I returned last Friday from a visit to Bere’ Adventist Hospital where my daughter works as a volunteer nurse. I am trying to understand my experience there and to learn what it offers to teach me about myself, other people and cultural interaction. To get to Bere’ I flew 7 hours from Washington D.C. to Paris, then 5 hours from Paris to N’Djamena, the capital of Chad. The next morning we rode by bus for 5 hours, to Kelo and traveled the last 50 kilometers to Bere’ by motorcycle. The whole trip including layovers took about 42 hours.

Bere’ Adventist Hospital is a small 50 bed hospital. There are a number of government hospitals in Chad that are larger and better equipped, however, patients frequently pass these hospitals en route to Bere’.

The nurses at the hospital obtain vital signs and perform patient assessments, administer medications, manage IVs and catheters, and dress wounds. The nurses do not feed or bathe patients, wash clothes, linens, or bandages. All of these tasks are performed by their families. The patients sleep in open rooms holding as many as eight beds. The adult patients are assigned to these wards according to diagnosis irrespective of age or gender.

When the doctor orders treatment for the patient, the family must go to the hospital pharmacy to purchase the necessary supplies such as IV fluids, IV catheters, antibiotics, dressings, and oral medications, etc. These supplies are all kept in small cardboard boxes underneath the beds. If there is no money to buy these supplies, the family may choose to impound a bicycle, cooking pot, or other valuable so that the supplies may be purchased on credit. The costs are miniscule by 1st world standards ($2 for a Rocephin injection) but are substantial when one considers that 500 francs ($1) is the usual daily wage.

There are no curtains. There is no privacy. Not only do family members overhear conversations between health care workers and other patients, family members or other patients may be actively recruited to serve as translators, asking personal questions and relaying sensitive information to the health care workers or giving the patients instructions on behalf of the doctor or nurse. Enemies sometimes find themselves in adjacent cots.

One feels that one is awash in a sea of humanity. People are sleeping on the beds, beside the beds, and underneath the beds. They are sitting on reed mats on the porches, cooking over fires in the courtyards, and hanging laundry out to dry on clotheslines. They are watching one another’s children and one another’s dressing changes. Medical conversations often pass through two translators.

During the few days I was a part of this it seemed that my emotional reactions were intensified. When a young Arab woman lost her pregnancy and then died a few hours later, I wept as I watched her turbaned husband sobbing at the foot of her bed. I wept again as I helped a Gumbai woman take her first hesitant steps after eight years of walking on her knees. Unfamiliar with the medical illnesses that are common in this region or how to treat them, I nevertheless felt compelled to attempt to help in some small way.

What created the intensity? Were my emotional reactions heightened by cultural differences between myself and these patients? Did my inability to communicate verbally make me more observant of non-verbal communication? Was I more sensitive to the feelings of these patients because of their marked lack of privacy? Was it simply because the whole situation, (smells, clothing, practice) was so unfamiliar that my senses were in overdrive?

This heightened empathic response was not unpleasant, indeed it was intoxicating. But does this emotional state actually make one a more effective caregiver? Was it created at the expense of good judgment? What are the corollaries between my experience in Chad and that of immigrants working in Brooke Grove’s facilities? These are some of the questions that I am still pondering as a result of this experience.

 

We’ve already begun receiving holiday greetings from friends. This year we’d like to join the majority of you who send out a greeting before the New Year begins.

Currently Elizabeth and I are living in our three-room guest house. We moved in October right after the last child left. Moving into the guest house was a “move up” in several ways. Its location on the crest of the ridge means we enjoy the bright morning sun flooding our kitchen as we eat breakfast together. Because it is small and tight, we are warmer with just one woodstove in operation than we were in our previous home with two stoves, and of course, we are consuming our woodpile more slowly.

In addition to her work at Washington County Free Library, beginning in January, Elizabeth will be participating in an effort to catalog the Doleman collection. This collection of African-American memorabilia was recently donated to the City of Hagerstown. Elizabeth was recruited to digitally photograph and individually describe each of the thousands of artifacts included in the collection. She brings books and DVDs to Papa several times a week. She recently organized family and friends to feed 70 people at the Reach cold weather shelter in Hagerstown for the Saturday evening after Thanksgiving.

Evan and Jenny moved from Missoula, Montana to Olney, Maryland last June so that Jenny could begin a graduate program at the University of Maryland. She will complete a master’s degree in education and will receive her credentials to teach English at the secondary level in time to begin teaching next fall. She is doing student teaching at the River Hill High School in Clarksville and taking night classes in College Park.

Evan is working 4 days a week as a concierge for the Independent Living community on the Brooke Grove Retirement Village campus. On day five he writes for the corporate marketing department and is reworking the information to be presented on Brooke Grove Foundation’s website.

