Christmas extravaganza!

This week has been busy with Christmas festivities!

Monday I worked a very full day. The clinic was spilling over with people, but everything went well.

Tuesday I was invited by Patsy and Dave to the local arts and culture exhibition taking place in the nearby town of Maroua. It is an annual celebration held in a different locale every year. Apparently it is quite well known and the president himself came.

So, after finishing ward rounds we drove to the fair and took our time looking at beautiful textiles, paintings, woodwork and pottery. Our favorite part however, was a long line of homes made in the traditional style representing the largest tribes of the “Extreme North” of Cameroon.

A home constructed in the traditional "Musgoum" style. There are many members of this tribe who work at our hospital

After returning from the fair, we were able to participate in the tail end of gift distribution in Gorgoria, a neighboring leprosy village. The inhabitants there are no longer contagious, as they receive medications from the hospital, however it is the hospital's custom to purchase them gifts each Christmas. Bags containing tea, sugar, a bar of soap, vaseline and cooking oil were passed out to grateful recipients.

I was able to greet Moussa, the man featured in my previous blog entry. He was happy to see me, however he has another infection threatening his remaining leg. Please pray for him.

As I made my way around the crowd of women seated outside the church, they sometimes shyly, sometimes exuberantly offered me their greetings. They thrust out deformed hands with huge smiles and one member of the group even began to sing her thanks.

On our way back to Meskine, we passed a leprosy patient who was just returning to Gorgoria. Her daughter had already received a gift on her behalf, and when she heard we had come with presents, she began dancing right there on the side of the road!

The following day, after work, our group of missionaries got together to celebrate. Patsy and Dave hosted our dinner and their home was decorated with bona-fide tinsel and lights! The dinner was wonderful, we sang carols together and read the Christmas story. Afterwards we had a small gift exchange. In preparation for the get together, Patsy helped me to make my mom's traditional chocolate covered toffee, so we all indulged in the sweets:-)

Today was Christmas! I donned my new outfit and we headed off to church. After an excellent sermon by our talented pastor we returned to the hospital for another gift distribution. The week previous I received a huge box from Calvary Chapel Battle Creek which contained goodies for myself as well as toys and practical items for the patients at the hospital.

Me with my enormous box! I was so excited to get it!

Thank you so much Calvary Chapel of Battle Creek for the wonderful goodies!

So, after preparing baggies with multivitamins, snack crackers, little toys, candies, and crayons last week, I had the privilege of handing these out in the pediatrics ward as teams of my fellow missionaries handed out bags of tea, sugar, and soap in the men's and women's wards. Thanks to the generosity of CCBC I was also able to include toothbrushes, packages of tissues, and snack crackers to the men's and women's presents.

The bags made for the children contained multivitamins, a small toy, snack crackers and crayons. Each child also received two color pages apiece!

Getting ready to deliver the presents on Christmas day!

The reaction from the kids was precious. One sweet little girl could hardly believe that the present was for her. She was given a fluffy yellow stuffed chick along with her other goodies. When she saw it a huge smile illuminated her face as she glanced at me shyly, making sure she had not misunderstood. She was just so pleased.

Sweet smiles:-)

I was particularly grateful to visit with another little girl who has truly been fighting for her life. After sustaining a broken leg, her family tried traditional treatment in the village. The treatment failed, the leg became necrotic and infected and she developed tetanus. Her leg was amputated and the incision subsequently became infected. The last time I saw her during prayer rounds about a month ago, she was suffering from uncontrollable and painful muscle spasms caused by the bacterial tetanus infection.

However, today, while still timid and a bit fearful, she is in much better health. Her smile upon receiving a miniature plastic kitten complete with decorative leash in her bag of goodies was a welcome relief to the pain I witnessed at my last visit. I was so grateful we were allowed to bring her a little bit of happiness.

Another room contained a toddler who has sustained significant burns to her thighs and lower belly. She was exhausted after a recent, painful dressing change, but perked up a little as we handed her a small stuffed piglet from “Winnie the Pooh”. Her mother and grandmother were so sweet, smiling perhaps for the first time since their arrival.

That afternoon after a lovely dinner with friends, a nice long nap and phone calls to my family back home, the “Christmas week extravaganza” rolled to a finish. I am so grateful to God, who has given me peace and contentment during my first holiday season so far from home. He has been so near to me, great is His faithfulness.

While the appreciative smiles, greetings, even singing and dancing of those receiving the gifts has been amazing, I remember that “every good and perfect gift is from above, coming down from the Father of the heavenly lights, who does not change like shifting shadows.” (James 1:17) and I am humbled. It isn't Sarah, the rich benefactor coming from her country, forsaking family and comfort to give to the poor, but rather Sarah the broken, the sinner, who struggles on a daily basis, being used by a merciful God who loves her. I am more grateful for these experiences than I know how to express.

Merry Christmas!

Merry Christmas friends and family!

It seems strange to be writing this letter when it is currently 90 degrees and sunny outside! I must admit I miss the snow, but I anticipate celebrating Christmas here in Cameroon. Since my arrival last January, so much has happened. Work continues to go well. Every morning, I conduct ward rounds, moving from bed to bed, visiting each hospitalized patient. In the afternoons, I consult patients in the clinic. The range and gravity of illness here is occasionally overwhelming, but always very interesting.

With prayer and continued effort, I feel I have reached a place of friendship and mutual respect with my African colleagues. Communication in this culture is still a challenge, but I feel we enjoy one another.

I have been in excellent health since my arrival, which is no small miracle! Thank you so much to all of you who are specifically praying for my protection.

My language skills are slowly improving! I am grateful for my ability to speak French and rely heavily on this language when working. However, the majority of the patients, especially the women, speak only Fulfulde! Usually, I can make my way through a patient history without a translator and can greet and carry on a small conversation.

The members of our team here in Meskine really enjoy one another. We often get together for pot-lucks or games and every Saturday evening is dubbed “pizza and a movie night”. This fellowship and their prayers have been such a blessing during my first year on the field.

I have had the opportunity to see quite a few of the local tourist spots. In the spring, I visited Waza and Kalamalawe game parks where we tracked down herds of elephant and bumped into various birds and giraffe on the way! One weekend this summer, we drove to the village of Rumsiki to hike and photograph it's gorgeous hills and valleys. Finally, for my vacation this past fall, I took a trip to Lagdo, a beautiful lake in the south. I have posted photos of these locations on this blog. You can view them by clicking on the "click here to see my photos" link to the right.

I will be thinking of you all this Christmas. While it is difficult to be far from you, I appreciate the news I receive of your marriages, new arrivals, graduations etc and look forward to being reunited with you soon. May God bless you, thank you for your faithful friendship,

Sarah

Nazara

Today was a difficult day.

