Dr. Paula Dhanda is being recognized for her dedication to improving the quality of healthcare for women and children in the most under served areas of the world. She began her international medical work in 2009 when she was invited by a fellow surgeon to participate in a medical mission in Chad, Africa. There they performed 50 surgeries in 2 weeks, delivered many high risk babies and trained the local staff. Since then she has led medical teams on 2 missions to Haiti in the aftermath of the 2010 earthquake. In 2012, Worldwide Healing Hands embarked on a mission to Nepal where they trained 10 midwives in life saving procedures, gave care to 1500 women and performed numerous surgeries.

Her efforts to alleviate suffering and promote wellness received recognition in 2010 when Adventist Health presented Her with its “Physician of the Year Mission Award.” In 2011 she received the Soroptimist Ruby Award, which acknowledges women who are working in extraordinary ways to improve the lives of women and girls. More recently, at the 2012 Stars celebration she was named Humanitarian of the Year. In 2013 she was given the American Red Cross Real Heroes award, which “recognizes those in our community who have shown courage, dedication and character through extraordinary acts of heroism and kindness.”

In the words of Dr. Paula Dhanda “Something happens to you, when you leave your family, friends and comforts behind to care for strangers. You discover the opportunity to touch lives in a lasting way.”

In March of 2011 she went back to Haiti for another medical mission, while there she visited the ‘Amputee Soccer Team’ that she had adopted the first time she was in Haiti. The soccer team is made of of young men who lost limbs during the earthquake.

Dr. Dhanda is extremely devoted to her mission and gives her all to help those who are in need. Her next mission will be to Nepal in 2012. She is truly an angel of mercy who spreads love and caring wherever she goes.”

– Stars of Lake County, 2012

In Chad, the people carried their medical records with them in a small booklet. When they came in for care or had surgery we made a notation in the booklet. It was amazingly efficient – no time wasted requesting and waiting for records. They were very diligent about bringing their records when they came for a visit. Also, there was only one copy which the patient carried with them so no one could access their records without their consent. In the photo it is the yellow booklet each of the women is holding.

Are you wondering why the women are looking away? This is my idea of privacy in a place where it was hard to find. I was examining a woman on a stretcher next to them and asked them to please look away. We would often find people peering through the windows at us anywhere in our little house on the hospital compound.

When we did surgery on a patient and removed an organ we would put it in a basin next to the patient and when we wheeled them from the operating room through the outdoor courtyard to the recovery the family members would gather round to have a good look at the patent and the specimen. I was always touched by the number of family members present till I was informed that these onlookers were not necessarily with this patient but perhaps waiting for someone else and just decided to join the crowd. Oh well, I still continued to do my best to maintain privacy.

I lay Miriam to sleep last night. She’s exhausted. She’s had malaria for God’s sake. She was swamped by visitors trying to console her parents. She was surrounded by sobbing and wailing and tears. She couldn’t sleep in all that. So now we’re in a familiar setting. Her crib and mosquito tent are unchanged. She has the quiet of her corner. So I lay her down to sleep, to rest in peace. She’s unafraid. She knows I’ll wake her up in the morning. She knows she’s safe. She knows I’ll be there. She drifts into silence. She knows nothing of what I’m suffering all through the night as I think of my little boy, pale and cold in that box surrounded by the damp, African soil.

He was on borrowed time. He shouldn’t have even been born. Sarah and I have had unexplained infertility for years. Thanks to modern science, Adam came to us after sitting in a freezer for months. Then his little body developed in the womb of his mother. But the enemy was already at work. Through his wild movements we have come to know so well, he managed to wrap his umbilical cord into a true knot that if pulled tight would cut off his precious supply of oxygen coursing through his mother’s blood, crossing the placenta and entering his body through those umbilical blood vessels.

