8 September 2019

The surgery nurse, Emmanuel, and I walked into the pediatric surgery ward. Ok, that gives you the wrong picture. Emmanuel and I pulled the curtain back from a doorway and ducked into a small room--a room not really built to be a patient ward but repurposed some years ago when this building became surgery instead of maternity--containing three small beds and three young patients. The first bed held our 5-year old who had undergone surgery for volvulus. His huge, dilated, air-filled intestines had been visible through his thin skin, which lacked subcutaneous fat as his spindly arms and legs also lacked fat and muscle mass. But now he looked like he was healing well from his surgery. The third bed contained another post-op patient. She had had an open fracture long before coming to the hospital, and the bone had become infected. The infected part of bone had been removed, and she had done well afterward, without any signs of infection now. The middle bed held a patient with a long laceration running across his scalp. The laceration had been neatly approximated with interrupted sutures. His face was swollen on the left side. The family explained that during the heavy rain a wall had fallen on him. He healed well during his hospital stay--the swelling improved and he showed no signs of serious brain injury as we observed him in the hospital for a few days. I wonder how many small children out in remote villages have less favorable outcomes.

Each season has its own wave of unique traumas. In March, as the mangoes are getting bigger but not quite as plentiful or ripe as they will be in April, kids climb up to get them and end up at the hospital with traumatic injuries due to falls from mango trees. During the rest of the dry season, many pediatric traumas are motorcycle-related, or the occasional gored-by-bull. Now, in the middle of rainy season, many pediatric traumas are from falling walls. Some brick walls have cement between the bricks. Others are built with mud in place of the cement, possibly because the family cannot afford cement. When the rain is heavy or persistent, the mud fails, and the brick walls fall.

If the parable Jesus told about rainy season were originally told in Béré, Tchad, it may have gone more like this:

Whoever hears my teachings and puts them into practice is like a wise man who built the brick walls of his house using cement. The rain fell hard all night and beat against his house, roaring on the metal roof, the water rising in the yard, but the walls stood firm. Whoever hears my teachings and doesn't put them into practice is like a man who built his house of brick, but used mud between the bricks. The rain fell hard and beat against his house. The mud washed away, the brick walls fell, and his whole house crashed down around him.