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. 

  

  

  

Giving and receiving 9/9/2014

  There is a village far from here that I have never visited. Apparently I cared for a very sick baby who lived there. He died from malaria. One of the younger men who works at the hospital approached me today and called me aside in private. His parents, wife and children live in that remote village but he rents room here in Bere so he can work at the hospital.   I have helped him with food and some other things in the past... He told me his mother was so grateful that I helped him and I cared for that baby. She sent her son to me with a sack containing 9 eggs--40km in rainy season over horrible flooded muddy roads. It was pouring rain (3" in a few hours).  He humbly presented this gift of thanks. 

I'm telling you, Im not sure I've ever received a better gift in my life. 

 I know perhaps not everyone reading this reads the bible but I was reminded of the story of the woman who gave a puny offering 

but it represented all she had. 

Today a woman I never met gave me all that she had. And I'm the one who is supposed to do the helping and giving.  

  I hope I will give as much when it's my turn to prove it.  Some days this place breaks me and other days it lifts me sky high. 

-Mason

The Widow’s Offering

Mark 12:42-44

42 But a poor widow came and put in two very small copper coins, worth only a few cents.

43 Calling his disciples to him, Jesus said, “Truly I tell you, this poor widow has put more into the treasury than all the others. 44 They all gave out of their wealth; but she, out of her poverty, put in everything—all she had to live on.”

Bad 9/6/2014

 I've been a bad dad and husband. I have been really focused on my work, just as I was before we moved here,  and  haven't given Kim or the girls enough attention. And, I've been too judgmental as well. Kim is feeling really hurt and isolated right now which she only just verbalized today. 

I have embraced "less is more" in a way that has obviously outpaced Kim's comfort level.  When she has expressed frustration, I have been less than sympathetic.  We don't  necessarily have the same expectation/observations of our life here.  A problem is likely I'm a bad listener and we plan differently. 

  Essentially, Kim is overwhelmed by needs presented at our door. Constant requests for physical and financial assistance which we cannot meet are draining. Our network here doesn't share the same sense of organization or prioritization that would help resolve our issues in the short term. 

  I think she is correct about most of the things which are stressful to her. I apologized today and committed to being a better communicator and partner. I'm surely focused on the mission but need to exercise better sensitivity when it comes to responding to my family's concerns.  

  I'm writing in the hopes you will pray for us. Pray for peaceful conversations, reduced worry over  finances, and for grace. 

  This isn't meant to be an alarming message. We are fine. I just feel like I've missed opportunities as the head of this house and I'm asking for your prayers that I would do a better job all around. Transitions are never easy and we still have a lot to learn about serving on the mission field. 

  I appreciate your wisdom, guidance and prayers. Feel free to reach out to Kim if you feel inclined. You can send me a message too and remind me to stop behaving like a moron. 

-Mason

Our mailing address:

McDowell's

 L'hopital Adventiste de Bere

52 Boîte Postale

Kelo, Tchad, Afrique

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

Grace and Love 8/6/2014

Sorry this is out of order but we forgot to post this update:

Grace and Love 8/6/2014

Though most of you know Madison as "Maddie", she has chosen and prefers her middle name Grace. She tried to switch last summer but upon returning to school, the old name "Maddie" was predominantly used by her friends, her sister and me too. Change is hard!

Leaving the States made her name transformation into Grace quite easy. Everyone and everything was new so she has had a fresh start. "Maddie" is seldom heard here in Beré except from slips by Emmie and myself; Mason adapted much quicker than us. 

Our current home sits very close to the edge of the compound next to a low clay-brick wall with see through fencing on top. During daylight hours, village children gather at the fence to peer through at the new "Nasaras", the local name for any foreigner no matter your skin color but whose meaning is white man. 

Daily, we hear the call of "Nasara" from the fence but it is peppered with our girls' names, Grace and Emmie, as the children become acquainted with their names. Grace is a cognate with an accented "a" pronounced as in "auto." (Grawce). Emmie has been slightly altered in pronunciation to the word in French for love, "Aimer." (Aye-may)

Though Mason and I are still "Nasaras", it is pleasant and unlifting to hear "grace and love" sail over the fence.  In effect, we have brought "grace and love" to Tchad with us ;-)

Many days are challenging for a variety of reasons but we are holding dear the local names for our children. A reminder for us to respond to those around us in grace and love but also an uplifting reminder of all our friends from afar covering us in prayer. As we hear "Grace and Aime" being called from the fence, church or soccer field, it is felt as a blanket of whispered prayer, encouraging and most humbly appreciated. 

