James Buhr, MD, a family practitioner at Mercy Hospital in Valley City, ND, is committed to supporting medical missions. Through missions sponsored by the Evangelical Lutheran Church of America, he spent time working in the Kwa-Zulu Natal province of South Africa in the 1970s; Liberia in the 1980s; and Cameroon in the 1990s.

James Buhr, MD, shows staff of the Emmanuel Health Center of Gallo in the Central African Republic how to hand-cut skin grafts. The patient needed grafts due to an arm that was badly burned when he suffered a seizure and fell into a cooking fire.

Most recently, in October 2011, Buhr traveled to the Central African Republic (CAR) on behalf of Global Health Ministries to check on the progress and needs of a hospital in the rural community of Gallo. Buhr is a member of the board of Global Health Ministries, a Minneapolis-based organization that works with Lutheran churches in other countries to enhance and expand their health care programs. “My job during my visit was to make sure that resources are being used wisely, to make sure the most urgent health needs are being addressed and to explore ways to improve the quality of care provided,” said Buhr. “I was there for six weeks, and it was an absolutely fascinating, thrilling experience.”

Health in the Central African Republic

The CAR has approximately 4.4 million people. Despite some significant natural resources, it is one of the world’s poorest countries. In the Gallo area, a $1.50 fee for a physician office visit and a $.50 fee for a lab test are unthinkable expenses for some of the people. Health concerns include HIV/AIDS, malaria, tuberculosis and measles.

In the late 1980s, Lutheran missionaries set up village health committees in the Gallo area, which successfully provided health education and an immunization program. But, the needs of the people began to change. Maternal and under-five mortality were on the rise. Residents suffered from lack of access to surgical and emergency care, and many needed treatment for severe cases of malaria. The area was in great need of a hospital.

Members of the village health committee in Gallo approached the Lutheran Church of the CAR to ask for help. With assistance from Global Health Ministries, Lutheran Partners for Global Mission and Lutheran synods in North Dakota, Texas and Louisiana, the 12-bed Emmanuel Health Center of Gallo opened in spring 2010.

Emmanuel Health Center

Emmanuel Health Center has a staff of 29, including two physicians. There is 24-hour nursing, midwifery and physician availability; reliable water and power supplies; wards for men and women; a birthing room and an operating room. The medical director, Christa Von Oertzen, MD, is an experienced OB/GYN and surgeon who is sponsored by a mission organization in Germany.

While in Gallo, Buhr stayed in guest quarters at the house used by Dr. Von Oertzen. Conditions were adequate, but basic. “It was a real change to have what I needed and no more than that,” said Buhr. “Christa kindly shared her home with me. There was a cold-water shower, and a guest bed with netting to guard against mosquitoes that carry malaria. We had plentiful vegetables but no bread and little meat. There was no cell phone coverage or Internet availability.” 

On the theory that just enough is all you really need, the hospital operates on a slim budget of $120,000 per year. “A larger hospital would likely take resources away from other essential mission projects, such as clean water and education initiatives,” said Buhr. “For now, the hospital is just about the right size for the population it serves, and I found that it is operating efficiently and well. Christa and the rest of the staff are doing a great job and delivering incredible value for the budget.”

Malaria and Other Health Concerns

More than half of the hospital’s cases are related to malaria. “It’s a high-transmission area for malaria, and the hospital sees many children who have the disease,” said Buhr. “About 25 percent of the infected children die before their bodies can develop immunity. Some of them need blood transfusions, and there are no facilities for blood banking, so the hospital staff has to find donors.”

The rest of the hospital’s cases are a mix of procedures such as deliveries, hernia surgeries, and treatment of injuries or burns resulting from accidents. One burn case had Buhr gowning up. “I wasn’t there to practice medicine, but I was able to help when a young man came in with a serious burn on his arm, which he received when he had a seizure and fell into a cooking fire,” said Buhr. “I was able to show Christa how to cut skin grafts by hand and apply them to the arm to help it heal.”

Buhr also helped out by taking inventory of the equipment and supplies in the hospital’s storage shed. Many supplies for the hospital arrive in shipping containers sent by Global Health Ministries. “I also went with Christa on a supply run to Bangui, the capital of the CAR,” said Buhr. “With diesel fuel running about $6.50 a gallon and the difficulty of traveling on unimproved roads, we were careful to make the most of the trip.”

While the people of Gallo have many health needs, Buhr saw encouraging signs of overall health improvement while he was there. “No one came to the hospital dying from diarrhea or dehydration – in fact, no one in the hospital died of anything while I was there, which was different from my past experiences in Africa,” said Buhr.

“Overall health in Africa is improving, but worries include the fact that malaria is still rampant in certain areas of the continent. The increasing drug resistance of tuberculosis will also become a serious issue.”

As he has done after other mission trips, Buhr has looked at his home and his practice with new eyes after returning to the U.S. “I have to say, it’s great to turn on a faucet and have water come out – much easier than carrying it up from the river,” he said.

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