Pray for Jos

As many of you may have heard, there has been rioting and violence in Jos after the recent elections, splitting the city along ethnic and religious lines. For a better idea, please see the Mitchell family blog at www.mitchellmissions.blogspot.com.

Things appear to have calmed down but the SIM missionaries are being evacuated to Miango for the upcoming Moslem holiday "just to be safe." Keep the Ardills, Mitchells and Nigerian faculty and residents in your prayers.

For those of you looking for my pictures, see the post below.

PICTURES!!!!!

Though they haven't been captioned yet, you can view all of my pictures on the link below:

SHANNON's PICTURES or if that doesn't work, the URL is:

http://picasaweb.google.com/sleighcastle

Please note that there is an album of Nigerian images that are "nonsurgical" in the sense that those with delicate sensibilities will see no blood or guts. The "surgical" images are in a folder labeled as such for those who want the gore. I'll label them later so you know what the heck they are.
An additional album has the Kenya/Tanzanian adventure.

Thank you SO MUCH to those of you who prayed for me, donated to Evangel, and continue to support me in my life back home. I'm adjusting to life back at work, and I look forward to having time to talk to each and every one of you.

Hell's Gate, indeed.

I'm back in California!!!!!!!!!!!!! Thanks to everyone who has been praying for my safe travels, especially while I was alone in Nairobi this last couple of days. I was staying at the Mayfield Guest House run by AIM, which was great. If anyone ever needs a place to stay in Nairobi I'll get you their contact info.

The funny story I have from my last day there involves me trying to get up to Hell's Gate national park via Nairobi public transport. I managed to get to the really sketchy side of town to catch a matatu, which is a mini-bus of sorts, out to Naivasha. The matatus are hilarious in that they try to get as many people on board as possible, and are contantly making stops to try to get more. So I get up to Naivasha, in the Rift Valley (where all the violence was last year!!! And I'm alone and white. :) ) and finally get another matatu to go down toward the park. I was within 10K of the park and all of the matatus start pulling over to the side of the road. I speak VERY little swahili but finally figured out that none of the matatus have working seatbelts, but that by Kenyan law everyone must be belted. There was a police stop up the road and no one wanted to get fined for the belt issue. By this time it was getting late and I didn't want to miss my flight back home so I hitched back to Naivasha and took another bus to Nairobi. An adventure with no fun in the middle.... I guess I'll have to go back.

After a LOT of flying and some sleep I am safely at home, in the land of drinkable tap water and beds without mosquito nets. Beautiful.

Out of Africa

Well, after 2 long days riding around in a Range Rover looking at animals in Tarangire National Park and in the Ngorongoro Conservation area, Brian and Megan and I bummed around Arusha for a day before Megan headed home. Brian and I did very little last night, though I did find out a little too late that the Guiness here is 7.5%. Brian has now left me as well and I am spending the night here in Arusha before heading back to Nairobi in the morning.

I have very little idea what I'm going to do by myself in and around Nairobi for a day and a half, but I'm sure I'll find a way to amuse myself.

I'm flying back to the US from Nairobi on Wednesday night, hopefully arriving back on Thursday if all flights go well. Then it's back to my exciting life at Thornton Hospital first thing Friday morning.

Thanks to all of you still reading my updates in here and I promise that we'll catch up when I'm back in California!!!

Jambo!

Well, the two ER docs and I have made it safely to Uhuru peak on Kilimanjaro (5895 meters!!!!) and back down safely. Megan and Brian both said that they are not going to listen to any ideas of mine anymore.

I found out that while I adapt quite well to altitude with some time and some acetazolamide, that I really, really, really do not like to be cold. On our summit day there was some worry on my part about frostbite on my toes (I prioritized the fingers due to my profession of choice and kept them warm at all costs) but when Megan and I got back to the tent and warmed up all 20 of our toes appeared to be viable. None have fallen off to date.

We are off to do a bit of safari action before I am left to my own devices for a couple of days, then I will be back in the US (and back at work... )

I will leave much more detailed, exciting tidbits about my Kili adventure (with pictures!) at a later date for those who are interested. Right now I need to go figure out which of my clothes are the least nasty.

Travelling in Style

I am safely in Arusha, Tanzania. Here is a brief list of the events of the last 2 days:

1) I survived the infamous Lagos airport-twice
2) Through some mixup during the long, painful adventure of booking my Kenya Airways flight from Lagos to Nairobi, I bought a first-class ticket. So I sat in the Lounge area until boarding, then had my very first first-class flight. I had a glass of champagne just because I could.
3) I avoided getting scammed by the crooks working the Kenya-Tanzanian border pretending to be "officials." The Irish girl next to me on the bus apparently lost $50 to them. That's my reward for never trusting anyone.
4) Due to nausea from travel and/or unavailable meals, I have survived for 2 days off of diet coke and british-style "digestive" crackers. Nasty.
5) I sat around the night before last watching BBC with a bunch of ex-pats who were much more concerned with the baseball playoffs than the Wall Street crash.
6) I finally got to read a newspaper and found out that Haile Gebrasallasie (I'm sure I spelled that wrong) just broke his own world record at the Berlin Marathon. Awesome.
7) I had to have a friend tell me via email that Lance is coming back. That's how out of touch I am.

