I’ve heard it said that there are more cell phones than toothbrushes in all of Africa. I believe it. I’m not saying people have bad breath in Chad, but I am saying that more and more people are getting access to “devices” and the internet. I truly believe access to modernized technology in much of Africa will be a game changer and accelerate advancement…Right up to the point where they learn about Minecraft and Pinterest. Seriously people, put down that device…And brush your teeth. 

#4. Beware of comfort… but a little is good!
We could have not moved to Chad. Life was typically pretty easy for us here in the U.S. I think an abundance of comfort can be like a rut that offers security and ushers you to familiarity. That is inherently satisfying, but it can also be limiting. I think moving to Chad showed our family that its good to have faith and try something new. And yes, you can be better because of it even if it doesn’t work out exactly as you envisioned. For now, we are regaining some comfort surrounded by farmland just outside of Asheville… oh, and we all got Pinterest accounts. I still don’t use Snapchat. Don’t judge us ☺.

#5. Its good to ask for help.
In addition to making incredible friendships in Chad, we found that friends (and a few strangers) back home were supporting us through prayer and donations to assist us with the many projects that occupied our time and effort. We asked for your help and you made a huge difference! After abruptly returning home, we were given free housing and loved on until we could get back on our feet emotionally and financially. So while 2015 wasn’t exactly as we envisioned, isn’t that the way life goes sometimes? “Life is what happens to you while you are busy making other plans.” 

Make your resolutions for 2016 and then embrace those unexpected forks in the road. And if you need our help, send us a snap chat. 

Merry Christmas friends!
Mason, Kim, Maddie, & Emmie
480 Buckeye Cove Rd Swannanoa, NC 28778
828.712.5785 (Mason) 828.676.8207 (Kim)

I haven't finished calling your name 19 Sept 2015

"I haven't finished calling your name..."

Kim, Kim, Kim, I haven't finished calling your name," she sobbed into my shoulder as we sat together on the cement floor of my home. This is the lamentation that cut through me, heart and soul. Naomi is my closest friend in Bèrè and was devastated by the news. She broke our embrace to pull both of my girls onto her lap crying "my girls, my girls!" She is a single mom of 5 boys and we often joked of swapping one or two. Emmie and Grace adore her and Mason would tease, if I ever succumbed to malaria she would be their new mom and they always happily agreed. Her children were my children and mine were hers.

The gathering of women surrounding us expressed their emotions as well, in tears, moans and desperate cries. "How will we care for our children? What will we do? Why? Please do not forget us..." People were streaming into our home as the news spread that the entire mission team was given notice of evacuation. The scene closely resembled a Tchadian wake, as new mourners arrived, others moved out onto the porch to rest on mats while they continued to grieve. It is always a fervent and palpable experience.
Those closest to us stayed all day. I can't count the number of cups of tea    I served with the help of my girls and Nicolas who ensured there was enough sugar in each pot.

We always knew we would say goodbye one day... But not this moment, not this manner, not this fast. I am still grief stricken as I write this with tears streaming down my face.  Goodbyes are never easy but those that come with the knowledge you will likely not see them again while on this earth are heart wrenching and extremely difficult.

Pray for the people of Tchad who suffer daily in extreme hardship and poverty. Please pray for Naomi, Celine and Babey, all single moms whose names I will not call again in this life. Looking forward to our reunion.  Until we meet again... I shall not forget you.

-Kim

Welcome "home" 16 Sept 2015

Welcome "home"?
Though we don't actually know where to call home anymore, its great to be in Asheville, NC.

Chad, Africa to Asheville:
One muddy rainy truck ride, a bus ride, 2 taxi rides, 3 airplanes, and finally into the van... We have arrived.
Bent but not completely broken.

12 Sept 2015 Evacuation?

Due to a recommendation by the US Dept of State, we are leaving Chad.
Not sure what is happening but the only good exit is through the capital N'Djamena so we are taking it seriously. Our flight will be Tuesday night :-(
Please pray for Chad and the work that is ongoing here. Our departure is sooner than we had planned :-(

The U.S. Department of State warns U.S. citizens against all travel to Chad and recommends that U.S. citizens currently in Chad depart as soon as it is feasible to do so.  As a result of the deteriorating security situation, the Department of State authorized the voluntary departure of dependents of U.S. government personnel and non-emergency U.S. government personnel from N’Djamena on September 11, 2015.  Consequently, the U.S. Embassy is able to provide only very limited emergency services to U.S. citizens in Chad.  This Travel Warning supersedes the Travel Warning issued on February 26, 2015.

The ability of the U.S. Embassy to provide consular services in remote and rural areas is extremely limited.  U.S. citizens should take steps to mitigate the risk of becoming a victim of violent crime, and maintain caution at public gathering spaces and locations frequented by foreigners, including markets, restaurants, bars, and places of worship.

