In the May 18 CrossWalk edition, James shared parts of his journey with Adventist Review
readers. We believed it such an inspirational piece that we present another installment from his journal. To read more of his journal entries, click here. —Editors.
May 9, 2006
After a rebel attack on Tchad’s capital, N’Djamena, forced us to reroute our return through Cameroon, we arrived in Yaoundé and took an 18-hour train trip up to Ngaoundéré. This was followed by a nine-hour bus ride to Maroua and a two-hour pickup truck ride up to the Koza Adventist Hospital, where we spent a week working with Drs. Greg and Audrey Shank. We then took a three-hour bus ride to Yagoua, a 20-minute motorcycle ride to the border, a five-minute canoe ride across the river, and a three-hour ride in our truck back to Béré.
Our staff has heroically been holding down the fort amidst strikes and local hospital closures, forcing our untrained nurse/surgeon, Samedi, to perform almost 80 surgeries during our absence, saving countless lives with 100 percent post-op recovery. If that doesn’t convince anyone that there is a God, nothing will!
May 17, 2006
The young woman’s eyes are swollen almost completely shut. Her face is puffy and deformed. She is unconscious. She has been having seizures since morning. I check her blood pressure: 176/132 . . . unbelievably high. The diagnosis is sure: eclampsia. I check the fetus’s heartbeat. It’s normal. David goes to call Samedi. Hortance has already given diazepam. She finds the vein while I run to the pharmacy to bring back an old bag of magnesium. As Hortance inserts a urinary catheter, I watch the magnesium drop in drop by drop. She’s still having occasional seizures. Samedi arrives, we transfer her to a gurney, and we wheel her toward the
Bloc Operatoire (operating room).
A quick scrub and drape, and the patient is ready. The knife is in my hand. We pause. Samedi prays. A small incision, a push with a clamp, and the amniotic fluid sprays up into the wound. Fingers in to guide the scissors, cut, cut, and a shock of wet black hair is revealed. . . . Clamp, clamp, and cut between and the baby is in Sarah’s hand to be dried, stimulated, and revived. A cry soon pierces the air. I clamp the bleeding edges of the uterus and start suturing it closed. There are no complications.
The next morning another woman arrives. She has had abdominal pain for a month now, and was seen at our hospital in April for the same pain, plus some vaginal bleeding. She was treated, the bleeding and pain had stopped, and she was sent home. . . . On exam I suspect pelvic inflammatory disease, and hospitalize her. The next day she is no better, and her pregnancy test comes back positive. We decide to operate.
She is prepped for surgery. I hold the scalpel again as I pray for God’s help. I slice open the abdomen from belly button to pelvis, and dark blood surges out of the wound. Samedi quickly starts suctioning as I jam lap sponges into the four quadrants of the abdomen. We finally get enough of the blood sopped up to see that there is a large ectopic pregnancy in the pelvis, but it is so advanced that everything is inflamed and stuck together . . .
After what seems like an eternity of mopping and aspirating up blood, I finally have a breakthrough, as suddenly the ectopic pops out of the pelvis, and I can identify the uterus and where the mass is attached. I clamp and tie off the blood vessels. . . . I close up and breathe a prayer of relief.
It’s always scary when that surge of blood rises toward you as you open up the abdomen. Then there’s that brief moment of panic when you wonder if you’ll be able to stop it. Then, somehow, you find, or God finds for you, the courage to calm yourself and proceed with persistence until it is finished.
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James Appel and his nurse wife, Sarah, serve as missionaries in Béré, Tchad. When not performing surgeries, they like to ride horses, jump off cliffs into hippo-infested waters, play drums, and sing in Nangjere. 