I will write once I get off the mountain!

Shikina.

In Hausa, 'shikina' roughly translates to "finished; done with this." I am leaving Jos today (in about an hour, actually). I didn't anticipate being so reluctant to leave; I've made some great friends and I really enjoyed my time in the hospital. Of course, there are things that I will not miss (the traffic; walking along the road dogding "achabas," the taxi motorcycles; and spending all of my time in a skirt) but I find myself wishing I could spend more time here.

I'm off to climb Kilimanjaro with my friends Megan and Brian, two ER residents that are friends from med school. I never get to see either one of them because we're spread out across the US, so it will be great to hang out with the two of them. Megan is the crazy friend who made me a triathlete, and not only have we hiked together before, but we lived in a tiny room in Honduras for a month together, so I know we can travel together. She's being kind enough to bring me Clif bars.

While I'm on the mountain I won't be able to blog, so if I don't get back on here before then, I'll be back online on the 10th or so. In the meantime, entertain yourselves by reading a book. I'm in the middle of "Infidel," which my mother has been telling me to read for some time now. Yes, mom, I have your copy. Sorry.

Bature!

Here's a pic of Gary and me looking very, very white on our way to church this morning. Believe it or not, the outfits are the norm and we were dressed like everyone else at ECWA Bishara 2, our worship place of choice, but as a bature (white person) in a headwrap I think I look pretty funny. Tomorrow Gary heads back to Northern Ireland, where he will once again blend in, whereas I head Tuesday for East Africa, where I will continue to look really, really white.
Starting Tuesday, I will be in the following cities for one night each: Lagos, Nigeria; Nairobi, Kenya; Arusha, Tanzania; then I head up Kilimanjaro. Please pray for my safety while I travel and that my luggage would stay with me!

I managed to find powdered cocoa in one of the markets this week so I am making brownies (Regan sent me her special recipe) for the Mitchells--they are about to burn so I've got to go!

Fever!

No, not the song. I just got done reading Fever! By John G. Fuller. It's a book about the identification of Lassa fever, which was initially recognized in an outbreak in Nigeria in 1969. Patient Zero was a nurse in Lassa, Nigeria and was transported for care to Jos, to the SIM hospital. Another outbreak occurred several years later and was also treated at the SIM hospital.

Lassa fever is caused by a virus of the family referred to as "hemorrhagic fever" viruses, which also includes Ebola, Marburg and many others. There is no vaccine. I have been fascinated for years, for some unknown reason, by hemorrhagic fevers. I read "The Hot Zone" at least 4 times during high school and college, and have continued to pursue books, fiction and nonfiction, based on viruses. If you've never read "Andromeda Strain," or "The Coming Plague," or I highly recommend both of them.

This is even more interesting to me given that we had a patient come through the hospital several weeks ago with Lassa. There are likely many more that do not get diagnosed as symptoms are vague and some people have asymptomatic infection. Scary. Sadly, I have not found a way to really mix my love of surgery with my obsession with viruses, since viruses generally don't have a surgical cure.

Yesterday we got to operate again with one small working autoclave. Once again I found that at Evangel "general surgery" really is that: very general. I started with a contracture release/skin graft, then removed the largest breast mass I have ever seen, then did my first external fixator on a fracture (orthopedics!), then finished the day with an exploratory lap and a diverting colostomy.

Thanks to all of you who are praying for me back home. Praise God that I have not gotten sick or injured and I continue to make great Nigerian friends! I will be sad to be leaving next Tuesday. Tomorrow is my last full operating day in Nigeria.

May your day be full of grace and free of viral infection.

My real-life ATLS course

Today all of the autoclaves are broken, and there are no sterile instruments/gowns/gauze/etc./etc., so we can’t do elective surgeries. I did do a hernia repair with a few drapes, sterile gloves and no gown. I’m a little upset because I had a great breast case to do but hopefully it will happen tomorrow. Instead, I’m trying to use the time to study and to read up on all of the hand-sewn bowel techniques that I can since I seem to have to do that here. We don’t staple anything and I’m finding out how incompetant I am. It’s kind of like how my generation doesn’t know how to use a card catalogue because we look up all of our information online.
In a way it’s a good thing that the day is a little less busy because yesterday was crazy. A 15-year-old boy had a shotgun wound overnight and when we rounded in the morning, the first thing I had to do was put in a chest tube (in a skirt… at least this time I wasn’t wearing heels like my last chest tube in the US.) We then proceeded to do exploratory surgery on his abdomen. I was way over my head, and the senior resident with me, while very confident, wasn’t much ahead of me as far as his experience level. We managed to get through a full exploration and a couple resections of injured bowel before Dr. Ardill was able to pop in an affirm that it looked fine to him. Praise God that the liver injuries had stopped bleeding already. I spent the remainder of the early afternoon in the ICU (see last post) trying to keep him alive while the nurse bag-ventilated him. He died at 4:30 pm.
My friend Laurie just sent out a copy of a prayer that has been on her heart that I think is applicable to things I am struggling with right now as well as to a few other people in my life:
Today, O Lord, I yield myself to you. May your will be my delight today.May your way have perfect sway in me.May your love be the pattern of my living. I surrender to youMy hopes,My dreams,My ambitions.Do with them what you will, when you will, as you will. I place into your loving careMy family,My friends,My future.Care for them with a care that I can never give. I release into your handsMy need to control,My craving for status,My fear of obscurity.Eradicate the evil, purify the good, and establish your kingdom on earth. For Jesus' sake, Amen. -Richard Foster

7 more days in Nigeria! I will continue to keep you updated.