I was in the middle of rounds, hidden by the screens surrounding a patient's bed, when a nurse entered the ward. He could not see me and asked the nurse nearby if the “nazara” was doing the round. He knows who I am and usually greets me by name to my face. I stuck my head around the screen and told him that indeed, the “white woman” was doing the round.

This afternoon work in the clinic was intense, and I did not get the chance to eat. While washing my hands I saw a number of soft-drinks sitting on the counter. I asked my supervisor who they were for and he stated they had been purchased for the those working in the clinic. However, he laughingly informed me that our nursing supervisor had purchased the drinks for everyone except the “nazaras” ie myself and another white doctor.

Later, while on the wards, the mother of one of our long-term patients approached me. She stated that her son wanted to talk to me. The young man is well known to our staff as he has been hospitalized for a number of months. He was pleased to see me when I walked in the room and asked where I had been. We talked about his family, his physical condition, and he asked when he might be discharged. I referred him to the doctor doing rounds that week, stating it was a team decision. His mother then revealed the real reason he wanted to see me. He was hoping I would give him a new duffel bag.

My feelings were hurt and I was angry with the treatement I had received.

When I expressed my frustration to my fellow missionaries, they understood, had experienced the same things and encouraged me not to take these actions personally.

What did I expect? Accolades? That the Africans here might fall all over themselves to welcome and comfort me, to be my friend? Where did I get the idea I deserve to work in an environment where I am unconditionally accepted and appreciated? Was Jesus extended this same courtesy?

No.

I understand that I will never truly belong here. However, God did not send me here for my own comfort. I have come in obedience and He desires that I show love, kindness and patience. I am required to let go of resentment and do my best, regardless of my bruised ego.

What a comfort to be intimately known and appreciated by the Lord.

I love my grandma

I love my grandma.

Since I left the United States in the spring of 2006, she has written to me every month, and every month I wait in anticipation, searching my mailbox for her letter.

She tells me about the beautiful sunny weather, the walk she took that morning, her new perm, about going shopping with my aunt and mom. She fills me in on the trips she has taken to visit our family, her work in the garden, how she just bought a new camera.

I come home from a workday filled with multiple languages, sweltering heat, flies, harsh smells, death and suffering...to find an envelope with her familiar handwriting. I settle in as she tells me about baking cookies for the neighbors, and I am comforted.

I remember home.

Moussa

Every morning, while rounding in the wards, I keep a list of notes, my “to do list” for the patients. Often I jot things down such as “talk with physical therapy” or “check on chest xray”. However, today I had an unusual entry...“flip flops”

Moussa is a leprosy patient from a neighboring village who came in last month with a very serious sore on his right foot. Leprosy, which leads to nerve death and subsequent injury due to lack of sensation, often causes disfigurement of hands and feet. His left leg had already been amputated, and we were desperate to save his remaining limb.

He was discharged to do wound care at home, however, because he lives alone and had very little help, the wound was neglected and worsened. He was re-admitted approximately 3 weeks ago. Today during the rounds, I saw his crutches in the corner of the room and asked him if he had been going outside. He replied no, that he had not left his room during his entire hospital stay because he did not bring his shoes and was nervous to walk on his sore foot without them. He would be receiving a special orthopedic shoe, but it would be another week before it was ready.

So I made my note and after work went to the makeshift market at the front of the hospital. For the equivalent of about 75 cents, I purchased a very stylish pair of blue and white flip flops (the other choice was hot pink) and returned to Moussa's room.

He was pleased and immediately squeezed the flip flop over his bandaged right foot, doing the best he could to wedge it between his deformed toes.

He then swung into action...

He asked me to hand him his prosthetic limb. I did and he then began the laborious process of placing sock after sock on his amputation stump. With nubs for fingers handling the thick, woolen material was not easy. I stood watching him, not really sure if he wanted me to leave. However, after remembering that Cameroonians do not guard their privacy as voraciously as Americans, I stuck around. He was patient with my silent staring and after several minutes had passed, he completed his task.

He then reached for his prosthesis and began to fasten the leather strap around his knee. This action was equally as difficult and required a certain amount of dexterity. But he was a pro and after strapping on a flip flop, a leg and getting dressed, he grabbed his crutches and slowly made his way out the door.

I was impressed at the amount of effort it took him to simply go outside, at the way he went about his work without complaints or loud sighs of frustration or fatigue, as if expecting nothing more, nothing different.

I left him sitting in the fading sunlight of early evening, watching the goings-on of the hospital courtyard, liberated from his room for the first time in almost a month.

ho ho ho

This evening I saw a woman who complained of infertility because at the age of 48 she had not become pregnant since giving birth to her eighth child 2 years ago.

If that's infertility, then I'm Santa Claus.

I congratulated her on her eight living children, reassured her that nothing was wrong and sent her home:-)

Summary

Someone recently asked me “what is it like to live in West Africa?”

My initial response was...”I don't really know”.

This question is huge, there is no one answer. So here goes...

I have become accustomed to bleaching my veggies to kill parasites, sleeping under mosquito netting, thinking of malaria each time I get a headache, the call to prayer of the local mosque, the lizard that lives on my porch, the bats that occupy one corner of my ceiling and the rain that thunders on my metal roof.

I am used to seeing men wash their faces, ears and feet for prayer, watching them prostrate themselves and come back up, sand on their foreheads. I skirt around the edges of their mats instinctively understanding that it is bad manners to step on them with your shoes. I know that the metal pots women use for food preparation are made in Nigeria, and that they are often given as wedding presents. I can tell you the monetary exchange rates for three different currencies, I daily function in at least two and sometimes three different languages and can inform you of the time differences between Cameroon, Europe and home.

I enjoy the brightly colored cloth the women wear and how they wrap themselves from head to toe in matching patterns. I like how they strap their children on their backs so that the baby's cheek is smashed against his mama and his little bottom sticks out making a sweet silhouette of mother and child. I am consistently amazed at how they so elegantly glide around with huge loads of firewood or cooking pots on their heads. I enjoy their greetings and bright smiles as they casually sit around the hospital with their children.

I like how the men take off one shoe and put their foot up on the bench where they sit conversing. I like how visitors at the hospital all remove their shoes at the threshold of the patient's room, leaving a little pile of flip-flops, or how they greet you while holding their hands out toward you, as if to bless you or receive blessing. I enjoy watching them moving in and moving out of the hospital, like ants in a constant stream or ducks in a row, carrying large loads of belongings.

I especially like the little old ladies who look as if they are made of dark brown leather, stooped over and shuffling along, holding their wooden walking sticks.