The Government of Chad requires all individuals traveling to or residing in areas hosting refugee populations in Chad to obtain movement permits (“autorisation de circuler”) from the Ministry of Interior and Public Security in N'Djamena.  All U.S. citizens affiliated with humanitarian relief efforts in eastern Chad should have an evacuation plan developed with the United Nations agency coordinating their work.  In addition, U.S. citizens are strongly urged to adhere closely to the policies and procedures of their host organizations to mitigate risks of becoming the victim of violent crime.  All U.S. citizens should prepare personal evacuation or safe-haven plans and be prepared to implement those plans on short notice.  U.S. citizens intending to enter Cameroon, Central African Republic, Libya, Niger, Nigeria, or Sudan from Chad should consult the Department's Travel Warnings for those countries and obtain any requisite visas or travel permits prior to traveling.

The Government of Chad has limited means to guarantee the safety of visitors in rural Chad. Incidents of robbery, carjacking at gunpoint, and murder have been reported in N’Djamena and throughout the country.  Violence is also associated with car accidents where crowds may form. If involved in an accident, it is essential to call the police. While there are presently no known specific threats against U.S. citizens in Chad, there are violent extremist organizations in the region, such as Boko Haram and al-Qai’da in the Lands of the Islamic Maghreb (AQIM), which are intent on harming westerners and western interests and are able to cross borders easily. Kidnapping for ransom is a potential threat in the region.

All U.S. government personnel require authorization to travel to areas outside of the capital, N'Djamena, and may be subject to restrictions within the capital.  As security situations warrant, the U.S. Embassy may periodically impose further travel restrictions, including curfews, on U.S. government personnel. While private U.S. citizens are not required to follow these practices, U.S. citizens should consider taking similar precautions when making travel plans. Review security precautions and consider measures to mitigate exposure to violent crime and other threats.  U.S. citizens residing in Chad should exercise caution throughout the country, especially at night.

Medical services in Chad are limited.  U.S. citizens entering Chad are strongly encouraged to verify their medical coverage extends to traveling within Chad – including medical evacuation – prior to arrival.
     
For further information:
•       See the State Department's travel website for the Worldwide Caution, Travel Warnings, Travel Alerts, and Country Specific Information for Chad.

•       Enroll in the Smart Traveler Enrollment Program (STEP).

•       U.S. citizens who decide to travel to or remain in Cameroon despite this Travel Warning are urged to provide their current contact information and next-of-kin information through STEP.

•       Contact the U.S. Embassy in Chad located on Avenue Felix Eboue in N’Djamena, at +(235) 2251-62-11, 2251-70-09, 2251-77-59, 2251-90-52, 2251-92-18 or 2251-92-33. After-hours emergency number for U.S. citizens is +235 6662-2100.

•       Call 1-888-407-4747 toll-free in the United States and Canada or 1-202-501-4444 from other countries from 8:00 a.m. to 8:00 p.m. Eastern Standard Time, Monday through Friday (except U.S. federal holidays).

Positive 07 Sept 2015

Positive
07 Sept 2015

I have a 10year old boy on the pediatric service...he only weighs 15kg (just over 30lbs). You probably can't imagine just how small that is.

On rounds this morning I greeted him in Arabic and he responded and gave me a huge smile. He is pretty sick.
His dad abandoned him and his mom when he was born. His mom is out of money so we gave her beans and rice today and bought his medicine.
Unfortunately his HIV test is positive. I was so hoping to be wrong...

You is kind. You is smart. You is important. 25 July 2015

You is kind. You is smart. You is important. 

25 July 2015

     I recently watched "The Help" and I love the recurrent line in the movie when the maid, Aibileen, speaks words of truth and encouragement to a little girl who needed someone to show her she was valuable. (You is kind. You is smart. You is important. )

     In the past few months, I've started talking to parents and children about their future. During rounds on Pediatrics, I often ask a mother or father to please tell their daughter/son to come back to the hospital when they are 15 to begin their formation to be a doctor here in Bere, Chad (Its a random age but its the idea that matters). All the other families gathered around us smile and laugh and the parents usually beam with pride and agree.   Usually I get a smile and nod from the child too as they think "Yes,I will be a doctor and help people."  I don't know what this will mean for their future but I'm trying to plant a seed of success as I whisper a prayer and offer encouragement to each family. They can be something more if they believe it. I want kids in school here. And I want them to know someone believes in them.   I need you to believe in someone too. 

If you can speak words of truth and offer financial support, we can help a child, a community and a country. 

     Children here need help with money for tuition, uniforms and school supplies.  I haven't yet seen the tuition cost for the approaching school year but it has been (unfortunately) raised. 

Kim and I are budgeting about $30 per YEAR for primary school and possibly $60/year for high school (this includes a uniform for $12 and supplies ~$3). 

     If you are willing to "adopt" a student and commit to their future, please visit our blog and make a donation via Paypal (use PayPal acct or a credit card). 

Your donation is 100% tax deductible but more importantly changes someone's life. 

You is kind. You is smart. You is important. 

Words worth sharing!