I never thought I'd miss the VA....

Several people have asked me about the specifics of the hospital setup, and I keep finding myself comparing and contrasting the system with the hospitals back home in San Diego. ECWA Evangel Hospital is relatively small but still sees the same diversity and severity of illness and injury that UCSD or the VA gets, albeit with several twists.
The first thing I was exposed to was the ICU, which is a 3-4 bed room with a greater nursing:patient ratio than the ward and the capability to suction, give oxygen and monitor blood oxygen level (pulse oximetry). Other than that, it’s really no different than the ward: it is not setup to ventilate patients or to monitor vital signs continuously. I have been told that the frequency of power outages in the hospital (at least several per day) would make it very difficult even if the equipment were available. On occasion they have left people intubated if a family member is willing to stand and bag-ventilate.
Down the hall from the ICU is the “private ward,” which consists of private rooms that cost approximately twice as much as a bed on the ward. To me this seems like a deal for those who can afford it, as the “wards” are truly that: old-school style long rooms with beds lined up on both sides. The “Male Ward” and “Female Ward” each have 20 beds in the room with an overflow off to the side. Each patient is provided with a bed with an old mattress and old, though clean, sheets. Meals are not provided—family must bring in any food for the patients. For our patients with severe malnutrition, this is a little tricky. We can order a mixture called “kwash pap” from the pharmacy for those who need liquid nutrition. Originally developed for those with kwashiorkor, it is a mix of peanut oil and some carbohydrate source that I can’t remember right now. Apparently it tastes horrible but it’s done wonders for some of my patients.
The pediatric ward is my favorite place, despite the fact that when I walk into any given room I am greeted by at least 10 mothers/family members starting at the “bature” (white person) like I came from Mars. There is a peds ICU which is roughly equivalent in ability to provide acute care as the adult ICU. There are also a couple UV beds for phototherapy as needed. The “ward” rooms have 8 children/babies in each.
There is no running water anywhere in the hospital except in the operating rooms, which makes everything more difficult. And as for supplies…. It’s so difficult to get anything that I don’t think I’m ever going to complain about trying to find things on the VA floor ever again.
There is a maternity ward and labor and delivery area in a separate building that I rarely go into. I think they deliver babies over there.
The operating “theater” (per the British term) is where I spend the bulk of my time. There are two operating rooms that differ in many ways from those back home, the most notable being the absence of disposables. We resterilize and reuse EVERYTHING, with the only exception being gauze and gloves. No throw-away gowns or hats-even the face masks are fabric.
The OR staff are great-we have a good group of scrub and circulating nurses, though the lack of supplies keeps the circulator less busy than in the US! Many have been working for a long time and thus seem to know more than the residents about the cases we do—just like at home.
We have no anesthesiologists at the hospital-anesthesia is provided by one of the 3 nurse anesthetists-the OR nurse in charge, Simon, is a CRNA and the others are designated on the paperwork as “RNA.” I have no idea what the technical difference that makes Simon “certified” in Nigeria is. They are all very capable of general anesthesia for the adults as well as the newborns. Their job is made more difficult (or maybe just simpler? I don’t know) by the fact that we have no narcotics at Evangel, in the OR or otherwise. General anesthesia is with gas and paralytics as needed. Unlike the situation in the ICU, we have a backup power supply for the ventilators in the OR. We end up doing a lot of cases under spinal anesthesia as well. Major dressing changes/debridement that would likely be done under general anesthesia in the US are done with ketamine for sedation. The area that is the equivalent of a US “Post Anesthesia Care Unit” needs some improvement, but hey, at least I don’t have anyone calling me to give anyone more Dilaudid.
All areas of the hospital are staffed by Nigeria family practice residents in cooperation with their “consultants”=attending/staff physician. Though other teaching hospitals in the area have surgery/internal medicine/ob-gyn residencies as well, there is only a family medicine one here and thus the residents are trained to do everything. In the surgery department, the senior residents are more than capable of doing many of the general surgery procedures. Dr. Ardill and the other staff physician mainly step in on more complicated or specialized cases, which is why I have gotten to do so much pediatrics, urology, and neurosurgery.
Now that I’ve given you a little tiny piece of the picture of Evangel Hospital, I’ll end this very long blog entry with a little bit about my day. Yesterday I spent 2 hours in the internet café attempting to upload photos—and failed. I’m sorry but you all will just have to wait. This morning I went with a couple Nigeria friends to the church across the street. Worship time was great, despite my relative claustrophobia—the Nigerians don’t see personal space as an issue at all! In the afternoon I went hiking with the Mitchells around the Jos Wildlife Park, which is a big area that has some beautiful trails and the most pitiful little zoo I have every seen. The lion and lioness were in a cage that was way too small. A far cry from the zoo I am used to. I did, however, get a great picture of me and a cow. Very exciting.
I only have a little over a week left in Nigeria. Please pray that I would use this time wisely and as God would want me to. I feel like I have so much to learn and so little time in which to do it!
Also, I want to say good job to Regan, who is much smarter than her mother. While I am running around the world making a mess, she decided to be efficient and stay at home to make a difference. Yesterday her Girl Scout troop did a beach cleanup, then she volunteered at the San Diego Rescue Mission with church! I guess I’ll accept that as her excuse for not writing.