I find this country beautiful and marvel at the homes made of mud. Their shape differs depending on location, some are square, some are round, some made of brown earth, others of red earth, others of stone. Flowering vines creep up and over their walls and children, goats and chickens run around the yards. Their roofs are often thatch, which on the round homes come to a point, secured by a tire, or a brightly colored pot. They sweep the dirt in their courtyards, giving their homes a clean, neat appearance.

I like how they never throw anything away, but fix or find new uses for everything, like the plastic chair in the market with only two front legs, a wooden crate has been fastened to the back and viola, a whole new chair! I enjoy the market, the constant movement, people coming and going on bikes and motorcycles, carrying what looks like impossible loads. Little old ladies sitting at the dried fish stands selling their wares, piles of ground spices and seasonings in colors of amber, dark green, brilliant white. The music plays and men drink tea and chat and women walk around with plates of cucumbers or eggs on their heads, just in case you would like a snack.

Since my arrival I have seen mountains, hills, valleys and bush. Cameroon contains them all. I have witnessed a group of elephants making their way to the watering hole at sunset, and giraffe running across the plains at full speed. In the hot season, everything is brown, and in the simmering heat, the Sahel opens up with a kind of savage beauty of thorn bushes and dry season millet. In the rainy season, cool breezes blow through, surprise thunderstorms come flashing in and everything is green and lush. Bushes and trees burst forth with flowers in orange, yellow, red and pink and birds in matching colors sing from every branch.

However...

It is so difficult watching people die of infectious illness that are so easily prevented in my home country, watching them struggle. I am frustrated when they choose to go to traditional healers in the village and seriously injure themselves, then come to us for help.

I don't understand how they can't accept chronic illness and death, but would often rather fight, even though they will not win, exhausting all their meager resources. To tell someone they will most likely die is a taboo, so I treat, knowing it will not help, knowing they don't have the money, wishing they could just go home in peace.

I am frustrated at the risks they take on the road, riding too many to a car or a motorcycle, driving too fast in bad conditions, then come in after their accidents in the middle of the night, bodies broken. I hate it when children die of malnutrition, wasting away as their faces tell stories of misery. I hate malaria, and the fevers and convulsions that accompany it. I hurt when a parent takes a seriously ill child home, stating they do not have enough money to stay at the hospital.

Trying to communicate has been a challenge. I do my best, I observe, try to use examples they will understand, I change my vocabulary, but there is often a disconnect and perhaps a deep-seated mistrust that blocks my attempts. So this ability has been stripped away and misunderstandings and conflicts have inevitably taken place.

I can't control death, this has been difficult for me to accept. I can't save them all, this too, has been difficult.

I often get tired of being conspicuous. Simply taking a walk in the village draws a crowd and cries of “nazara” and “bye bye”. People stare at me all the time and watch every move that I make. Teenagers mock me. My skin is too white. Moving through the market illicits attention from children forced to beg, the mentally ill, and vendors who assume you are rich. Coworkers ask you for loans, patients ask you for medications, people glance hungrily at your bag, skirt or shoes, coveting them.

I miss my family.

I am aware that no matter how hard I work to understand this culture or show love, I will never truly belong.

I realize that there is so much I don't yet know.

So, there are many things about my life here that I appreciate. There are also some difficulties that come with living and working in a culture and amongst a people so different from my own. Perhaps the best thing about my time here is what God has been teaching me. That I am powerless, that this is too big for me, and I need to rely on Him with complete dependence. This understanding is liberating, and it draws me closer to Him.

I also have a new, deeper understanding that God is good in all circumstances. In the midst of poverty and suffering, He is the only thing that makes any real difference, that brings any real hope or peace. I have witnessed this.

If given the option would I do it all over again? Yes. It has been worth it.

Trust

This morning during rounds, the doctor and I started ward 3 together.

I saw and greeted the husband of one of my previous patients. His wife was back in the hospital a 3rd time in 2 months for respiratory difficulty. In all of my dealings with this couple they have shown intelligence and understanding, patience and kindness.

However, this morning, the husband was obviously concerned and told me that his wife's status had worsened. But before I was able to see her, I was called away to another ward, and left the doctor to finish the rounds on her own.

Later that afternoon, an examinateur came and found me, stating that this patient was in severe respiratory distress and I was needed right away. Upon our arrival, we saw that she was unresponsive and breathing with great difficulty. As I entered the room, the husband looked at me and in a choked voice stated “I wanted you to see her this morning...”

God bless this sweet man. Desperate to save his wife, he believed that I could help him. He trusted me...not knowing that I am powerless.

I just coordinate care, it is God who saves lives.

I placed my hand on his shoulder and told him truthfully that his wife's case was serious, that we had done everything in our power to bring her back to health, and that he had done an excellent job caring for her. After taking all the emergency measures possible, the team left the room.

Shortly afterward, she died.

Her husband shook my hand and thanked me and the team for our help and kindness. He then sat outside in shock and grief as his family packed their belongings for the journey home.

God

There is so much pain here.

There are so many seriously ill people. Sometimes I wonder how much a body can take.

Just recently I escorted one of my patients into the operating room and stared in shock as he was placed on the table. Naked, feverish and emaciated, he was mumbling something that didn't make sense. He was a pitiful, wretched sight. It will be a miracle if he survives.

The only prayer I could manage was a strangled, “Father...”

In the face of all this pain, these eyes that plead with me to do something, the hopeful, desperate relatives that keep vigil by the bedside I cry out to God.

I am powerless, this is too big for me, I can't relieve their pain and I hurt for them.

God is good, He is faithful, and He hurts for them too.

Pagnes

Here in our part of Cameroon, most of the women wear "pagnes" which consist of a wrap-around cotton skirt with matching blouse, head cover and shoulder wrap. The colors are crazy and the patterns can be quite amusing.

I have decided to keep a list of the different patterns I have seen.

This list will be updated periodically:-)

Here goes...

1. cellular phones 2. perfume bottles 3. billiard balls 4. gas pumps 5. hair dryers 6. fans (electric and hand held) 7. chickens 8. the president of Cameroon, Paul Biya 9. high heeled shoes 10. parrots 11. peacocks 12. playing cards 13. armchair (complete with side table and lamp) 14. bowls of fruit 15. apples 16. light bulbs 17. gas lanterns 18. stacks of money 19. champagne flutes 20. windmills 21. whales 22. bulldozers 23. birdcage (complete with bird) 24. cuckoo clock 25. tubes of paint 26. turkey, dressed for cooking 27. the Taj Mahal 28. crawfish 29. chandeliers 30. balloons 31. ladders 32. cars on a street with trees 33. raffle tickets 34. toasters

That's all for now, I will keep you updated!