Chad 2.0 Déjà vu 4July2015

Chad 2.0 Déjà vu  

4July2015

     Returning to Chad for year #2 has felt like déjà vu. Everything has a season and I've seen this season before. Chad has endured its typical dry season when it likely doesn't rain one drop from November or December until June. The rains came late this year but finally,  everything is now green and alive. 

     The rains don't only bring life. Malaria season is now in full swing.  We see plenty of malaria year round but this is an explosive time. Typically I have 12 or so babies on the Pediatric ward. Recently I was down to only 4! But the past few weeks have been very rainy and I had 35+ kids on my Peds service today. There are a few with typhoid and 4 with severe malnutrition and one 12 yr old boy had symptomatic rabies from a dog bite 4 months ago!  It is 100% fatal. He will die and we can't stop that. 

     The other 25+ kids have a chance to survive. We cover them with assorted meds, IV quinine and prayer. We treat their severe anemia with blood transfusions (hemoglobin of 2 or 3 is an everyday occurrence here). Sometimes we don't have the patient's blood type and there is little we can do except wait. We test the parents, neighbors and anyone willing to be a blood donor. Twice this week we had kids with convulsions from severe malaria with hemoglobin of 3 and O-negative blood type. We couldn't find a donor. Unfortunately I recently gave 10 units of O blood to a pregnant woman who was bleeding to death from coagulopathy from a snake bite. Danae had to perform an emergency C-section and hysterectomy. Sadly, that young mom still bled to death that night. Her baby girl was dead on delivery. And now 10 units of precious O blood are gone that we desperately needed for these other children. 

     So, I asked every family member & visitor on the pediatrics ward if they would donate. In exchange I offered to buy ALL of their child's medications. No one would give (or claimed to be the wrong blood type... O neg is a bit harder to find). We even went to the Emergency Department and asked all nurses and families if they would let me buy meds in exchange for their blood-- no takers. People are afraid to give blood here.  I did finally find one student with the right blood type...but he was HIV positive. We never pay for blood. Its a bad precedent but I was desperate.  

     It poured down rain again today bringing relief from scorching temperatures. Tomorrow we will see the mothers straggle in...trudging for an hour,or two or three hours  through muddy paths and roads with gravely ill babies tied to their backs. And we will be waiting at our little bush hospital. Waiting and ready to give the best care we can. It's déjà vu. 

     -Mason

Céline 26June2015

Celine 26June2015

whyweshouldgo.blogspot.com

    

     I watched American Sniper during our flight back to Chad. Besides feeling patriotic, I was also feeling emotionally raw.  In the movie I was struck by the following line:

Back from a tour of duty, Chris Kyle said in exasperation, 

"It IS ok... Im fine...

I'm driving down the freeway.  It's sunny and 72degrees. I'm fine...

There's a war going on. There are  people dying and no one is talking about it.  It's like it's not even happening. 

We're all on our cell phones; living our simple simplistic lives. It's not even on the news. And no one cares.  There's a war going on and I'm heading to the mall. I'm not supposed to be here. I'm supposed to be over there. "

...

     Honestly, that is exactly how I felt about being back in the United States again and about serving as a medical missionary in a terribly challenged, developing country. Does anyone even know what is happening over in Chad?

     Think about your daughter... or your wife, or your mother or your sister. She is someone you would do anything for.  Now think of Celine. 

     Celine is a young mother of 4 beautiful children. She is a single parent because her husband was a terribly bad man. After years of abuse, his violence escalated against Celine. I imagine the scenario and the dread she felt as she heard his footsteps approaching outside their mud brick hut. He grabbed her by the arm as she struggled against his anger. 4 children crying and screaming as their mother was dragged out of their one room hut.  Celine's husband tied her to a tree, stripped her naked, and left her there. He repeatedly beat her and she had to flee.  She finally did escape with her kids.  Now she struggles to feed and support her children. She found work washing laundry for our family. She scrubs our clothes with soapy water on a concrete block and then hangs them to dry on our clothes line. Oh, and she is nearly blind. 

     Actually she WAS nearly blind. Her vision was completely failing but finally we found a specialist to surgically replace her lenses. Kim and I were back in the US when we heard that the specialist was coming back to a city "nearby".  We arranged transportation for her and her brother to travel back and forth for preop/surgery/ and post op appointments. We paid for her surgery. We paid for her medications.  

     Today, Celine can see. She can continue to work and care for her family. When we arrived back in Chad, she saw me and gave me a great big hug and offered the most sincere "thank you"  that I've ever felt. And she SAW me smile back as I said "Merci Dieu!"  

     Celine needed help. We are thankful that we could be here for her. Would you be able to help offset the cost of helping? Someone just like your daughter/sister/mother/wife will be coming to our door tomorrow. Help us to be able to say "yes."

 

Your donation is 100% tax deductible. Go to whyweshouldgo.blogspot.com

and give to our non-profit: Comfort Ministries. And please share with others who may be interested. 