10% is OK

First and foremost, Happy 1/2 Birthday to Nancy (Palmer!) Sorry to the rest of you... Nancy is the only one in my life who gets 1/2 birthday wishes. It's a long tradition. Only 6 months until she is over the hill.

Today I'm spending my Saturday morning trying to catch up on emails before the Saturday morning Ultimate Frisbee game.

Yesterday was a mildly busy day in the OR, mainly because it takes forever to get anything done in this system. I did a couple hernia repairs in the morning, then did my first prostatectomy ever (and likely my last...?). My urology collegues would faint if I told them how we did it (no TURP's here!) so I'll just leave that part out. The afternoon brought me an appendectomy which turned out to be a removal of a totally normal appendix. I count myself blessed that I found the darn thing since I don't ever do open appendectomies at home. But... as it is said, if you don't have a 10% rate of negative appendectomies, you're not doing enough. Really.

I've had a couple people express concern that I may be going into bicycle withdrawal over here... which I am. Even if I had access to one, I feel unsafe just walking along the roads here, since the cars and the motorcycles have no real sense of traffic laws or normal driving patterns. Riding a bike would be a death sentence. I can't wait to get home to the 101 which feels relatively safe. I have been able to run almost every morning, which is very boring since I have to run back and forth on the compound, but at least it keeps me sane.

Have a great weekend and check back soon-- I hope to upload some pics either today or tomorrow.

Also, tomorrow is the first Southern California Cyclocross race of the season. I'll be missing the first few races, and will be horribly out of biking shape when I get back. Good luck to Dot, Lisa, and the rest of Team CICLE tomorrow--and take it easy on me when I get back!!

Dude

So, today I found myself having to explain my use of the term "dude." Even as an educated, adult American who should, in theory, have a great vocabulary, my speech is riddled with "dude." The few Americans that are here are not from California, so my use of the term as an exclamation for all purposes does not make sense to them. I finally explained it using what seems to be the equivalent in Hausa, "Kai!"

Yesterday I got back to my general surgery roots by doing an inguinal hernia repair. For those very few that know what I'm talking about, it was a modified Bassini, as "we don't do mesh here."

Today I got a call first thing in the morning from Dr. Ardill explaining that he was away at a meeting all day, the other surgeon had left for London yesterday, and the chief resident of the team had just gone to the hospital with his wife in labor. As Dr. Ardill explained, this effectively left me in charge of Evangel Hospital's surgical service for the day. So... while we had no major cases to do, I spent all day attempting to fix all of the patients with the help of Ettang, a "house officer" (intern) who works very hard, and Dr. Emma, the junior resident. Everyone, including myself and the patients survived the day.

I'm off to a party tonight as Gemma and Gary are leaving town... we are all supposed to dress in our traditional Nigerian outfits but mine is not made yet. I guess I'll just go as a California chick who says "dude" a lot.

I would kill for some Drixoral

So, I have a really bad cold, which I'm kind of whiny about, but other than that things are good.

Yesterday was "clinic day," so I got out of the hospital relatively early and went food shopping at the market with Gemma, Hanna and Gary. Since I'm living with the Mitchell's I've been pretty spoiled because they keep me fed, but I've been getting together to cook with the Irish/Swiss contingent as well. All that shopping was for naught, though, as the Ardills had me over for dinner.

Today I once again ventured out of general surgical territory into Urology. A woman had a blockage somewhere along her urinary system, but we have very little in the way of imaging (no CT, no x-rays during operations) and a very bad cystoscope (bladder camera) so Dr. Ardill had decided to do a surgical exploration. Luckily, this "maximally invasive" surgical approach was successful as she had a large stone in her ureter.

Surgery #2 for the day was a skin graft on a man's non-healing leg wound. In the US we have a machine called a dermatome for harvesting skin grafts, but here we harvest with a straight "weck" blade. I have never done this and so the senior resident offered to scrub in and help me. It rapidly became apparent that he had very little idea how to do a skin graft, and he admitted that he had never done one with the weck blade either. With a little help from a wonderful scrub nurse with the weck, I managed to do what I feel was a very nice skin graft... we'll see if it takes. I am very grateful today to the hours and hours that I have spent in the OR at UCSD with Dr. Potenza doing skin grafts... I learned from the best, and I tried to pass on a little bit of it to my Nigerian partner in crime today.