This one's for you, mom:-)

Today during morning rounds, I came across a patient that was newly admitted. The examining nurse had written in the chart that she had multiple necrotic sores on her foot. In addition a blood sugar test showed that she is more than likely diabetic.

After perusing the chart I then asked to see the foot. She began to unwrap her homemade bandage of cotton strips to reveal that almost her entire foot was completely black...except for the part that was leaking pus.

A maggot fell out of the wound and started crawling across the floor...

I told her to cover the wound again because the smell was so strong I had tears in my eyes and hastily wrote in the chart that she needed to be seen in the OR.

Just another day at the office:-)

Helpless

This evening was prayer rounds. Upon walking in to the OB ward, my prayer partner and I encountered immediate resistance. I tried to strike up a conversation with a mother who was taking care of her sick infant. She did not smile, barely acknowledged my presence and refused to talk to me. I continued my attempts and even went so far as to call the nurse over to care for the child's IV, but to no avail. The young mother in the bed next to her followed suite and also refused in the same rude, cold manner.

We then entered the women's ward and approached a new arrival. Her husband refused our prayer, demanding to know if we were Christian. When we replied to the affirmative, he nervously and forcefully demanded to speak to one of our hospital chaplains. The chaplain was called, but the man stated that even though he was also a Christian, he did not want our prayer because we did not worship the same God.

My first response was to feel threatened, then angry at their treatment of me. I was frustrated by their ignorance. For the first time I had a glimpse of what life must have been like for the disciples. I can not imagine trying again and again to share God with a people who shun these efforts with coolness and hostility.

I came home and prayed for them anyway.

After prayer rounds I was then informed that the young patient whom I wrote about in the previous entry (Overwhelmed) had developed yet another abcess in her arm. The situation seems truly hopeless. She is only 16 and dying very quickly. She is so frightened of evil spirits and witchcraft that she seems to have given up. She refuses to leave her bed, she no longer eats and is wasting away before our eyes on a daily basis.

So I do my best, changing her meds and securing appropriate therapies, but I can not even begin to touch the real source of the problem. This leaves me feeling helpless and impotent.

We have assured her that God protects this hospital and that He is more powerful than any evil spirit that might be sent to attack her, but what happens if she dies? The enemy wins? How do you prove the presence of an all powerful God when the family's greatest fear is validated, their belief in witchcraft seemingly justified?

I came home and prayed for her too.

Overwhelmed

One of my patients, a young woman of approximately 16 is currently hospitalized due to recurrent high fevers and a severe pulmonary infection. When multiple different antibiotics resulted in little to no improvement, we moved to the diagnosis of tuberculosis and began treatment.

However, this morning, while preparing to do rounds on the ward, I was told that this patient was again running a very high fever. Upon examining her we found that in addition to her tuberculosis, she has a very swollen and painful left thigh. Her heart and respiratory rate were greatly elevated and she began convulsing.

After running a few quick tests and giving her a sedative, I added medications, spoke with the family and reminded myself to check on her at the end of the day.

When I completed work in the clinic, I spoke with Dr. Jacqueline Koster, who had been with me during the patient's episode of convulsions. She had visited the patient to obtain more history and at that time the mother confided that when her daughter began experiencing abdominal pain that morning, the family had desired to take her home immediately.

Apparently they have been greatly concerned and frightened that there is someone in the village practicing witchcraft and that their daughter is the target. When the patient began experiencing this symptom of pain in the “stomach” the family believed that the evil spirit was trying to eat her. This “tactic” of witchcraft is very well known, and some victims even choose to take their case before the Laamido (chief of the village) in order to punish the alleged perpetrators.

Whoa...

So...what lab test can I order that would give me that kind of information?

I sat in stunned silence wondering once again how I will ever break through the barriers of language, culture and spiritual beliefs that keep me from understanding these people I want so desperately to be well.

Every time I step on their cultural toes with my actions or mannerisms, every time they try to explain their symptoms in ways I simply can not understand...I wonder the same thing. When they come in to the clinic, having cut or burned themselves, trying to cure themselves of their illnesses, I just look at their scars or burn blisters and am reminded again of all that I don't know.

I'm chipping away at the tip of the iceburg, just hoping to treat what I don't fully understand.

tick tock...

I would just like to make it known that since my arrival 6 months ago, two of my friends have become pregnant, a third friend will have her baby in the fall, another four have gotten married and two have gotten engaged.

Keep praying people...

My Day

Today started like any other, I woke up, got dressed, ate breakfast and headed out the door with my bag of books. I got set up in my office and began to receive patient charts.

Patient #1 was a young widow with complaints of lower abdominal pain. During our time I found out that her husband died of an unknown, mysterious illness. We ordered a number of exams including an abdominal echo and an AIDS test. We found that she has a large ovarian cyst that requires surgical intervention, and that she was positive for HIV. We spent a while talking about her upcoming treatment, we prayed together and she left.

Patients #2 and #3 were a married couple who came in for evaluation of their infertility. They conceived two children, both of whom passed away. They have not been able to conceive for the past 6 years. They have undergone a number of tests and treatments already in N'Djamena, Chad, but chose to come to our hospital for a second opinion. We discussed their options including lab exams, imaging studies and medications. They will talk about this info together and possibly return in the future.

Patient #4 was an elderly gentleman who was waiting for me in the hallway. He has lost quite a bit of weight and has been coughing up blood. After a 2 week course of antibiotics he felt better, but the exams showed that he was positive for TB. In addition, during another revision of the lab exams, we determined he may need his prostate removed. He was referred to the surgeon and the TB dept. It was tough to convince him of his need for further treatment, he has a large family and wanted to return to them as soon as possible.

Patient #5 was young woman who also came with the complaint of weight loss and chronic cough. Her lab work was positive for both TB and HIV. We prepared the appropriate referral paperwork for the TB department and her upcoming ARV (antiretroviral) treatment, prayed together and she left.

Patient #6 was a skeletal 3 year old girl. She was so weak that she urinated on my office floor. She was coughing uncontrollably and her mother stated she had suffered from diarrhea for months. I picked the child up and carried her to the pediatrics ward as the mother followed with a second baby on her back and a large bag of belongings in her arms. I ordered a number of lab exams and left, reminding myself to return to check the results.

Patient #7 was a middle aged woman with complaints of pain and weakness in her legs. She stated she was simply “not feeling well” However, during physical exam I found no problems with her legs, but discovered that she was feverish and had a widespread rash over her whole body. Her test results revealed a bacterial diarrheal infection, urinary tract infection, malaria and HIV. I prescribed a number of medications, attempted to explain all of them, prepared the referral letter for her to begin ARV treatment and prayed with her before she left.