Sarah went into active labor a month early. Then her labor stopped. If she had gone till term, in all Adam’s wiggling and kicking he may have pulled that knot tight and been stillborn. Or if her labor had progressed, as he was squeezed out the birth canal, the knot may have tightened and killed him or given him brain damage. But God intervened and stopped Sarah’s labor progression and Adam and Miriam were born by c-section, healthy, screaming and eyes wide open.

His life was a miracle, a gift. He was on borrowed time the whole six months of his precious life. “The Lord giveth and the Lord taketh away, blessed be the name of the Lord.” (Job 1:21)

Is God really so cruel if he’s just a Father putting his child to sleep for the night only to wake him in the morning? “For his anger is but for a moment; his favor is for a life-time: weeping may tarry for the night, but joy cometh in the morning.” (Psalms 30:5)

  The moon has gone down. I walk in the dark with only the stars and the promises of yore to light my way. I make my way past the silent benches that all day held crowds singing in French and Nangjere as the drums pounded out their mournful beat. My body is as limp as the pillow I carry. Every last tear has been wrung from my eyes. I make my quiet pilgrimage to the site of my greatest sorrow. I enter the room that holds so many memories. As I open the rickety lock I remember locking that same door from inside as I cared for two little African babies struggling for their lives while outside men fought to end each others. The faint odor of bat guano greets my nostrils and makes me think of the time the winged mammal hit the fan and landed on the face of the baby fighting for breathe in the clutches of an asthma attack. I shine my light on the IV slowly dripping into the arm of my sweet little daughter, Miriam, as she tosses and turns in a fitful slumber. Sarah lies by her side in the mosquito net softly comforting her one remaining child. It seems like an eternity already since the morning when two babies wiggled and squirmed and flipped and grinned and giggled and squealed together in that same tent.

Sarah woke me up less than 24 hours ago. “The twins are really active and I’m having a hard time. Can you come over?” I arrived to see Adam staring at me with a silly grin right before flipping off the mattress between it and the net and letting off a howl of frustration.

“You should have seen them. They both woke up, looked across the mat, grinned and tried desperately to crawl to each other,” said Sarah.

We’d arrived in Bere the day before. Thursday night, Adam had a fever of 104. We were in N’Djamena and I bought a rapid malaria test. It was negative. I wasn’t convinced. I opened a capsule of Artemesia, poured it on his mashed sweet potatoes and fed him despite his obvious preference for medicine-less food. The next morning, I fed him another dose and we loaded up the scalded dog and were on our way to Bere by 6:30am. By 2:30pm, both Adam and Miriam had been diagnosed with Falciparum malaria and started on IV Quinine. Through the night, they each got two of the every 8 hour doses.

I start Miriam’s next IV perfusion and turn to Adam. I let 150 mL of 10% glucose solution run from the IV bottle into the pediatric reservoir on his IV tubing. The tubing has special air traps to avoid any accidental entry of air into Adam’s veins. I pull out 0.5mL to flush his IV and then carefully measure 90mg (0.3mL) of quinine and inject it into the top of the reservoir of 150mL. I open up the IV, see that it was running well and slow it down to a drip.

I turn to look at Miriam and talk to Sarah.

“Is that a seizure?” Sarah interrupts our conversation and we turn to look at Adam. He’s not breathing. We start CPR. I run and get some 50% glucose solution, afraid of low blood sugar. I text Olen who is there in minutes. Still no breathing. Olen confirms a heartbeat, slow and irregular, but there. Olen gets a bag valve mask and starts breathing for him while I do chest compressions and Sarah continues to give glucose. Anatole arrives and checks the blood sugar. It’s high from all the glucose we’ve been giving him. We try Adrenaline in ever increasing doses. His heartbeat never picks up. Every once in a while he grimaces, groans, struggles for a couple breathes, giving us hope. We work on him for over an hour. His heartbeat disappears. His pupils are fixed and dilated. I’m praying desperately for a miracle. We stop.

Deja vu.

How many years ago did the same thing happen to my friend Gary and his little boy Caleb?