-Mason

Video update (from Feb2015)

In case you didn't see this on Facebook... see a semi-recent update on our work in Chad!
Please consider supporting those families with desperate needs in Chad.  Find the link on our blog homepage to make a tax deductible donation to our new 501c3 (Comfort Ministries).  And remember to Ask2Help :-)
Mason, Kim, Grace, and Emmie

Ask2Help

Ask2Help

The Journey
Following two short-term medical mission trips to Chad, Africa, I sold my home, resigned from work, learned to speak French and moved to Chad with my wife and two young daughters to serve full time at hospital in the bush of Africa. Our first year in Chad has been incredible, encouraging, and tremendously challenging. We have felt hot and tired, overwhelmed, and often inadequate.
The Need
One of our greatest struggles has been serving in a place where so many have great needs; that we just can’t handle on our own. Our family receives just enough to sustain us in Chad; but we also wish to meet as many needs as possible. 80% of our neighbors live below the poverty level. The community of Béré hasn’t a single well with clean water. Education and medical care are considered luxuries. Homes are made of mud brick, which crumble, in the rainy season. The needs are great. If one of your neighbors were having trouble, wouldn’t you offer to help?
The Challenge
We have been confronted on a daily basis with choosing how to provide assistance in a way that is both effective and non-damaging. The greatest limiter to meeting the real needs of this community has been financial. Some of you have asked, “How can I help?” I offer you, your family and friends this following request/challenge. I have created a "campaign" that not only benefits our work in Béré, Chad but also your family and your community:
Ask2Help
There are 3 obligations: 1) donate time, 2) donate money, 3) SHARE our link.
*Additional SHARE challenge: After you complete the challenge, take a photo of yourself holding a “handmade” Ask2Help sign and post on Facebook. Tag Mason McDowell and Kimberly Womble McDowell in the photo. We would love to see your smiling faces and see “Friends of Friends” getting involved.
Challenge STEP 1: Donate time
Maybe you have an elderly neighbor. They need something. I’m sure of it. They need a friend; or they need a box moved; or a lawn mowed. Or maybe you can help with something at your church, local charity organization or community. In the next 30 days, find someone and simply Ask2Help; that is, ask someone, “How can I help?” Then do it!
Challenge STEP 2: Donate to our new nonprofit: Comfort Ministries.
We serve people who need your help too. Our goal is to raise $70,000 for 2015/16 for medications, equipment, food assistance, school tuition/uniforms/supplies, micro-business start-ups, transportation, rebuilding homes, clean water projects and much more. Please make a tax-deductible donation to our 501c3 non-profit organization, Comfort Ministries. We have an all-volunteer Board of Directors to provide us with guidance and oversight in utilizing all donations. All contributions go directly towards supporting our work. Every donation large or small will be a tremendous help. Please click the PAYPAL link at the top of our blog and make your donation today (using Paypal or any credit card) OR send a check to made out to Comfort Ministries &

mail to:

PO Box 55

Skyland, NC 28776

http://whyweshouldgo.blogspot.com

Challenge STEP 3: Share our link!
Facebook, email, twitter… and post that photo of you supporting our Ask2Help campaign! Remember to tag Mason McDowell and Kimberly Womble McDowell in your photo.

Thanks for helping!

Feeling Grateful 31Mar2015

After 45 hours of travel, I had to wake up for an 8am dental appt today! Ugh.
They wanted to start with X-rays...I was embarrassed and apologized but had to decline because I have no insurance. The hygienist spoke with the dentist and returned with a surprise: they did all of my xrays and my entire cleaning for free. Thank you Stuart Yoon DDS for being so kind. Feeling grateful.

  

1st real sleep 30Mar2015

Laying in a real bed in a real house after being greeted by many real friends at the airport. Now we sleep!
Goodnight friends. Zzzzzzzz. (Oh, and we are real(ly) cold smile emoticon
It is usually 90degrees when we go to sleep in Bere, Chad. (Pic on the plane ATL--AVL)

31Mar2015 HOME

Shared post for us on FB:

Precious friends safely home for short period of time, after 10 months in Tchad, Africa- we will treasure time with these special girls!!

 

Homeward 30Mar2015

Homeward.

29Mar2015Bus ride to NDJ

Bus ride to NDJ.
Those smiles won't last long smile emoticon

 — with Kimberly Womble McDowell.

29Mar2015 But Im NOT on call!

29Mar2015
But Im NOT on call!