Thank you all for your continued support and encouraging comments and messages. These have all truly buoyed our resolve, purpose and faith. 

 -Kim

Sunset moto ride 8/26/2014

  I took a ride on the motorcycle after I finished my day at the hospital. The roads were slightly drier since we didn't have rain today so I was able to relax and take in the scenery. Most of my rides happen around sunset and it is just beautiful here. We live in rural Africa and there are vast expanses of land with just a few small mud brick structures dotting the landscape. As usual, my ride was peppered with gleeful shouts & waves from the local kids who ran alongside me while shouting out variations of "Nasara bye bye". 

 Before returning home I pulled off into a field and turned off the engine. The sun was slipping away and I sat in near silence and took in a deep breath. Rainy season is such a nice break from scorching temperatures. We traded in sweat soaked sheets for mildew on our bath towels. Kim prefers the former but I'll take this weather any day. Tonight the air was thick and humid though not hot and I could smell the rich soil and manure. 

 This setting is somewhat similar to the smells & sounds of any farmland in the United States but this is Chad so there is no machinery, no tractors, no man made noise.  I sat quietly while listening to birds, and frogs, and cows & distant laughter. As the clouds gathered  in the distance I was reminded of the effects of rain here in Chad. 

  Rain waters the crops & provides drinking water for people & animals.  Unfortunately it also floods the dirt roads and paths, limiting access to supplies for us. Worse still, it means travel to the hospital will be difficult for families. Typically a torrential downpour is a killing rain: it multiplies malarial mosquitos and restricts the victims to their home village. It takes a day or two after a hard storm to see the aftermath--as flooding recedes, families will trickle into the hospital with a lethargic baby burning up with fever.  Sometimes its just too late to turn things around.  

  As I finish writing this update, it is pouring rain. Thunder and lightning fill the sky and we are strategically setting out our buckets to catch the rain that leaks through our ceiling. And I am thankful. 

  I am thankful we have this house with running water, & electricity, & a roof that keeps us mostly dry.  I'm thankful we have full-stomachs tonight after 3 good meals today. I'm thankful for the screens with only a few holes which cover our windows & keep out most of the mosquitos. I'm thankful that my family is healthy, safe from war & Ebola, & the other problems plaguing many other countries.  And I'm thankful for your thoughts & prayers (and occasional Oreos & coffee beans-- gotta do something while it rains!)

-Mason

  

Did somebody call for an anesthetist? 8/8/2014

Did somebody call for an anesthetist?  8/8/2014

  After 2+ months in Chad, it has become apparent that we are being served at least as much as we are serving others. We also find ourselves taking on roles we didn't anticipate. Almost everything here is foreign and we rely on a lot of help. Hospital employees, friends, new neighbors, and short term missionaries, all contribute something to making our lives better or easier or more efficient. 

  Even my patients offer encouragement or joke with me when I butcher their local languages. My French is improving quickly but so many people only speak other languages. Normally I speak to the nurses in French and they will translate that into a handful of other languages. Occasionally someone from another family steps over to help translate if we encounter a language we can't speak (no HIPAA issues here).  I have managed to pick up a few "other language phrases" but rarely say them correctly. The other day I thought I  asked a mom if her child had diarrhea  but I actually asked her for a kiss. I wish all my intended jokes got as much laughter! Needless to say, I am pretty popular at the hospital. 

  With 2 physicians gone on annual leave for 2months, I now serve as the Pediatrician AND Anesthetist. I felt a bit like a fish out of water at first since I haven't focused on pediatrics since the late 90s. It turns out its a lot like riding a bike except this time the bike has malaria.  My work day begins with morning rounds on Pediatrics: 90%of my ~28 kids have malaria and the average age is probably 18 months old; There likely will be closer to 40 inpatient kids/day in the next month as rainy season is in full swing and malaria overwhelms the villages.  Everyone gets malaria. Some kids will be brought for treatment but many will die at home.   It's a sad reality. 

  I also treat typhoid, and meningitis and pneumonia, and Giardia, and everyone seems to have worms. Unfortunately we are seeing more snake bites now that everyone is working in the fields. Burn injuries are also common since children live with little or no supervision and everyone cooks over open fire. Scalds from boiling water are typical. Still, malaria gets most of my focus. 

