Mercy

While there are plenty of sad outcomes at a hospital like this - it's the surprisingly good ones that I want to remember.

Last week we closed our Lassa ward as the rainy season has begun and this lessens the interaction between the rats who carry the terrible virus (in search of water) and humans. Based on prior years' trends, it seemed like a long shot to ask God to protect our hospital entirely from the disease but he did! We had several suspects but all eventually tested negative and we made it through this dry season without any confirmed cases here.

The first suspect (based on symptoms and a screening questionnaire) set off the procedure of setting up an isolation ward, making concentrated bleach water wash and all the needed contact precautions. She was a young girl with a persistent fever of unclear source and recent hospitalization elsewhere - both red flags. You can imagine the terror in these kids who are isolated in a room away from their family and approached only by nurses cloaked in plastic protective gear. After she eventually tested negative and we were able to do more diagnostic studies, we found that she had a perforated esophagus. When we had her drink contrast it flowed freely into her chest behind her heart. In the absence of a stent to cover the hole or complex reconstructive surgery - this would often be fatal. 

Initial leak on right, follow up swallow study on left.

She had a coexisting pneumonia and was coughing up an unreal amount of pus. It’s unclear which process came first - the esophagus issue or the pneumonia. All I could do was place a chest tube to drain the fluid around her lung and a feeding tube in her stomach for direct nutrition. She wasn’t allow her to drink or eat by mouth for weeks. 

Through the amazing mercy of God, her esophagus healed. Many weeks later - after a negative leak test and then proving she could eat again - I got this photo of her the day we took out her feeding G-tube and discharged her from our care.

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I probably spent more time with this guy than any other patient in my time here. He recently lost both of his parents and then was badly burned in a field fire in Ghana. His chance of survival in this setting was low but so many people spent so much time in his care. I lost count of how many trips to the OR and how many skin gratings we did. I dreamed of the the day that he could come back to clinic. 

Here he is on the day we discharged him back to Ghana, giving me a high five which means his burn scar contractors are not too severe.

Thanks for praying for us and our patients. We see God a work here!

Dirt Bikes - by Avery

In West Africa, the cheapest form of transportation for the average Joe is the small motorcycle (aka “moto” ). These are used both for personal transportation and as taxis. These bikes are very often from Chinese companies who make extremely cheap scooters and motorcycles with an engine of 125cc or less, which is pretty small. 

I myself have a Yamaha YZ85 dirt bike, a higher quality bike imported from Japan. My dad was awesome to buy it for me, and we hope to sell it to another missionary kid here when we leave. This bike is a LOT of fun as it’s a 2-stroke competition bike with an amazing amount of torque. Even though it’s pretty small, I’ll say it’s way better and way faster than many bikes here. 

Although it’s a great bike, Yamaha is a Japanese company. Since it seems like 99% of all bikes here are Chinese, fixing a Yamaha/finding parts here is nearly impossible. There is a TON of dust in the air because of the desert and winds, so wear and tear on engines happens pretty quickly. Getting something like this here and keeping it running is quite an adventure. 

Garage David in Dapaong

Here are the steps we took:

1. Arrive in Mango and quickly figure out that our “car” is at the end of its life. It is clear that we need a few motorcycles to get to the market, for dad to go to and from the hospital quickly, and just for having fun (not much else to do for fun here).
2. Talk to “Uncle Adam”, the go-to missionary for logistics here,  about what motorcycle he would suggest we get. He says that Chinese bikes would get beat up pretty quickly and that we should instead consider a bike that he’s “had his eye on” in the capital city. He was, of course, talking about the 2014 2-stroke race bike at a place called “Garage Petite Japon” in Lome. He told us “that’s the bike I would get if I was you” and that it was “a great learning bike”. 
3. Take delivery of the bike from a taxi sent up from Lome (9-hour drive). It cost 800,000 CFA francs, or about 1,600 USD.  Who knows how many owners it’s been through; the cost of a new one at home is more like 5,000 USD.
4. Dad takes it for a test ride. When he comes back, we tell him that he did a small wheelie while starting out, and he didn’t know it.
5. Finley and I learn to ride our first motorcycle, which is in fact a competition motocross bike:0
6. Run out of gas and discover that 2-stroke oil isn't sold in our town. We borrow 1 liter of it from the construction shop on compound and promise to pay it back with an order of oil from Lome.
7. The bike manual says that some pretty serious maintenance has to done on the bike “every fifth race”. We don’t take it too seriously, but we do order some parts for the bike to be sent here when our Grandpa visits.
8. Grandpa’s flights get thrown out of whack because of weather issues, so instead of easy travel here, he has to fly from Indianapolis to Atlanta to Amsterdam to Casabalanca, Morocco to Conocou, Benin, and THEN to here. Almost before he even took off, we knew the luggage with our parts probably wouldn’t make it here because of all the switches.
9. Grandpa gets here with none of his bags. A few days later, we receive two of the three bags, and OF COURSE the most important parts were in the third bag. We highly suspect the bag was stolen because of the fact that Delta claims the bag was said to be delivered to the airport here..
10. Right after Grandpa leaves Togo, the ol’ YZ starts to have problems. Unburned oil starts to leak out of the muffler, and the bike has a rapid loss of power. Troubleshooting online says that it’s likely because of a worn piston, rings, or cylinder. Just so happens that those were the parts to be brought with Grandpa.
11. We do actually have the piston rings, which are usually the first thing to go bad in a motorcycle engine. Another missionary guy kindly offers to take us and the bike to Dapoang, a city north of here with a certified Yamaha workshop. We stuff the bike in the back of his Landcruiser. The people there do a nice job of putting the new rings in.
12. The bike runs great again….for about a day. It then starts having the same problems as before.
13. An older missionary kid here helps me clean out the carburetor, as that can also be a problem with these things. No improvement.
14. We order an engine rebuild kit on Ebay and ship it to Iowa City  to be sent to a visiting medical student who will bring it out here. There isn’t good enough internet on the hospital compound, so I have to go into town to another house to order it.
15. The medical student arrives with all his bags! We send the to Daopong along with the parts laid in the back of a station wagon taxi and receive it back 4 days later.
16. After 3 months of sitting in the garage on a stand, it finally works!

Brothers

Plenty of fun places to ride here!

Ride to the Ghana border

Some noise and air pollution :)