I have to be up in 3 1/2 hours. We are heading back to the U.S. for our 2 month break. 2 months sounds like a lot of vacation to most people but I've been on call and working 24/7 for the last 10 months. And I am tired.
Kim and I finished packing and got to bed by 10pm tonight. A good nights rest is much needed ahead of our travel. Our bus departs at 6 or 7am (Africa time) Sunday morning. We will drive north through scrubby Palm, Tamarind and Neem trees until reaching the scorched desert climate of NDjamena. We will be on the move until Monday at 539pm. 40hours of travel to get back "home". Must. Get. Sleep.
But the phone rang at 1040 pm. Hemorrhaging mother. 12th baby. Emergency C-section.
I have to admit that I was less than cordial when they asked me to come in. I already said my "goodbye" and did my last case Friday afternoon. (Oh, and another quicky procedure this afternoon). Why the heck are they calling me? I'm done! I was a bit angry but sensible enough to know they wouldn't ask if they didn't really need help.
I arrived to find a very pregnant woman hemorrhaging to death. The machine repeatedly couldn't find her blood pressure. This is bad. We gave IV fluids and units of blood as fast as we could and then started the surgery.
Danae Netteburg moved fast. Cut. Clamp. Baby delivered. Unfortunately it was too late. I quickly assessed the lifeless baby girl and had to turn my attention back to the mom. She was still bleeding profusely and was in serious trouble. Danae made a quick decision to proceed with a hysterectomy to stop the hemorrhage.
More fluids and more blood were given. We were working at full speed and SWEATING like crazy. At moments it seemed as
though the mother could die. Her blood pressure was staying low despite fluids and blood and medications. And suddenly--she got better.
Her blood pressure stabilized. The incision was closed. LOTS of blood was mopped up and mom was taken to maternity. This was the happy ending we all wanted and it was a great way to leave Chad, Africa for a much needed rest. Kudos to the team tonight. In a country with the #1 or #2 maternal mortality rate in the world, our crew kept a mother alive tonight. Obstetrics is one of the happiest and saddest specialties to work in. If one of my daughters wanted to be an OB/GYN, I would tell them they are completely crazy...and then I would hug them say how proud I am. We need more crazy OB doctors!
Ok. I'm off to bed if this place will let me sleep. We have a bus to catch. We are coming home!

A picture is worth a thousand words...28Mar2015

(from a friend):

Just saw this picture listed in the Sony World Photography Awards for 2015... made me think of you and the people you all care for daily. Wanted to share. Hope all is well

ExOfficio 22 Mar 2015

ExOfficio 22 Mar 2015

It started slowly. Just a few droplets at first. Within minutes those droplets were merging into streams which became rivers...of my sweat. I had been manually ventilating a newborn baby boy for 30 minutes and it was hot. I hadn't paused to pull on my OR clogs so I was barefoot and small puddles of my sweat were starting to form on the concrete floor. At least I was wearing my ExOfficio underwear. It's good for wicking sweat.
Flashback 35 minutes earlier: I had been watching a movie in bed with Kim. Its useless to try to go to sleep "early" when it is 90degrees in your house. Instead we just lay in pools of our own sweat waiting for the right mix of fatigue and hot air from our fans to mercifully lull us into something more resembling a nap than a nights rest. As I slipped into a semiconscious stupor, footsteps approached from outside and a voice called for me. There was a baby not breathing. Can I come?
After a quick stop to grab the key from Olen's house, I dashed to the OR. As I approached the door I heard the familiar sound of mouth to mouth resuscitation. A nurse was trying to ventilate a baby as she waited for me.
Flash forward again: I've been breathing for this kid for 30minutes and I'm pouring sweat. We are inside a cinder block OR that has been heated all 110degree day long and it feels like we are in a tandoori oven (man I miss Indian food). I usually try neonatal resuscitation for about 30 minutes...after that the success rate is pretty close to zero here in Chad. There were now 2 nurses plus a "pharmacist" watching me resuscitate this baby. I started explaining the science of resuscitation, acidosis, oxygen saturation, Carbon dioxide, etc. I felt like a Professor again.
When we reached the "quitting" point, I stopped ventilations and talked them through this boy's dying process. Yes he had a pulse but he hadn't initiated more than a rare gasp for ~45 min of his short life. His color changed from pink to dark and dusky blue as his oxygen saturation dipped to 43%. I walked out of the OR to wash my equipment. I returned a minute later to see him breathing a bit more...and his oxygen levels were marginally climbing. Instead of dying, this boy took a real breath. His pulse did not slow and then stop as I had described and seen so many times before. This kid was refusing to die. I grabbed the ambu bag and gave him oxygen again. Good color, good pulse, good oxygen levels. UNBELIEVABLE.
After an hour he wouldn't cry but he was alive. His eyes were open and he was breathing consistently. I sat with him for another 20minutes as the nurses continued stimulate and clean him up. I tied his umbilical cord and eventually we sent him back to maternity to reunite with his mother! Wow.
So here are the final scores for today:
My day started with a Cesariene section. Happy mom, happy baby. A+
By mid day we had done a sad laparotomy for a 6yr old girl with ultimately a non-resectable cancer. I stayed with her until she was fully awake and carried her to the pediatric ward. She is laying on a bed made of concrete with no mattress and no mosquito net. D-
I completed Pediatric rounds by late afternoon. 21 inpatient kiddos but discharged a few who are doing much better. A+
My night is wrapping up with a small and possibly short lived victory. A baby fought for life and refused to die. A++
I'm going to take another shower now and try to find that elusive sleep. Maybe I will pull on those ExOfficio underwear again too.

22Mar2015 Wake up call

Started the morning with a C-Section. Home for breakfast and now called for moto accident with multiple fractures. Peds exploratory laparotomy (?cancer) will have to wait.