I was just about to take a look at the results of patient #8, a pregnant young women with asthma, when our accountant from the hospital called to let me know I needed to meet him in Maroua, the nearby city that afternoon to complete paperwork for my residency card.

So, I shuttled my remaining patients to other workers, changed my clothes (since I had already been urinated on that day:-) and went to the entrance of the hospital where my director hailed a taxi. I crawled into the backseat which smelled strongly of either dog or goat and headed out.

The roads are quite an adventure during the rainy season and I held my breath as our little compact car navigated a number of deep puddles. However, it was a beautiful day, and I enjoyed the ride. Everything is green now, including the mountains. The skies are full of enormous, fluffy white clouds which cast impressive shadows. The riverbed is no longer dry, since the most recent rain, there is water spanning about 1/3 of it's width. Children swim and play, and people wash clothes.

The local neighborhood restaurants were hopping, and vendors were selling their plethora of used clothes by spreading them out on the sidewalk or walking down the road with them on their heads. Little boys ran together down alleyways pushing metal rings with their sticks and riders on moto taxis waved to one another. I recognized carts full of manioc and peanuts and huge bunches of bananas lined the road.

A group of old men were sitting together selling bundles of something that looks like grass and I made a mental note to ask someone what it was. The road was absolutely full of bicycles, motorcycles, cars, chickens, push carts, pedestrians and children. The whole city is in a state of controlled chaos, everyone going their own way, yet fitting together somehow.

We arrived at the police station and I hopped out, met up with our accountant and entered the building. I was greeted by a cloud of cigarette smoke, dirty walls and a blaring radio program, conducted in French. We waited patiently as my paperwork was finished, payed the correct amount, moved to another room where I was fingerprinted, then moved to yet another room where I was photographed. I had to remove my head scarf for the pic... I inevitably looked like a serial killer...as I do in all passport/formal photographs:-) Voila, I am now an almost legal resident of Cameroon, West Africa.

Our trip back home was uneventful, except for a couple of near misses with a rooster, a chicken and a baby duck. Upon arrival at the hospital, I headed back to work on the hospital wards. In pediatrics I found the little girl I admitted sitting up and eating, which was promising, however a review of her lab results shows that she was positive for malaria and HIV. We consulted with the mother, who has been wonderfully cooperative, and we decided together to wait and test the rest of her children and herself after her husband arrives and gives permission. A positive diagnosis of HIV carries with it accusations and blame, and testing is often quite a delicate matter. We started the little girl on treatment, I will be visiting her this week.

I then made my way to another bed containing a 14 year old patient I saw just yesterday. He returned with his mother that morning and underwent incision and drainage of a huge abscess of his right thigh. The contents of the abscess were a little suspicious and I asked the nurses to send a sample of the drainage to the lab to check for TB. This bacteria can take up residence in many different areas of the body. In the meantime, this young man, who has been suffering with a hot and swollen thigh for a month and who just underwent surgery that very morning was in the process of making his bed when I left him. His strength is amazing.

As I was sitting at the nurse's station, writing up treatment plans in the charts I heard screaming from the far end of the room. A little boy of about 7 was undergoing a dressing change for his right thigh which is almost 50% burned. This is an exquisitely painful task. His mother, baby strapped to her back, was all alone except for the nurse performing the procedure. She had to leave the room to escape his cries. I walked to the bedside and sat next to the boy, stroked his head and back and talked softly to him. The mother returned and sat next to me, she was so tired. As the nurse was placing the fresh bandages, the little boy actually remained perfectly still, holding his leg up in the air in order to help the nurse. I was once again struck by the strength and resiliency of these people and in particular, their children.

My work in pediatrics done until tomorrow, I headed for the women's ward. I looked in on a patient that just recently had her thyroid removed, another older women with heart failure and significant fluid accumulation in her abdomen, and lastly a patient that just underwent a second surgery for a non-healing femur fracture.

The work completed, I headed home. It was an unusual, yet interesting day. My coworkers wave their goodbyes and wish me a “happy weekend” ...I am looking forward to it:-)

Blood Donation!

I don't know what possessed me to wait and proceed with my first blood donation upon arrival in West Africa, but that is precisely what happened. You'd think I would have done a practice round on my home turf, but nothing doing...let me just say they didn't give me a cookie and orange juice afterward:-)

Upon working with Dr. Jacqueline Koster at the beginning of the week, I met a young woman with prolonged and probably fatal liver failure. She was hospitalized and found to have a significant anemia. A few days later, while pursuing her records, I noticed that a donor had not yet been found. There is no blood bank here, and multiple patients have been sent home with dangerously low blood counts due to the lack of blood for transfusions.

Wouldn't you know it, we had compatible blood types. I could not ignore her need. I proceeded to the lab for the initial screening exams. We had to swat away a few flies, but the lab technician was an expert, I barely felt the needle.

Upon arriving on the ward for the donation, the nurses joked with me saying I looked a "little pale" and was I sure I wanted to donate? (pale...I'm white...get it?) I told them I had plenty of blood and hopped up onto the table with a courage I did not feel. A mere 15 minutes later, a bag of my blood was ready and waiting for Aissatou. During the procedure the patient's mother was called as a witness to the source of the blood. Mistrust is understandable in a country with an AIDS epidemic.

The next day, the mother spotted me and called me over. She took me by the hand and pulled me into Aissatou's room where she proceeded to give me a bolt of fabric used to make a pagne, the outfit commonly worn here. She and her daughter were very appreciative and while I would have been happy to remain anonymous, I was touched by their gratitude.

I don't know if Aissatou will survive. The odds are certainly against her. I can only hope that my action brought her comfort during this time of great illness.

Observations

During my past 4 months of work in the clinic, I have made certain little observations. Life is so different here, I try not to take anything for granted.

I have become a pro at pronouncing most of the names of my patients, such as Fadimatou, Ousmanou, Fatime and Aissatou. I also know that “Mht” is a very convenient way of abbreviating “Mohammet” and that Hamadou indicates the eldest son of a family.

I can now distinguish Cameroonians from Chadians on sight based on their clothing, personal belongings, height and the color of their skin.

I am familiar with the fact that many Chadian women come in multiple layers. They often wear shorts then a slip then a skirt plus blouse plus a head scarf and top it all off with about 3 yards of extra material which wraps them up like a present:-) It often takes a few minutes for them to disrobe in preparation for their examination.

One of the most common health complaints here is pain. When the patient sits down with his translator and begins to point to his head, shoulders, back, stomach, hips, knees and feet in rapid succession I know I have my work cut out for me:-) Last week we met a man who believed he had been poisoined when someone shook his hand and a woman who after 6 years of amenorrhea, came to us convinced she had been pregnant for that entire time and requested we remove the baby.