The man today was not a burn victim but we end up doing a fair number of skin grafts for burn victims, particularly children. In addition to the "normal" burn patterns of children pulling hot liquids off tables, etc, there are additional hazards in this culture. Most people heat up water by placing an electric heating coil in a bucket of water on the floor, into which children fall and get burnt. Electric wires are often exposed on the walls of homes. Young children are helping with work on cars and motorcycles. These all add up to a lot of childhood burns.

Adding to my difficulty in posting pictures of these things is the fact that I brought the USB cord that belongs to my old camera, not this one. To upload pics I have to borrow a camera, swap the card, and then pay to upload. So... please be patient (Allison.) :)

Bunches of baboons

Today a whole group of us, including some Nigerian residents and staff, made the three-hour drive from Jos to Yankari National Park. The park is a protected site where, allegedly, there are lions, elephants, antelope, etc, etc. However, because it is the wet season the animals can get food and water wherever they are, and thus are not forced to come near the pre-planned safari route. So... we saw a lot of the warthogs and baboons that run around the parking lot looking to steal food, and little else.

There was a small museum with some pitiful old skins of animals and a display of the types of animal dung in the park. Really.

The park also has "warm springs" (31 degrees C) with beautifully clear water so we spent a long time swimming. Overall, the day was interesting but not entirely worth the time in the car.

For those keeping tally of the surgical procedures, yesterday Dr. Ardill and I did a cystectomy and penile reconstruction (yes, that's right: some poor boy is going to spend his life with the member that I put back together) on a 3-year-old with bladder extrophy, and an above-knee-amputation.

I'm now going to bed because someone gave me a nasty cold.

All this neurosurgery is hurting my brain

So today I did relatively little. The VVF's were few because most of the women who would be presenting to the VVF center are working on their farms to support themselves, or have deferred their treatment until after Ramadan. Instead, I passed my morning taking care of a man with a head injury. Without a CT scanner, we are forced to rely on physical exam alone for decisions. Our decision, then, ended in me getting to do a "burr hole" in the man's skull and evacuate a hematoma. At home, I have a CT scanner, and I have a quick call to neurosurgery, not a drill in my hand. My roommate Klaudia, who is actually capable of cutting people's heads open, will be horrified.

In the afternoon I got over to the market and bought some typical Nigerian fabric so that I can have a Nigerian outfit made. The market is CRAZY, with some vague organization of areas by food/fabric/various other things, but generally a lot of chaos and a lot of people. We had a hard time getting a taxi back because half of the taxis were stopped without drivers because we were right at afternoon prayer time for the Muslims. The thing that struck me the most was that we walked past a group of men washing before prayer where they had all met--which was the Mobil station. If any of you have read "Three Cups of Tea," which I just read on the plane, you'll remember that the author learns to pray at a gas station. Funny.

I'm still enjoying my time here though I have more "down-time," and thus time to think about what I'm going to do with my life which is not good. It stresses me out. One of the Nigerian residents was talking about the same with me and he summed it up as such: "Well, you know where you're going to be for a few years while you finish your residency. And then it's up to God." So simple and yet.... not.

I also feel like I should acknowledge that it's 9/11 today. It has absolutely no significance in this country, but every time I write the date today I'm thinking about it. My prayers and thoughts to the families that I'm sure are still missing people today from that tragedy.

Up to my elbows in...

It's been a busy few days....so I apologize to my more anxious blog-readers that I have not posted in a while.

Since Sunday when I last wrote, here's what's been going on:

Sunday night Gemma (yes, I have been spelling her name wrong) and Hanna had some of us over to their house for a worship/singing/prayer night which was great, especially since we had most of our Nigerian friends their. Dr. Ameh was trying to teach us a song in Hausa. I have some hysterical video footage of the night that will get posted at a later date.

Monday was clinic day, which had a couple interesting cases come in, with the most striking being a 14-year-old female with a VERY large left breast mass, which is most likely a big fibroadenoma. We're hopefully operating on her before the end of the month. Then I helped Dr. Mitchell and Dr. Apoyar with a parotid case.

Tuesday some of our cases got cancelled again due to missing labs (it doesn't just happen in the states! Anesthesia blocks cases here if the hematocrit is under 30, no matter what), but I did a thyroidectomy with Dr. Gidago (a family med attending who does a bunch of surgery, especially ortho). I then did a lipoma on a staff member's head and finished off the day with a crazy hand case with Dr. Ardill. The kid had a contracture on the dorsum of his hand after a snake bike killed off the soft tissue, so we did a release, tendon repair, and skin graft. Once again, out of my general area of knowlege.

Today was a great day, operatively speaking. Once again I got to do some pediatrics. I helped Dr. Ardill with a cleft lip repair in the morning, then we did a anal pull-through operation on a little girl with Hirschsprung's disease. Her first name is Blessing. You find a lot of people here with names like Blessing, Comfort, Love--I've even heard "Godsaves" as a given name.