Comforting the needy 21 Mar 2015

Comforting the needy
21 Mar 2015

We have experienced "need" for nearly one year in Chad, Africa.
Yes, people absolutely have need in the United States too. But here in southern Chad, in the landlocked center of the African continent, there is essentially zero aid. No apparent government programs are available. No social services, basically no free national hospital care, no unemployment income. No subsidies. Nothing. And some people are truly suffering. To make up for the gap, we pay out of pocket to extend care for people who don't have money.
We help with education, micro-businesses, medical care, nutrition support, and much more.
Someone is presented to us daily with some type of need. At times, it feels like an ocean; where wave after wave of need crashes over us. It's hard. But if its hard for us to help so many, it's surely even harder for those who are suffering with nothing.
Giving is a delicate balance. We realize it's not a long term solution but it matters greatly to each child or mother or grandparent who is comforted or healed because we had money to give. I read a book titled "When Helping Hurts" and it describes how aid can hold people back and there are unintended consequences to "giving." It made some excellent points. But, I also see the consequences of not giving.
People in this country are suffering and struggling in ways that likely are not imaginable to the average American. Many of the struggles are preventable or curable. We Americans are extremely fortunate to have been born in a stable and prosperous country.
I visited Chad twice before relocating here full-time with my family. I knew we were moving to an area of great need, so we started the process of forming a 501c3 non-profit organization. Thanks to Kim's Dad, Jon, Keila, and Shawn--> we have our final state and federal approval and recognition. Comfort Ministries is official!
If you are reading this, you have likely followed our mission work over this past year and perhaps you would be willing to contribute in some way. You can help us with our service by praying, volunteering or supporting our projects financially. More information will be posted once we get home to reliable high speed Internet.
We land in Asheville, NC on March 30 at 5:39pm... not that we are counting down smile emoticon

The king is dead. Long live the king! 15 Mar2015

This is an edited journal I wrote days ago. Edited means Im not posting a lot of what I wrote (at the end) because it looked like I was complaining about what "we" don't have. But this story is about someone else:

The king is dead. Long live the king! 15 Mar2015

I killed a 3 yr old boy 2 weeks ago... Except he didn't die until today.
As I finished pediatric rounds this morning I was called to see a few consults. Outside on the dilapidated wooden bench sat a malnourished boy in obvious discomfort. It was Koumla. Koumla means "King" in the local Nangjere language. Right now, this tiny 3yr old boy looked more like a pauper than a king.
Koumla had been here in late February for vomiting and diarrhea and fever (just like 75% of my pediatric patients). He was hospitalized, treated and discharged after several days--presumably because he was doing better. Apparently he wasn't better. After 2 weeks at home, his mother returned with him. His skin was hot to touch and I could see an abdominal mass. Maybe we missed some symptoms 2 weeks ago?
After a quick physical exam I carried him to preop. He needed surgery today and soon! The surgical team assembled and we searched for an IV for a while without luck. He was really dehydrated. I finally put an IV in his jugular vein and started rehydrating Koumla. Tough start.
The first 30 min of surgery under general anesthesia were relatively uneventful but Koumla had a huge intusseception and it was a tough reduction. Then suddenly the pulse oximeter went flat and the blood pressure wasnt registering. After some trouble shooting I started CPR because his pulse was very slow and weak and likely he had very very low blood pressure--that's why his pulse oximeter was no longer working. (We have no ETCO2 monitor or EKG pads). I auscultated his chest again-- he went from a weak pulse to pulseless. Rollin, Danae and I continued CPR and repeated atropine and epinephrine. Danae brought his mother into the OR to witness our resuscitation efforts so she could see him while he was still "alive." After another 30 minutes I decided to exercise good judgement and stop CPR. Koumla was gone.
But he wasnt! Through his skinny little chest wall we could see his heart was fluttering again. It was like some cheesy story in a"B" movie, but this was true. He was "alive" again. More CPR, more meds, and new hope measured with a healthy dose of skepticism. Koumla now had a strong pulse but he wasn't breathing on his own. We quickly finished surgery and closed the abdomen as I continued breathing for Koumla. We have no ventilator. I chose an arbitrary time-- if he's not breathing in 2 more hours, I'm gonna have to extubate him and let him die...Let him die? Who says that?
As the first hour passed I grew more depressed. I'm not a fool and I knew what was going on. Koumla was likely brain dead.
As soon as I started to doubt he could survive, Koumla started to breathe! Just a gasp at first then eventually several times a minute. We may get a miracle after all?!
But then another hour dragged by with no improvement, no responses to stimulation, no cough, no pupil reflexes, nothing.
Another 30min passed and I had to face the realty. We have no ventilator, no rehab center, no nothing. I had been alone in the OR hand ventilating Koumla for hours and he wasnt going home.
I summoned the mother to the OR and explained the what must have been incomprehensible: Koumla is warm and has a pulse and a blood pressure but he is going to die. I invited her to lay with Koumla on the OR table and hold her baby boy one last time.
After I removed Koumla's endotracheal tube, I placed his mother's hand on his chest so she could feel his heart beating, and then slowing and then it stopped.
I'm telling you, friends, that was a gut wrenching moment for me.
This was my first intra-operative death in Chad. Sooner or later we all lose a patient in the OR. But here in the bush in Africa it just feels different. Tonight I am crushed and I am frustrated...