  Many children come in with a hemoglobin of 3, or 2, or even  1.1--my all time new record low!!)  high fever, lethargy & occasionally having convulsions. Scary sick kids are becoming routine and malnutrition is ever present. Now I refer children to Kim for nutrition consults and she refers them to me for medical care. We see each others names in so many medical records now. What a team! 

  As I make my inpatient rounds, I greet each patient and family with a handshake. Sometimes the kids will cry as I approach simply because I am white and that is an extremely rare sight. I also have a puffy beard now and am affectionately named "the lion of Chad."   Sometimes I make a silly introduction or joke as I lay my hands on the child's forehead, chest and stomach. I whisper a quick prayer  over those children as I'm checking for fever, respiratory difficulty, and hepato/spleenomegaly. I also gently pry open their eyes to see if their inner eyelids are too pale indicating severe anemia. After a quick glance to make sure the IV isn't infiltrated, I quickly order labs or explain test results and treatment plans, request blood transfusions, add or change medications, discharge, etc. Ideally I spend 3-5 minutes at each bedside in a large, dimly lit, noisy open ward that apparently is an old abandoned church on the hospital compound. It is crammed with beds, family members, and a small entourage of nurses & sometimes students. "Has she eaten today?", "Is he vomiting or having diarrhea?"

 With +\- 30kids, Pediatric rounds normally take at least 2hours. It takes even longer when I have to ask why a nurse didn't give medicine, or why parents didn't buy medicine, or is someone coming today from their village with money? When the child is very sick and there just is no money, what do I do? Discharge her and say "good luck with that?"

  Lets just say being the Pediatrician has become an expensive profession. There is no social safety net here. The reality is, I buy a lot of medicine for my patients or they will die. It's a common model that the missionary docs follow here. In a land filled with overwhelming need, who could ever say no?  [One day I want to write about Olen & Danae. They do so much for so many people and are absolutely humble heroes.]

  Finally after finishing rounds we try to begin the surgery schedule. Luckily we are pretty slow in the OR right now. Everyone is in his field working during the rainy season so elective surgery just isn't happening for most people. They also have no money because they haven't harvested crops to sell yet. Weeks ago we were doing surgery 5-6 days/week, typically not stopping for lunch and pausing around 4pm until we return later for urgent surgical add-ons or an Obstetric emergency.  For now, I'm thankful for more time in Peds, more time to eat a midday meal, & more time to build relationships. It's so gratifying and exhausting at the same time.

I wrap my day up by eating a final meal around 7 or 8pm to keep up my calorie count, guzzling lots of water, and studying some French and reading a lot. Mostly I read about pediatric care in Africa. 

  Children die in my hospital.  It still guts me every time. Typically they come here too late after a disease has ravaged their frail little bodies. It's a heavy burden and I have become a bit obsessed with studying tropical diseases, malnutrition, and pediatrics. I spend each night reviewing research, treatment protocols, and guidelines published by the World Health Organization, other NGOs or other African hospitals with similar situations & limited resources. I finished my doctoral studies when I was 41 yrs old but it seems I will never be finished learning. And that's just how I like it. 

  P.S.  

The power went out at the hospital the other night. Guess who is in charge of checking fuses, resetting the inverters and maintaining the generator? Thankfully Rollin can lend an experienced hand & Olen is (usually) just a text message away. I knew I would be stretched when I came to Chad, but I didn't imagine how much.  

Um, did somebody call for an anesthetist? 

-Mason

Goodbye sweet baby girl

  Please keep Kim in your thoughts and prayers. This is an extremely difficult day for her. 

  Chantal Tcha Kouma was Kim's first baby girl in the nutrition program and she was tiny. She was also perpetually sick. Kim manages the malnutrition nutrition program here & I am serving as the pediatrician for the next two months so our patients often overlap. 

  Today Kim called me out of the Operating Room to see Chantal and her mother, Anina.  Chantal was in real trouble. She had been getting nutritional & medical treatment for many months but never improved. I took one look at the baby and swallowed hard as I scooped Chantal up into my lap & rested my cheek on her head. We knew this day was coming. My eyes burned as I spoke to the mother in French: we have no other medication to help. Chantal is going to die..today. 

  With a lot of sobbing & tears, Kim and Anina held each other and stayed with Chantal.  I blocked off our preop & delayed patients so two loving mothers could sit in silence with that beautiful baby girl.  

 In a few short minutes, sweet little Chantal took her last gasping breath and was gone.  Friends, this is what real pain feels like. Please God, give us strength.  

 -Mason