We finished the day with an attempt to fix a man with a high-output fistula, which for all of you non-medical types is a connection between the intestine and the skin. It was, in scientific terms, a mess. Part of the problem became apparent, though, when we found a sponge in the abdomen left by his previous surgeon at some other hospital. Yes, these things really do happen.... just not to me. :)

The funniest part of the day was a break I took to go to a drug representative-sponsored presentation with the other residents. It was almost the same as in the states (before regulations against the gifts....): free snacks and a boring presentation on a drug. The only redeeming factor was one of the freebies which was a notebook that on the cover said "Preventing Worms!" and on the back was all kinds of ways to prevent worms. I'm going to carry it all over the US hospitals and see if anyone notices.

I apologize if I've bored any of you with all of the surgical speak--but I'm excited. I'm going to have to get some pictures up here soon.

Tomorrow I'm going to spend all day repairing VVF's--as one dear person who will go unnamed put it, I will be "up to my elbows in vag." Eloquently put.

Happy Sunday!

Right now it is POURING outside, so I’m taking advantage of the time and the functioning internet connection at the Mitchell’s house. The rain is actually good since it’s the source of our water—we have well water also but the apartments where the Nigerian house officers/family med residents live have been without running water for a month, so they are completely dependent on the rain water. Our neighbor Dr. Emme, a resident who came over to watch a VERY bad Denzel Washington flick (“He Got Game.” Don’t ever watch it.) with us on Hanna’s computer had been reduced to borrowing buckets of the tap water in the SIM apartments.

I guess I should explain the housing situation. The Evangel Hospital is run by ECWA, the Evangelical Church of West Africa. They have a Nigerian-accredited Family Medicine residency. All of the residents and other staff live on the ECWA “compound.” The compound is the hospital buildings and all of the housing surrounded by a wall with barbed wire. The doctors live at the back beyond an additional security gate. Apparently in the past they have had quite a problem with theft and a couple of armed robberies at the senior doctors’ houses. The residents are all Nigerian but the staff physicians consist of approximately 50% Nigerian doctors and 50% “baturri” (I think I spelled that right), that is, “white” doctors who are all SIM missionaries with their families. They all live in houses on the compound, and the residents have apartments, which are pretty minimal as evidenced by the water situation above. There are a couple apartments that are nicer for short-term students, etc. where I was living for a couple nights with Jemma and Hanna. I am told that it’s not safe to go off of the compound alone –I have heeded this warning and so have not tested it. When I go out it’s always in a group, and I’ve never felt in danger at all.

On the other side of the security gate, on the “street side” of the compound is some housing that is even more minimal for other staff: nurses, techs, cleaning, etc.

This morning I went to church with Jemma, Hanna and Gary-we went to the church at JETS, the Jos Evangelical Theologic Seminary. It was all Nigerians except us and one other family. I dutifully wore a head wrap as women are expected to cover their heads in this society so as not to appear “loose.” It was a great service full of people and singing. It was pretty mellow and actually very close to my church back home (yes, FPC folks, I am referring to you….)in style—this actually surprises me a bit as I have jokingly refferred to Presbyterians over the years as the “Frozen Chosen.”

The pastor this morning had a great Bonhoeffer quote from “The Cost of Discipleship:”
"The life of the spirit is not that which shuns death and keeps clear of destruction: rather it endures death and in death it is sustained. It only achieves its truth in the midst of utter destruction."
Bonhoeffer was in a much more horrible situation than anything with which I have ever confronted, but I think that it provides an interesting view in a hospital situation, especially a less-than-adequate hospital situation in the midst of advanced illness and injury.

I would give you some pictures but it costs a lot of internet credit to upload. I’ll try to get over to the internet café and post some when I’m using my money and not the Mitchell’s bandwidth.

Shout-out of the day goes to Drew---There was a guy at church this morning rocking out on his bass and I thought of you.

They let me sew dura!?!?

So today a bunch of the cases we were going to do were cancelled, but I got to do a myelomeningocele repair on a 1-day-old little girl. For those of you who don't know what that is, google it... or just accept my explanation that it's surgery on/very near the spinal cord. Effectively, I was doing pediatric neurosurgery, which is definitely a bit out of my field. Dr. Ardill was a great teacher and I really enjoyed the case.

This nice case was followed by me having to do CPR on a man with a very, very, very infected, necrotic leg after it was torn off in an "RTA," or "Road Traffic Accident," which is the Nigerian equivalent of our "MVA/Motor Vehicle Accident." So I was forced to pronounce a man dead on my second day here. I guess that's what happens in hospitals, no matter what country. Still, it was a bit of an unsettling way for me to begin my day.

I've moved housing situations and am now living with the Mitchells, sharing a bedroom with 13-year-old Camille. Dr. Mitchell is a Head and Neck surgeon from Oregon who is spending a year here with his family. Camille has been very gracious in letting me invade her privacy.

Tomorrow I'm going to spend the Saturday morning playing Ultimate Frisbee (the official sport of San Diego) with some other SIM people.

I'm a bit stressed about a decision I have to make about my research options for next year, so any prayer would be much appreciated. I just want to make sure I know what God wants for me before I make my decision.
Have a good Friday and a good weekend!!

A fine white powder

Sorry it has taken me so long to write---I have been safely in Jos since yesterday morning but couldn't get any of my available internet connections to work. At the moment I am sitting outside the OR using the laptop of one of the Nigerian family medicine residents.