7 Mar 2015 Countdown to Home

The countdown begins! After 1 year of service in Chad, Africa we get to fly back into Asheville (AVL) on Mar 30 at 539pm!
After that, we have a 2 month whirlwind agenda: time in Asheville,NC-->then to Florida-->then back to AVL-->then we plan a scenic cross country drive to the Pacific NW and then back across to MA-->VA-->AVL-->then maybe a beach trip for a few days-->then FL--> then back to AVL for our return flight to Chad, Africa.
Lock your doors! If you live in, or near, any of these places my beard may be popping by to say hi smile emoticon

 — with Kimberly Womble McDowell.

21 Feb 2015 tay-Rez

21 Feb 2015 tay-Rez

I've become good friends with one of the local nurses in Pediatrics, Jonathan. Jonathan just had a baby girl born and he asked me to name her. What a humbling honor.
I'm choosing the name Thérèse (pronounced very Frenchy: put on a beret and twist your mustache while saying it: tay-REZ). It's the French version of Theresa. I was trying to think of a French name with symbolic meaning of someone who represents hope and love and giving.

Mother Teresa seems to be a fitting namesake.
Enjoy a few of her quotes:
"Make us worthy, Lord, to serve those people throughout the world who live and die in poverty and hunger. Give them through our hands, this day, their daily bread, and by our understanding love, give them peace and joy."

"You and I, we are the Church, no? We have to share with our people. Suffering today is because people are hoarding, not giving, not sharing.
Jesus made it very clear. Whatever you do to the least of my brethren, you do it to me.
Give a glass of water, you give it to me. Receive a little
child, you receive me."

18 Feb 2015 All better now

18 Feb 2015 All better now

When Helene came to pediatrics she was 7months old and weighed 5 kg. She was suffering with malnutrition, malaria and debilitating anemia. She also had a recto-vaginal fistula and no anus (a correctable surgical problem).
I can't say for certain why her parents brought her to the hospital...I guess maybe they wanted her to get better but I had to press them everyday to help me help her. I tried not to be judgmental but I was judging them big-time and I didn't like feeling like that.
Maybe they believed it was hopeless. Their daughter was defective. And that mom... She always smirked and smiled when we discussed her baby was dying. She said she hadn't breastfed her baby for 7 days?! I was angry almost every morning on Peds rounds. She was bed#1 and I was in disbelief each time we talked.
So baby Helene worsened day by day. Every day that dad wanted her to leave and I refused. I offered to pay for everything if they would stay. They stayed.
When Helene's hemoglobin got dangerously low, I had to ask them to give blood. They demanded to leave but I fought again for Helene. Then Danae fought for her too. Helene got her blood transfusion and I finally believed that she had a chance if her parents were going to try.
I started the next morning on Pediatric rounds ready to take on that family again but there was no need for a fight. Bed #1 was empty. Helene was already gone. I missed her by two hours and I didn't get to say goodbye...

With one gentle hand on my shoulder the nurse told me that my sweet baby Helene died that morning around 6am.

No more hunger. No more pain.
All better now.

17Feb2015 For the Friendly Lion

After 21 years with the same Littmann Cardiology II stethoscope, I now have a new Cardiology III. Thanks Mark & Megan Spindler Klein!
I had my last one longer than I've had my wife smile emoticon

22 minutes 14 Feb 2015

22 minutes 14 Feb 2015

Limp and lifeless. It didn't seem like a fair Valentine's Day gift for this mother. We just delivered her baby boy via C-section and he looked awful.
Just one hour earlier I had been enjoying a pot luck Valentine's lunch when my phone started ringing. Generally that's an unwelcome sound. We rarely call each other for social things because cellular minutes are expensive. When my phone rings, its nearly always something urgent.
After a quick chat I excused myself from lunch and dashed home to throw on my scrubs & head to the hospital for 2 potential C-sections. Fortunately the first was delivered with forceps and we hurriedly cleaned up & set up to deliver the second patient.
This would have been the 7th child for a mom who has had multiple C-sections in the past. The baby was delivered quickly but was completely limp and lifeless. Unfortunately I've grown accustomed to seeing newborns who need resuscitation.
Suction. Stimulate. Oxygen with an Ambu bag. We repeat this cycle again and again. This baby boy is going to die. I've seen it many times. Here in Chad, if a newborn doesn't breath in the first 10 minutes of resuscitation, they typically never do. We don't have a mechanical ventilator. I have kept babies alive in the past by hand ventilating for extended periods of time but eventually have to make the difficult decision to stop. Without respirations, a newborn's heart will slow and then stop in just a few minutes.
I was approaching that point today. This baby's pulse was strong but he just wouldn't breath on his own. Nothing. 5 min. 10 min. 20 minutes went by.
We paused our ventilation and watched him. At first it was just a small gasp but it was something! More ventilations, more stimulation and finally after 22 minutes we got our Valentines gift. He was breathing & he cried. LOUDLY! I truly had already given up on him
and I was just going through the motions.
We wrapped that baby boy in some fabric from his mothers dress and carried him over to her. She looked exhausted and didn't seem to respond to seeing her newborn son. I know she had watched much of our effort to resuscitate him and I wonder if she had given up hope as well. This is Chad, Africa. Babies die. She had seen 2 of her own children die before and I guess she was braced for that reality. But in a matter of seconds...her face softened and tears filled her eyes. Her baby boy is alive...and she loves him.

