There were three surgeons serving Béré Adventist Hospital, a missionary clinic in rural Chad that is one of the only options for patients across Central Africa in desperate need of care.
Now, there is one.
The day after President Donald Trump issued a travel ban on citizens from Chad and 11 other nations, President Mahamat Déby announced a stop on visas for U.S. citizens, saying he had made the decision because Chad has “dignity and pride.”
Two of the three American surgeons who kept Béré going — Andrew Trecartin and Stephen Waterbrook — are now stuck outside the country, fielding calls and messages from the patients and their families that had kept their operating room busy from 7:30 in the morning to long past sunset.
They say they’ve left dozens of people, including a toddler with a nonfunctional colon and a teenager with a worsening fistula, waiting for critical follow-up procedures after their initial surgeries, and hundreds of others have not been treated at all. There is one surgeon left, they warn — and her visa will expire.
The fate of those patients, the surgeons say, shows the importance of American assistance abroad and also the unintended consequences of political decisions made far from places of extreme need.
“It’s not about politics, but about pleading for mercy and compassion,” said Trecartin, a pediatric surgeon and father of three in Tennessee who had planned to return to Chad in January. “I plead for the children who are dying without care.”
He thinks of patients like 1-year-old Keurtis Madjirabé, who was scheduled for a follow-up surgery to address a potentially life-threatening colorectal abnormality. His mother, Milaine Bonodji, said they are praying that their government lifts the ban and fearful of the alternative.
“If the door does not open for him,” she said of Trecartin, “we are stuck.”
Chad’s Communications Minister Gassim Cherif Mahamat said the decision to halt visas for American citizens was a matter of protecting national sovereignty, but acknowledged there was a price. “We’re sad that we had to arrive at this situation because of a decision that Donald Trump made,” he said. “It’s about Americans in Chad but also Chadians who need to go back to the United States, for work or study. The situation hurts everyone.”
Even before the visa ban, Trecartin and Waterbrook said the need was so crushing at Béré that it often felt overwhelming.
The 100-bed hospital, located in southern Chad and run by the Seventh-day Adventist Church, serves patients from across the region, including Cameroon, the Central African Republic and Sudan. Getting there means a nearly 10-hour bus ride from N’Djamena, the capital, and passing through vast desertlike landscapes dotted with mud-brick houses.
In Chad, as in much of sub-Saharan Africa, studies estimate that more than 90 percent of people do not have access to surgical care.
Trecartin and Waterbrook said their days were so long that they’d ask for food to be delivered to the operating room so staff had the energy to keep going. They said they saw what should have been once-in-a-career cases every week, because the dearth of medical care meant that by the time patients arrived, the situation was often dire.
In the mornings, Trecartin recalled weaving his way through patients “tugging on our arms, saying, ‘I came from Cameroon; I came from Sudan, and we are running out of money for food,’” he recalled. “I’d say to them, ‘we are going as fast as we can.’”
He wondered whether he’d be able to continue.
But over the next three years, he and his wife, who is also a physician, settled into the rhythm of life in the region, learning French, one of the country’s official working languages; bonding with staff at Béré; and growing their own family. Each year, he said, his group operated on more than 1,000 patients, many of them children.
“I felt like what I was doing mattered, which was nice,” he said. “But also felt like it wasn’t enough, which was overwhelming.”
Trecartin said the hospital leadership wanted to diversify its ranks and recruit Chadian or other African doctors but had struggled to do so, often hearing that African surgeons in high demand didn’t want to work in a place so remote and far from good schools for their own children.
He spent 2023 and 2024 doing advanced training in Colorado. This year, he started what he hoped would be a new setup; splitting his time between Béré, where he lived from January to June, and Tennessee, where his wife and three children, ages 7, 5 and 3, would be based. He’d been planning to head back to Béré in January, but the reciprocal travel ban has made it impossible for him to renew his visa. Waterbrook, who arrived in Béré in 2023, said he’d planned to stay until this month but left in October because his visa ran out and could not be renewed.
Appeals to the Chadian government for humanitarian exemptions to continue their work have been unsuccessful, Trecartin said. The one surgeon who remains declined to comment for this article, telling Trecartin she was too overwhelmed with addressing the crush of patients.
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When Trump implemented the travel ban, he signed a proclamation declaring Chad among the countries that posed a “very high risk” to the United States, citing the large overstay rate of Chadians on visas in the United States. When Déby responded with his own visa ban, he said it was “in accordance with the principles of reciprocity.”
As Trecartin watched the spat unfold, he said his focus was less on politics than the people going without care, who he knew would bear the brunt of it all.
Bonodji said that it was thanks to Trecartin that their family “got our hope back,” after spending much of their son’s short life with him in the hospital, trying to address a colorectal abnormality that he was born with. It was at another hospital in southern Chad that her brother-in-law met a nurse who works with Trecartin and told the family to get to Béré to see Trecartin, who specializes in intestinal issues.
The family got on a bus the next day. Three days later, Trecartin did the first operation. “Dr. Andrew gave our child the second chance to live,” she said.
But costs are now building up, and the toddler needs a second surgery, Trecartin said. Bonodji said she is not sure what the family would do if Trecartin is not able to return. “Only God knows what will happen,” she said. “We are suffering a lot.”
Trecartin said he regularly gets calls and voice notes from families asking when he will return. Their stories, he said, are always at the top of his mind.
There’s the baby girl born with a variety of pelvic malformations whom he operated on earlier this year but who needs an additional reconstruction surgery so she can have normal bladder and bowel function, and another patient with problems with the nerves in his intestine, who is waiting for a surgery.
Waterbrook thinks of a teenage girl struggling with stigma as she awaits surgery to help correct a fistula formed in the wake of appendicitis left untreated for too long.
“It is heart-wrenching,” he said “that I am not there.”
Trecartin said he initially feared that sharing what was happening at Béré could backfire and make it even harder to get visas. But he said he ultimately decided it was important to try to draw attention to the kind of suffering that “the rest of the world has no idea about, or wants to turn a blind eye to.”
“There are tangible, practical things we can do,” he said. “And it starts by lifting the restrictions.”
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