After what seemed like forever on the plane, I landed Tuesday night in Abuja, spent the night and then took a 4 hr ride to Jos, where I spent the day in a clinic feeling generally yucky. The Ardills very nicely had me over for dinner, then I went home to the apartment I am sharing with two medical students, Hanna (from Switzerland) and Jemma (Northern Ireland.) I quickly found out overnight that I should have taken the time to hang my mosquito net. Ouch.

Today I made rounds with Dr. Ardill on the surgical patients, then spent the day in the OR learning to repair vesiculovaginal fistulae (VVF). The VVF program here is one of the biggest in Africa, doing over 15 per week. Check it out on the Evangel home page. Jody I'm sure you're stoked for me. Tomorrow I get to spend the whole day in the OR again, most likely feeling like I don't know any urology or orthopedics and trying to learn some on the fly.

I'm off to have dinner with my roomies and another med student from Ireland, Gary. Apparently, when he was shopping in the market the other day a woman was laughing hysterically at him because his name, in the local language, Hausa, means "a fine white powder." That's all the Hausa I know, folks. :)

Labor Day

Regan and her cousin Katy are doing their interpretive dance expression of how excited I am right now.
I don't know if travelling all day counts as labor, but it's not nearly as fun as hanging out at the beach, which is what the rest of you seem to be doing.
I'm catching a flight out of LAX this afternoon which will land me in Frankfurt tomorrow. From there I go down to Abuja. I'm very excited about the prospect of sleeping on the plane. Historically, I have not been able to sleep on the plane, but I think sleeping upright is still preferable to sleeping with my pager.
I'll post when I can!

"Rely on It"

The title is what the Magic 8 Ball replied when I asked the question "Will I be packed in time to leave the country on Monday?" While it would be wrong of me to place any faith in the plastic source of answers... I believe that it is right. It seems like I have SO much to do before I go, with very little free time in which to do it.
What I will "rely" on, then, is the grace of God and your prayers to get me off safely and with everything (more-or-less) in place.
Now I'm going to go ask the Magic 8 Ball if I'm going to get any sleep on call tonight.

It's snowing in Africa

So, I suddenly realized that I am leaving the country in less than 2 weeks, and there are a LOT of things left to do.
Most of my planning at this point seems to involve not my Nigeria trip, but my little jaunt over to East Africa afterward. I am meeting my friends Megan and Brian at the foot of Mt. Kilimanjaro after I leave Nigeria, and we're going to hike the famous mountain. This involves some cold, potentially snowy and rainy conditions at the top, not to mention the very low partial pressure of oxygen.
I've been trying to get together the gear I'll need for this cold hike, which is a bit pricey and pretty comical when friends notice me packing my down jacket for my africa trip.
One of my attending surgeon's wife hiked Kilimanjaro last year and is graciously lending me her sleeping bag and trekking poles, and giving me a lot of advice!

Time for some shots-and I'm not talkin' about Tequila.

I have an appointment tomorrow afternoon with a "travel medicine" clinic. I made this appointment in anticipation of needing some vaccines prior to my trip to the exotic lands of Nigeria, Kenya, and Tanzania. I was slightly bitter when they told me that I would be paying out-of-pocket as travel vaccines are considered elective and thus not covered by my insurance. The friendly clinic nurse explained the breakdown of my fees as follows: $65 for the doctor's "consultation fee," the cost of the vaccines, and the fee for the "administration" of the vaccines, which is $38 for the first and $22 apiece for each additional vaccine. This bothers me on all kinds of levels. I am pretty poor at the moment, and the idea of paying someone to do what I am doing now, which is looking up the CDC travel recommendations, and then paying a nurse to jam a needle into my deltoid (which I'd rather not do, but am perfectly willing to do to save some money) irritates me.
In doing my homework on the CDC website and reviewing my immunization cards, (because although I'm sure that my $65 doctor is very smart, I'm not going to trust anyone with my immunity) I have found the following:
1) My previous travels have forced me to get immunized before, against all kinds of things, so my Yellow Fever, Typhoid, and Tetanus are all up-to-date. How many of you can say that? Now if I end up in a trauma bay in the next 2 years I will be able to say with certainty that my tetanus is within the last 10 years.
2) Nigeria is one of the few remaining areas where polio is endemic, much to the distress of the Global Polio Eradication Initiative . It does appear, per their recommendations, that I need an IPV booster shot to complement the polio series I had as a child. After getting my hopes up that I could skip the travel clinic appointment (I'll be going to this appointment post-call, and very sleepy. I'd rather be in bed), this information made me think I should keep my appointment. Otherwise I don't know how I'll get my hands on some polio vaccine.
3) As always, I am traveling to a malaria-endemic area and I will have to spend a lot of money on some Malarone, as the area is chloroquine-resistant and Larium makes me crazy.

Isn't Microbiology great?

Give to ECWA Evangel Hospital!