Happy Valentines Day.

22 Jan 2015 Where the streets have no name

22 Jan 2015

Where the streets have no name

    We have participated in several mobile medical clinics and provided care for hundreds & hundreds of people out in distant villages.  This outreach has HUGE potential and we are working toward acquiring more medications and reliable transportation.  We are visiting places far off the beaten path.  These villages are found on trails off of rutted up sandy roads. It reminds me of the song by U2 (& redone by Chris Tomlin): "Where the streets have no name".  Great song. Play it as you read this--

    2 nights ago we drove home from our mobile clinic deep in the bush. I was riding in the back of a pickup truck with 4 men, a mother and her baby girl and young son (plus 2 wooden benches, a stool, several mats, boxes of equipment and medications.  It was one of those reassuring and inspirational moments that remind me that its all worth it. The clinic was a huge success (Thanks Zach & Charis for Project 21) and I was now enjoying an open air view of a brilliant night sky from the back of a truck.  The hot dusty air blew in my face and parted my beard as I stared up at infinite stars and a sliver of a moon. We bounced along passed countless villages and saw people sitting around cooking fires in the pitch black darkness. I imagined elders telling stories to their children and grandchildren around those fires. There are practically no real books in this part of Chad so history is passed along through story telling.  

    I wonder if one night they may be telling stories about how the hospital or the church or God or even "you" reached out and made a difference.  We all have a part in shaping that history. 

 

-Mason

24 Jan 2015 Fatigué

24 Jan 2015     Fatigué

Je suis fatigué. [I am tired]. 

 I think everyone who serves here is tired too.  We work 6 days a week at the hospital and are on-call every night. This is busy season for the OR and we have about 2 more months before our annual leave.  Je suis fatigué... I haven't written much for a long time. Here are a few  highlights of our past few months: 

*Grace & Emmie are thriving. They are making friends and learning more French.  Our compound is surrounded by a wall and every day (morning & evening) kids are sitting on top wall calling "Grace"..."Emmie"...

"Give me ball" or "Give me water". 

We received 3 soccer balls in a care package and we loan them out every day and the local kids return them (almost) every night when they are done. We also give them fresh water to drink. It's such a little thing for us but it builds relationships and trust with our "neighbors".  The girls now frequently hop the wall to play with the locals. 

*We've had two great visits in Dec and Jan from friends/anesthesia students.  They all brought gifts and stories from home and really served to lift our spirits.  One group had perfect timing because a visiting anesthetist (Shawn) covered the OR for me (& gave me an IV!) while I was bedridden with malaria for 3 days. Everyone gets it--that's life in Chad, Africa. 

 Our 2nd visiting group brought fresh energy and encouragement. David kindly took on any project thrown at him & Jessica rolled up her sleeves and ran the OR like a seasoned anesthetist and not like a 3rd year student. They are future missionaries no doubt as they departed for home continuing treatment for malaria without complaint. 

*Three  Chadian nurses are still in-training to be safe anesthetists. They are mastering spinal anesthetics, learning simple pharmacology and how to administer general anesthesia. It is exciting to see them improving.

 

*We have received amazing donations from a few people and have been able to fund student tuitions, school supplies, and uniforms.  We could easily triple this with more resources. The need is so great and opportunity limited.  How do you break the cycle? Education is so important.  The issues Chad faces likely will be solved by a Chadian.  The kids we aid may help shape this country's future. 

*We have been able to pay for medication for many children in the village and on the pediatric ward whose families just couldn't afford care.  We continue to see kids needing treatment for severe malaria, typhoid, tetanus, meningitis, terrible burns from fire or scalding water, various cancers, snake bites, and debilitating malnutrition. Again, the need is great. 

*We have received many emails and care packages over the past several months. Your messages, care packages and prayers have been truly encouraging.  Life here is incredibly rewarding, incredibly stressful and exhausting!

So as I reflect on our time here, we are making an impact. You are part of that impact. 

Our family is getting used to dirty black feet, insects, heat, and lots of meals served with rice. We are ready for 2 months in the U.S. to eat well, relax and reconnect with you all.  If you want to hear stories, see pictures or have us over for a meal in April or May--please let us know.  Just don't serve rice & beans. Je suis fatigué of that meal :-)

  -Mason

"Love your neighbor as yourself"

         Matt 22:39