When asked, most women will reply that they have given birth to about 10 children and that approximately 5 of them are still living.

The following excerpt came from a thank you letter I recently wrote to a church in my hometown;

"One of my favorite things about life here is watching the family members of our patients. Often they will come with their sick relative, spread out their mats and cooking supplies and carry on with life in one of the many hospital courtyards. The children will play, the mothers will feed their babies or cook a meal, the men will sit together and talk. Clothes hang from the trees to dry, people nap, women wrap and re-wrap their “pagnes” or skirts as they bend to pick up a load of wood or a bucket of water and proceed to place it on their heads:-)

And so they move in...and move out, and life continues to flow in and around the hospital of Meskine. I cherish my time here and am so grateful for all of you who have shared in this experience with me. God bless."

AIDS

I went into the clinic today to find that our supervisor was attending a funeral for his sister who was a long time AIDS patient. She had just been hospitalized two months previous for overwhelming infections.

This week I have diagnosed 3 different individuals with AIDS. I open the envelope, read the test results, and wonder how I am going to break the news. It's that precious moment between knowing and not knowing, they are still oblivious to the fact that their life is about to change forever. This moment breaks my heart.

Two days ago, the missionaries here lost a dear friend to this disease. She had struggled for a number of months, and despite our prayers for a miracle, passed away. She has been a believer for some time now, and I have been told that she displayed peace, joy and a true understanding of God. Please pray for our team as this loss is quite a shock and please pray for the other believers, that they would come together to care for one another during this time of mourning.

Sweetness...

Today as I was walking through the crowded dispensary, dodging feet and knees, trying not to step on anyone, I felt someone take my hand. I stopped and looked behind me and there was a little boy, returning my gaze. I said hello and we just stood there a minute, hand in hand. I think he was fascinated by the color of my skin and I was happy to oblige his curiosity.

During one of my visits to the pediatrics ward, a toddler hastily crawled up to me, grabbed both my ankles with both his hands and just held on! So I stood there awkwardly, with this little guy massaging my ankles as his mother and her friends howled in laughter. They said that he was so interested in the "nazara" - white woman.

Recently, when passing the lab, a little girl cried out "nazara!" with a huge smile. She was truly excited to see me, as though she had known me for some time. This caused her mother to break into a smile and we laughed together.

I love kids, I appreciate their lack of inhibition. They break down the barriers of insecurity and uncertainty and allow you a chance to connect.

Ward Rounds

Each morning, before starting work in the clinic, I complete rounds in the hospital. This means reviewing vital signs, lab results, medications etc on each patient in the ward. This week I am in pediatrics, here are my patients...

Bed 4 contains a little boy of 7 who currently has significant fluid accumulation in his abdomen. We think it may be due to liver failure, but we aren't sure and can't find the cause. So he continues to “fill up” on a daily basis. Just recently the fluid became infected, we started him on antibiotics. He has lovely long eyelashes.

Bed 5 is a 5 year old little girl currently undergoing chemotherapy for an abdominal tumor. She is skeletal and vomiting. Just recently she developed an abscess that had to be drained. She howls whenever we come near her. Her mother dresses her in the prettiest clothes.

Bed 6 is a tired 10 year old little girl with heart failure secondary to an infection that damaged her mitral valve. She currently has fluid accumulation in her lungs and difficulty breathing. There is no valve replacement surgery here in Cameroon as in the US. She will remain on medications for the rest of her life.

In bed 12 is a cheery little 7 year old whose platelets are dangerously low. Platelets cause the blood to clot, so without them he bleeds out his nose and stomach. This has caused his anemia and within the past year he has received 5 transfusions. He will be returning to the hospital for further testing within the next month. He has the cutest smile.

Private box 3 contains two infant girls approximately 2 years old who haven't been given enough to eat. They are dangerously malnourished and weigh only about 12 pounds apiece.

In private box 4 is a little girl of 8 who recently woke up from her coma following a car accident. She has significant facial fractures and lacerations and is now blind in her left eye. A maxillofacial surgeon is coming to the area and she will receive surgeries to repair her injuries in a nearby hospital. She is the sweetest and always sits up when I enter the room, paying great attention to my every move.

These are the patients who stand out in my memory. Soon they will be gone, their beds occupied by others. I know their stories aren't easy to read, but thank you for sharing in this with us.

Loss

We lost a pediatric patient. He struggled and suffered until finally dying a week after his admission. We did every test we could think of and placed him on appropriate antibiotics. However, the cause of infection remained a mystery and in the end, we were unable to save him.

The family was gathered throughout the week in a silent vigil until one morning when they seemed to just disappear. The bed was empty and they were gone, the battle lost. They collected their things and quietly returned home with their grief. They had been so patient, so wonderfully forbearing in the face of suffering and fear.

They had placed their hope and faith in us, you could see it in their eyes.

And so it begins...

I started work at the hospital this week. I am enjoying myself, happy to be back in the swing of things after a year of language study. I missed medicine, although I am finding things much different over here!

I never imagined myself working in a clinic where TB, AIDs and Malaria would be some of the most common illnesses, where I would need to wipe my face with my handkerchief during the physical exam to keep from dripping on the patient, and where one of the questions I routinely ask is “how many wives do you have?”

I can't pronounce half the names, let alone read them, so most of the patients waiting in the hall get a real kick out of my attempts and quite often the Arabic has to be translated to Fulfulde to be translated to French before I can understand the response to my question.

So, with God's help, I am making friendships and learning the ropes. It has been great meeting people face to face, they become so much more than “Africans”. It has been a relief to care for their needs, to feel productive in easing their pain.

Culture Shock

I dread walking over to the hospital.

It happens every time, I get up to the gate and begin to open it, I step onto hospital grounds and my heart starts beating faster. I am suddenly very conscious of my clothes, hair, skin and I want to run away.

I begin to walk past the buildings and everyone stares. This is no exaggeration, here, staring is perfectly normal. All heads swivel in my direction and hawk my every move. Children stop what they are doing to stare, women stare with a strange mix of resentment and uncertainty on their faces. It is only when I greet them that I see their smiles. Occasionally I am ignored.

The men stare, I try not to meet their eyes.

I reach the counter to purchase something to drink and wonder to myself, why the women at the registers are kind to me and no one else. People standing next to me stare as I pull money from my purse and push to get ahead of me in line. One time a man got angry at me for socializing with the employees while he was waiting to be served.