Thanks to all of you who are helping Evangel hospital get equipment!!!!
If you look a couple of posts down, you can see the info on donating to ECWA Evangel. However, several people have let me know that they've either 1) Had technical problems with the online donation site, 2) Do not feel comfortable donating online or 3) Are "too old-fashioned" for online donation.
If any of those are the case, you can feel free to mail a check to me (make it out to me and I'll just write one big check to ECWA). If you need my address, please email me and I'll get it to you.

I have to get on the phone at 1 am.

Now, this is nothing abnormal for me, actually. In my line of work I end up spending a great deal of time on the phone in the wee hours of the morning. If you listened to my half of the conversation, you'd hear lines that are reassuring ("It's OK. I know his foot is blue"), entertaining ("Yes, it's OK for him to scratch his groin"), and occassionally containing intelligent information.

However, my midnight conversation tonight will not be with the ER, or with a nurse, but with the questionably helpful staff at Kenya Airways. I have had multiple issues getting my flight booked from Nigeria to Nairobi, where I will be flying after I leave Nigeria. Their satellite office in Los Angeles has had issues, so I have to deal with the Nairobi office, which involves a time difference-thus the early AM call. For those of you that are the praying type, will you please lift up my travel issues--I need this ticket. Thanks!

When I grow up I want to be....

The scrapbook that my mother kept through my elementary and high school years, titled "Shannon's School Days," has pre-printed blanks to fill in friends, teachers, hobbies, and a section each year titled "When I grow up I want to be."

This section in my first grade year has a check in the box marked "Nurse." By the next year, apparently God had convinced me of what He already knew, which is that I am not nearly patient enough to be a nurse, and the box is marked "Doctor."

This box stays marked throughout elementary school and junior high. At some point in high school I decided, for reasons that I can't remember, to abandon medicine in favor of a pure research career. By the time I was in college, the plan was to get a Ph.D in the biosciences and live happily ever after in the lab.

May of 1999 changed this plan. Suddenly and inexplicably I became interested again in medicine. Never one to be unambitious, I immediately enrolled in an MCAT course and attempted to fix my GPA. Even then, though, I don't think I had any idea that I'd ever be doing surgery. After all, there was no box in the scrapbook for "surgeon." There should have been one.

Happy 93rd birthday Mr. B!

My sister Jody has voiced her complaint that I am not updating this blog, especially given the copious amount of free time that I have. I apologize for not entertaining any readers of this blog with a new post. Since Jody may, at the present, be my one and only blog-follower, I feel obliged to post.

I am happy to be back on the general surgery service at the VA, though we have been quite busy. Next month I'll be doing general surgery as well, and then I'm off to Nigeria!

This weekend I will make an attempt to fill the picture links with something functional-so Jody, check back.

Finally, I'd like to wish a happy birthday to my patient Mr. B, who celebrated his 93rd today by being transferred out of the ICU to the floor--once he passes his swallowing study, we'll get him a cake.

Frequently Asked Questions.....

Q: Are you a doctor yet?
A: Yes. I graduated with my M.D. from UCSD in 2006 and I'm licensed to practice in the state of California.

Q: What's a residency?
A: For those of you who don't watch Scrubs and Grey's Anatomy, residency is specialty training after medical school. I'm starting year 3 of a 5-year general surgery training program. I will likely do two years of research as well, which means I won't be a surgeon until 2013. So for all of you asking if I'm almost done....I'm not.

Q: Surgeon? So, you're rich, right?
A: Um... no.

Q: Why Nigeria?
A: Dr. Ardill, the surgeon with whom I will be working in Jos, worked last year at the VA hospital in San Diego, where we do a large part of our training. He is regarded by all of the residents as an excellent teacher and had great pictures of all of the work he is doing in Nigeria. I seized the opportunity before he left the U.S. to ask if I could come work with him, and he said yes.

Q: Have you ever been to Africa?
A: No. I've traveled a bit in Central and South America and Europe, but Africa is a new experience.

Q: Are you going alone?
A: Yes. Once I'm in Nigeria, of course, I will have the support of Dr. Ardill and his family, along with the Nigerian hospital staff.

Q: Is Regan coming with you?
A: Regan thinks this question is hysterical, because she has no interest in coming to Nigeria with me. When she's a little older I'm sure I'll find a way to include her on overseas trips if she has the interest, but this fall she'll be tackling a more difficult land--7th grade.

Q: What are you going to do about your freakish exercise habit while you're in Nigeria?
A: I'm not sure. Pray for patience? Find a new Nigerian friend to run with me?

Donations for Evangel Hospital

Prior to my departure in September, I am hoping to raise the money for 2 new blood pressure monitors and 2 pulse oximeters that are much needed by Evangel hospital. The total cost for this is $3400. To donate, please follow the link below and mark your contribution as designated for Nigeria: Evangel Hospital, and select "Ministry Account" on the pull-down tab.

https://apps.easydraft.com/Payment/SIM/SIMinUS.asp

Any questions/problems with the online donation please contact me and I'll make sure that your money goes where it is needed.

Welcome to my blog!

I have, until this time, resisted the urge to keep the world updated on my minute-to-minute activities via a blog. However, in this case I think that it's justified. It will remain a work-in-progress for a few weeks, so keep checking back for more information. I promise to post pictures soon!