It’s 8:00 am and my life has suddenly changed for the worse. Sarah and I hold Adam’s still warm body. I desperately kiss his neck, my tears know no bounds. My cries echo across the campus to join the thousands of others I’ve heard over the years in this corner of Africa. Will I never again see his tongue half hanging out of his silly grin? Will he never again wrap his legs around my arms, bringing my fingers to his mouth as he softly coos? Will he never again thrash his arms in legs while staring at me with a look of pride and joy? Will he never again take up the airplane position looking around for confirmation of his abilities? Not in this life.

A day long ritual of African mourning begins as the news spreads like wildfire through the village. People come to offer their condolences. Miriam becomes agitated with all the visitors. I wrap Adam’s body in my green and black checked Arabic head scarf and carry him over to the house where friends have arranged to let the mourners come in and visit. All day long the songs sung in rhythmic Nangjere drift in as people make their way to where I am sitting on a thin Nigerian mattress. So many people, so much collective pain and loss. Salomon comes in and hugs me. A flood of tears bursts forth as I remember him holding Adam so many times as we ate together in Moundou, enjoying one of his famous sauces. Frederic kneels down and holds my hand long and hard in an undulating shake of sympathy. Just last year I was at his house as he held his son who had just died. The mother of the boy across the street who fell down a well and died crouches and holds my hand as we share tears of sorrow and she offers words of comfort and hope.

The steady stream of people brings me a steady stream of tears as I shake and hold the black calloused hands of so many people who’s lives have been filled with loss. The strength of the grip and the power of the muscular arms of both men and women combined with their roughened feet tell a thousand tales of woe. Their is no awkwardness. They’ve done this before a thousand times. Tears come from faces I’ve never seen before. But we now have a common bond of tragedy. The only ones who seem uncomfortable are some of the westerners, but their warm embraces make up for the lack of familiarity with death.

Gary and Wendy fly in from Zakouma just in time for the English portion of the day long wake. Hymns of hope sung gently and powerfully by the many musicians in our group of Nasaras warm my soul as Sarah holds Adam’s now cold and stiffening body.

“When the trumpet of the Lord shall sound and time shall be no more…when the roll is called up yonder I’ll be there.” The rollicking song brings bursts of tears from Gary, Wendy, Sarah and I as we remember Caleb’s favorite song and the other little foreigner buried in Bere what seems like ages ago. Now it’s time for last good byes. Sarah and I bring Adam’s long little body into the house and place it gently in the casket made by Jamie just this morning. I kiss his cold brow one last time and we put on the lid.

The pathfinders are outside to carry the body to the grave site. Under a little tree in front of our old house in Bere lies a volcanic stone with a little plaque that says “Dinah Bindesboll Appel”. Next to it is a deep, rectangular hole waiting for our second child to return to the African dust. Noel gives a stirring eulogy reminding us of the day when God will say “Viens” to both death and the devil and both will be done away with forever. Then God will turn to Sarah and James and say, “Here’s Adam.” And to Gary and Wendy, “Here’s Caleb.” And the innocents will be restored to their rightful place.

But for now, we miss him terribly…

RIP Adam David Bindesboll Appel, June 25-December 31, 2011

Many of the problems faced by volunteers in developing countries are complex and vast. There aren’t enough resources available. Poverty is overwhelming. Education is lacking. Clean water can be difficult to find and malnutrition makes medical care even more challenging. It is almost too much to bear to see a mother die in childbirth of something that is preventable. How do you send a child back to the same environment they came from knowing they may become sick again?

Many times, though, we have an opportunity to touch lives in a very lasting way. So many people suffer from lack of access to the most basic medical care, which really does mean the difference between life and death. Partnering with local healthcare providers and sharing your knowledge leaves behind something that is everlasting. And that’s just the beginning of the difference our volunteers can make.