I have been told, when I am in need of a prescription for Motrin, malaria prophylaxis etc, that it is perfectly acceptable to walk past the line of sick who are waiting their turn and knock on the examiner's door. He then lets me in ahead of everyone, and helps me within minutes. This goes against my cultural training. I have been taught to wait patiently, but this is how things are done. I know that I receive this preferential treatment because I am an employee of the hospital, but I also know that the Africans waiting in line think otherwise.

When my African friends ask me for my clothing, or the specifics on how much I pay for rent, or send me veiled messages that they want me to help them financially, I am struck by the differences between us, and realize that my definition of “friendship” must stretch and change to fit this culture.

I want to love these people, to be a part of their lives, to hug their children and comfort them when they mourn. I want them to understand who I am, but the wall of culture and race seems impenetrable.

Don't be shy!

Hello Everyone! Just a note to let you all know that anyone can comment on any of my blog entries. I love feedback and would be greatly encouraged to know that you have been enjoying my efforts.

Thanks! Sarah

Tension

During my two months here, I have encountered something that I naively did not expect. Just below the surface of many relationships, implied by nonverbals and unspoken words, apparent in the looks of the occasional stranger, is a undercurrent of resentment because I am white.

I don't fully understand the offense I have committed, I haven't been here long enough to wrap my mind around it. I can't fully grasp the pain, the suffering that fuels it. I am not sure what to say. When I smile and greet a woman and am ignored, I want her to understand that I am sorry, that I don't want things to be this way.

How can you serve penance for a crime you did not commit? Or did I? Is it now my responsibility to make amends?

The one thing I know for sure is that Jesus is the only one who can bring comfort to us, in the midst of this tense and sensitive climate. Without him, there is no redemption, healing or love.

What do you mean I'm white?!

I looked down at my feet yesterday and was surprised that they were white! After being around Africans for the past two months, some of my perceptions have changed.

For example, church will last a minimum of three hours, there is no limit to how many people you can fit on a motorcycle and anything can be carried on the head....anything. Chicken is rarely worth the work to eat it, since the poor things have no muscle to spare, and boule made from millet flour is not half bad. Being stared at in public, having children touch your car and chase your bicycle is not at all rude, but perfectly normal. Greetings are no longer a simple “Hi, how are you?” but rather “Hi, how are you, how is your health, your family, the heat, the work, are you fatigued”...etc:-)

The other day, I realized that I was riding my bicycle with one hand, holding my skirt down with the other, dodging goats and a woman carrying water on her head in 105 degree heat while bumping over potholes.

Lord willing, I think I can do this:-)

soobaajo am "my friend"

Today was a good day.

My language tutor was not able to make it to our lesson this morning. He told me that, if he was able to find enough help, he hoped to harvest his crop of millet. He planned on working all through the evening and stated that possibly he would be too tired for our meeting. I believe this qualifies as one of the most legitimate excuses I have ever received from a “prof”:-)

The weather here has consistently remained between 104 and 105 degrees for the past week and riding my bike into the village during the hottest hours of the day did not sound very appealing. So instead of my lesson this morning I got ready and left to visit my language contacts in the village.

Sureeya is a young woman with three children who is an incredibly good language helper. She lives with her two sisters-in-law as well as her mother-in-law in the same compound. We sat and chatted for approximately 45 minutes, all in Fulfulde! She speaks slowly, repeats herself often and is very patient. She can also re-word phrases when she understands that I am hung up on a particular noun or verb, she is a huge help.

Two weeks ago when I visited I asked if I could take a photo of her boys all dressed in their duds to go to Koranic school. She said yes and asked if I could take a photo of both of us as well! So this time I happily obliged and brought along my camera. Well, the boys were not photo-ready, but she hastily changed into one of her best outfits and dressed her newborn. When I took a pic of the baby and showed it to her, she asked why she wasn't in it as well:-) So then we set up the auto timer and went to town! The result was some very lovely photos.

Before leaving she fed me some fried bread balls and a very sweet coffee. She placed my coffee in her prettiest teacup, Africans are wonderful hosts.

So today was a good day. I talked in Fulfulde, avoided the heat and advanced a bit farther in my understanding of this culture. Most importantly, I made a friend.

Birthday girl!

I just celebrated my first birthday in Africa! I have to say, it was definitely unique.

I started the morning with my language tutor Adamu, and we had a great lesson. I am currently learning the local tribal language of Fulfulde and practiced constructing sentences like “Debbo oo don haa wuro Bogo” (This woman lives in the village of Bogo)

Afterward I headed for the market that is located in front of the hospital. I greeted the ladies at the “donut shop” a little stand where they fry dough balls. One of the women told me to give her my skirt, which is her way of complementing me, saying that she liked my outfit. I told her if I were to do that, I would be walking around naked, and we couldn't have that. All of the women laughed at my joke. Joking and being clever is greatly appreciated and valued here in Meskine.

I then bought some candies and headed for the pediatric ward. I have been visiting a little girl named Esther, who lost her father this past July and was badly injured this January. She got too close to the cooking fire and sustained significant burns to the entire circumference of both thighs. I had seen her mother the day previous, and was told that Esther did not sleep well the night before due to pain.

Esther was pleased with the candies, and my promise to return the following week. However, she was quite nervous as she prepared for her daily bath and the excruciating dressing changes she would have to endure. Please pray for this family.

After lunch, I went shopping with Jacqueline. As usual, we beeped our way through a flock of children playing soccer on the road and weaved past goats and sheep on our way into town. We then parked and headed to our usual grocery store. Finding our favorite shop is always an adventure. After hopping over the gutter and dodging a fleet of mopeds to cross the road, we enter a maze of alleyways full of vendors. I am beginning to recognize landmarks and soon we make it to the “supermarket” which consists of one room with two shelving units in the middle. We are greeted and assisted by employees who obtain things off the top shelf by knocking them off with a broom and catching them before they hit the floor! Armed with our groceries, we return to the compound.

I placed my veggies on the counter, reminding myself to bleach them later, and headed out the door. I had a party to attend! The other missionaries organized a game and pizza night in honor of my birthday, and we had a great time.

In a quiet moment, I thanked God for his kindness to me. He is truly such a sweet God and I am grateful for what He has decided to do with my life. I am in a good place now, and plan on enjoying this last year of my 20s!

God has not forgotten us

Yesterday I went with Jacqueline to visit the mother of the little girl who died two weeks ago from rabies (see blog entry "Please Pray") They welcomed a new baby into their family just this past weekend, and we took baby clothes, soap and a few sweets to congratulate them.

The baby has not yet been officially named, that will be done by formal ceremony. However, his parents are referring to him as "God has not forgotten us".

Please continue to pray that this family would have peace. Thank you.

Party!