Ansley is a volunteer nurse at Bere’ Adventist Hospital in Chad. She lives with a laboratory technician, his wife, and their five (soon to be six) children. She has planted a garden and purchased a horse. Thanks to Sarah Appel, the director’s wife, she is learning to ride and care for it. She emails posts for her blog via a satellite phone to Alban who puts them up on the web. You can learn more about her life in Chad at www.howeareyou.blogspot.com.

Alban is a math major at Walla Walla University. He is living in an apartment with his friend, Phil, and calls Elizabeth frequently for recipes. He worked on the Obama campaign in Oregon last fall and is flying back in January to attend the inauguration. Last summer, Alban traveled from Bangkok to Frankfurt largely on trains. You can learn a bit more about that trip at www.albaninasia.blogspot.com .

Ted is thankful to be related to the rest of his family and to have so many loyal and interesting friends. He is enjoying good health, more time with Elizabeth, and daily morning walks with his father. He is working with an architect to create a plan to renovate the main house, and is trying to get up the nerve to begin the actual project early next spring.


Love,

Ted and Elizabeth

Returning Children

Last night our youngest son, Alban, returned from a three month Transasia excursion. I believe he was happy to be home but I suspect that his return was a larger event for me than for him. I always feel that the first 6 hours or so after a child returns are the most precious. The ride home from the airport and the first meal together are the times when memories are most readily shared, before they are diluted by the next day's responsibilities and while the contrasts between what one has just experienced and what one is coming back to are most vivid.

He talked about food, taxi drivers, and loneliness on the central Asian steppes. He recounted conversations on trains and shared insights about himself gathered from traveling with one other person across nine time zones.

When our children were small we were often counseled by older parents to enjoy the present because it is over so soon. I didn't anticipate how much joy I would experience when my children became adults.

 
 
 
 

This post is for those of you who enjoy seeing the subtle visual changes that occur as one moves through a season. This is a wistful time. Summer isn't over but there are clear signs that its days are numbered. We anticipate Fall's beauty, but one can't relax in Fall when winter is coming.

 

This is a hand drawn post card I received today from Alban.

 
 
 
 


Here are a few snaps from a week ago when we spent the weekend at the farm with the Fords and Evan and Jenny.

 
 
 
 


These are a few pictures from Ted and Beth's 29th anniversary.

This one's for you, Paul B.

Tools

I like tools. I am not the first owner of the tools I treasure most. My corner (mortising) chisel, whetstone, blacksmith vise, and scythe were in the woodshop next to the home I grew up in. My brother and I spent many happy hours working there. Our home was a log house built in 1794. The woodshop was of later vintage, probably late 1800s.

I have a 12 oz claw hammer that belonged to my maternal grandmother. She would not let my grandfather touch it because he always lost her tools. I also have the knife she used to split salmon before hanging them up to dry. Dried salmon was what the sled dogs ate through the winter. In later years she used the same knife to cut her raisin bread.

A number of my tools came from patients, most of them now deceased. It's always a bit delicate to ask their widows if I can buy their tools, but I do really treasure the beautifully made sanding block that once was Clairmont Friday's. I have a really nice brace and set of augers that belonged to a patient of Dr. Secondari's in Boonsboro. Dr. Secondari was recovering from a mitral valve replacement and I did a locum tenens for him 20 years ago. The patient, whose name I'm blocking on but whose initials A.H.S. are on my tri-square, had been a handyman. He had suffered a stroke and had lost the use of his right arm and could just barely walk. His stroke had also affected his speech and he couldn't say much but he cried as he handed me his toolbox.

I have two anvils made from a short piece of train rail. One of them was made by my patient, Willard Hodsden's father. (More about the other one below) Mr. Hodsden was an electrical engineer and a master craftsman. I have many of his tools including his Delta drill press, table saw and wood lathe. He sold those to me but gave me the circa 1940 GE range and oven that is in our farmhouse. He had hung on to it because of the memory of the apple pies his mother baked in it.

I have several of Cecil Powell's tools. Though just five feet four, Cecil Powell was the strongest man I ever personally knew. He was the maintenance man for the nursing home I grew up next to. As a young man he had lived in Grafton, WV. He plowed the family farm with a team of horses. He laid rail on the lines built to haul coal out of the mountains. The other anvil I have was his. Cecil Powell was not a finish carpenter, but you could count on what he built would "hold you". He was always punctual, kept his word, said little and worked circles around most everyone else. He put away his tools for the last time when his second hip prosthesis failed.

This evening I needed to straighten a piece of steel I found at the dump. I'm going to use it to strengthen the tow bar on my tractor. I got out Cecil Powell's three pound ball peen hammer and his anvil. Years ago he cut some grooves in the hammer handle to increase its grip. He used a grinder to do it and the result is effective though not pretty . In about 10 minutes I had straightened the steel bar and now have it clamped to the tow bar ready to weld.

I'm thankful to have known all of these people. I think they would be happy to know I treasure their tools, the memory of their friendship and the lessons they taught me. I wonder what will become of my tools when I can no longer use them.