I am always humbled by the kindness shown to the volunteers. People who have nothing go out of their way to make sure that we are as comfortable as possible, and they are genuinely grateful for our presence. The Haitian staff expressed gratitude to our volunteer team for choosing to stay at the hospital during the turmoil and danger caused by the election. How must it be to know that strangers cared enough about you to fly across the world to care for you? On a very basic, human level, volunteers change lives simply by reaching out.

When you care enough about strangers to leave your family, friends and comforts behind to make a difference in their lives, something happens inside of you. You discover that the secret to happiness is not in what you have, it’s in what you give away. Yes you will absolutely make a difference; perhaps more in yourself than the people you came to help.

I was speaking to a church group last week about mission work in Africa and I still feel such sorrow over the tragic death of little Caleb. When I offered him a toy he chose this angel doll he is holding.  This was written by Dr. James Appel:

http://bereadventisthospital.blogspot.com/2009/06/tragedy.html

Dr. Paula Dhanda and her daughter Jasmin

As we run, Jacques fills me in.  A pregnant woman has been brought here in labor and she needs a Cesarean section because there is an “arm or something in vagina.”  I ask if he is sure, does he feel the baby’s head?  Dr. Jacques is just out of school and not very experienced.  I tell my brother Shan to get the keys to the office and bring the small portable ultrasound to the labor room.

The woman is lying on a hard metal table, sweating, silent, in labor.  There is a man with her who appears too young to be her husband.  He has apparently brought her from another clinic because of the difficult labor.

I ask to examine her and quickly put my gloves on.  As I examine her I ask Jacques to ask her how many children she has.  Seven babies but only four are alive.  I feel a tiny foot hanging out of her cervix, which is fully dilated.  Shan arrives with the ultrasound and we find the fetal heart beating at 140 beats a minute.  This breech baby is tolerating labor well. The mother has been transferred from one clinic to another, unable to deliver.  She was brought here in active labor on a motorcycle.  I cannot even imagine how she tolerated the ride.

The standard of care for a footing breech is to do a cesarean but this is Chad.  I make the judgment call to allow her to deliver vaginally.  I believe it is safer and quicker but I was trained not to break the rules.  What rules?  We are in the middle of nowhere and lacking so many essential things.  Jacques has been my student and translator since I arrived and he is anxious to learn how to deliver a breech baby.

The woman is contracting and everyone is shouting at her in some tribal dialect.  I don’t know what they are saying and I tell Jacques that everyone is to be quiet.  I will instruct him and only he is to direct the patient.

I tell him not to pull the baby, that mom has to push the baby out while we just support the body.  One foot is out and now we can see it is a boy.  Things are progressing and I coach him on delivering the other leg.  The baby boy is out to the chest, and my hands are on top of Jacques guiding him.  The body is out and Jacques follows my instructions and delivers the arms, but the head is not delivering.  I need a timekeeper but there is no clock, no watch, no sense of time.

There is a sense of urgency because with each passing second the baby’s oxygen level is dropping.  It may only be a minute but it feels too long.  I take over, putting my fingers inside the vagina to find the babies mouth to facilitate delivery while I hold the babies legs up in the air.

I ask Jacques to apply gentle pressure above the mother’s pubic bone and at first there is a language barrier but with gesturing he understands.  Out comes the head but the baby is not breathing.  There is no oxygen, just a mask that is much too big for the baby’s face.  The heart rate is low but not critical.  We stimulate the baby and use a bag device to blow air into the baby’s lungs.  After a few breaths the baby attempts to cry and fight the mask.

I step back and watch as they deliver the placenta and take care of mother and baby. Dr. Jacques is elated, smiling. I walk back to our quarters to shower off the sweat and blood.

Later we go to check on the mother and baby.  She is alone which is unusual.  The nurses inform us that she is from far away and there is no family here to care for her, as is their custom.  The family usually brings them food and water, and tends to their needs.  She is lying on a bare mattress and is using her only wrap to put around her baby.  We bring her a wet washcloth, a mango, a piece of bread and a bottle of water.  We don’t have much else to offer the mother who is exhausted but she is very grateful.

– Dr. Paula