Yesterday was “la fete de la jeunesse” or the festival for the youth, here in Meskine. One of the year's most celebrated holidays, the streets were lined with people. Tabea, her daughter Naomi, and I did not arrive in time to get seats, but when the chief's brother saw us, he escorted us to the front row! He works with Tabea's husband Martin at the hospital.

We no sooner sat down than the parade began! Each school in the area, dressed in their uniforms, marched in formation. After this initial presentation, each group came out individually to perform dances and singing. They were totally animated and the crowd roared and clapped their approval.

Next came the games. Clay pots were tied up like pinatas and the children were blindfolded and given sticks. Upon breaking the pots, gifts like shoes or material fell out. A few pots even contained chickens! That was a prize that had to be caught before it could be claimed!

Another popular game required kids to climb up a pole to reach prizes that were attached at the top. Most all of them made it, one little guy buzzed up the pole, then sat there for a while, trying to decide which gift he wanted to choose:-)

The kids of the village were out in full force, and to keep them from running all over the parade/game grounds, men used long sticks to strike the ground just in front of them, forcing them to back up, this was a form of “crowd control”.

After a couple of hours had passed, we decided to leave before the donkey races. People were everywhere! Perched on walls, spilling in to the streets. It was a special day for them, a day set aside for celebration.

Babies in trees

Jacqueline, one of the doctors at our hospital, invited me to come with her to a community health function in a neighboring village. We bumped along a nearly impassable road as I held on for dear life, praying that our 4x4 wouldn't tip over.

Upon arriving, a large group of women and children had already gathered under the shade of two trees. They had begun weighing their children using a scale similar to those seen in the produce department at the grocery store. The scale was first hung in the tree, then a poor, unsuspecting baby was placed in a sling and suspended from the scale while he or she howled miserably:-)

One of the babies went to the bathroom in the sling! The whole group erupted in laughter! That sling was then placed in another tree to dry:-) Infants in this area do not wear diapers. Their mothers just seem to sense when they have to relieve themselves and take the child out to the field to go potty.

The weights were recorded, and we all enthusiastically applauded when the child had gained. In an area where women often endure the death of at least one of their children, weight gain is a very big deal.

Afterward, Jacqueline presented some brief health tips to the mothers on topics such as water sanitation and appropriate food choices and we said our goodbyes.

Village Life

Yesterday evening as I was soaking my vegetables in bleach to kill any amoebas, I laughed at how my life has changed so drastically in just 3 weeks. I have almost gotten used to the sound of lizards skittering across my tin roof, the daily call to prayer that is broadcast from a mosque just next to my home and the nightly ritual of washing the day's dust from my feet.

The village of Meskine is a strange paradox. The dust is thick and plastic bags, trash and animal droppings litter the dirt roads and parched grass. Donkeys, dogs, goats, sheep and chickens are everywhere and most all of the buildings are made of mud so everything takes on a brownish hue. However, lush, mature trees line the roads, the women's vibrantly colored outfits break the brown monotony, and upon arriving at the village border, deep green onion fields are dramatically framed by mountains.

Moving through the village, I am hugely conspicuous. The children scream out “white woman!” when I pass, as I am trying desperately to keep my knees covered while riding a bicycle in a skirt. However, just as I begin to feel intimidated, someone calls me by my real name, not my race, or offers a smile as I greet them in my faltering Fulfulde. I am enjoying the interactions that I have with the women in the village as they are patient, cheerful and full of laughter. They build my confidence, and I am grateful to God for them.

Please Pray

This email was sent out by the wife of our director after a recent death at the hospital. Thank you in advance for your prayers - Sarah

Dear Friends,

We are writing to you with deep sadness in our hearts as the brothers and sisters from our local village church have experienced a terrible crisis. Last month, during a church service, the pastor’s dog began going after the children. Three of them were bitten including the pastor (the pastor was trying to catch the dog). The dog had been vaccinated for rabies, so they all believed this infection would not be an issue.

Monday night one of the children, a 5 year old little girl who was bitten in the face, presented at the hospital with symptoms of rabies infection. She could not drink water, her body was beginning to tighten, and she had an aversion to light. Everyone was devastated. The doctors hospitalized her, gave her IV sedation and everyone began praying for God to do a miracle. Unfortunately, she died Wednesday morning at 4:00a.m. The blanket of emotion, deep, deep sadness, is very tangible at the hospital and in the Christian community. The child’s father works at our hospital as well as two other fathers of the other children. A spirit of apprehension is also present at this time as everyone fears for the other four victims.

We are asking everyone to please intercede for these families. Ask the Lord to completely remove the rabies (if present) in all four of these people. Pray for this young girl's family and the other families that the Lord will give a supernatural peace and strength to all. Lastly, pray that through this terrible crisis, God will be glorified and His love will be seen and understood by all of our neighbors who are witnessing this trial.

Thank you friends for interceding before our Heavenly Father.

I have arrived!

Thank you friends and family for waiting so patiently for news of my arrival. On the eve of Jan 19th, after being awake for approximately 28 hours, I arrived in N'Djamena, the capital city of Chad. During my flight I met an American missionary family who spoke Arabic, the local language, and they helped me to navigate passport checkpoints. Two members of my organization then met me at baggage claim and we drove to a local missionary guest house to stay for the evening. Everything went very smoothly, thank you for your prayers.

The following day, we began the 4 hour drive to the hospital. N'Djamena is absolutely packed with people, and I held on as we swerved around bicycles, motorcycles, cars, goats, camels and pedestrians! There are no lanes on this stretch of highway, generally you drive to the right, however, enormous potholes dictate your speed and direction:-)

We made it through the border checkpoints of Chad easily, which was a huge blessing. Apparently it is very common for local officials to take any opportunity to stall a traveller in order to extort money.

Over the past week I have settled into my new home, have gone on a tour of the hospital and have begun my language lessons. I have had multiple occasions to visit the village, and have made trips to visit missionaries, the local seamstress, and the women's Bible study.

A small market has cropped up just in front of the hospital. It is open daily and sells snacks and some groceries for out-of-towners who are staying with patients. One of our contacts, a lovely Fulani woman, has agreed to let me sit with her and practice my fulfulde (the tribal language I am learning). So yesterday, I went, armed with my stool and workbook and sat amidst the foreign tongues and swarms of flies. I was way outside my comfort zone, but they were kind to me and the women laughed at my attempts to say "A nyalli jam na?" the local greeting. They got a kick out of me and I was happy to provide them with entertainment:-)

I will attempt to keep you all updated on the many things I am experiencing here in Meskine. I am convinced that this will be the hardest thing I have ever done, and I greatly appreciate your prayers.

"Assalaamu aleekum" Peace be with you, Love, Sarah