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.
Tuesday, September 30, 2008
Sunday, September 28, 2008
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!
Thursday, September 25, 2008
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.
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.
Tuesday, September 23, 2008
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.
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.
Sunday, September 21, 2008
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.
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.
Saturday, September 20, 2008
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!!
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!!
Thursday, September 18, 2008
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.
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.
Tuesday, September 16, 2008
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.) :)
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.) :)
Saturday, September 13, 2008
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.
Thursday, September 11, 2008
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.
Wednesday, September 10, 2008
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.
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.
Sunday, September 7, 2008
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.
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.
Friday, September 5, 2008
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!!
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!!
Thursday, September 4, 2008
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. :)
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. :)
Monday, September 1, 2008
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!
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