Herald Times Reporter article - 3/15/09

The local newspaper, the Manitowoc Herald Times Reporter, ran this nice article on my recent trip to Ethiopia. It's much of the same material that has already been posted on this blog (minus about 90% of the twisted sarcasm). The article is very well written, and let's just say that it's nice to be mentioned somewhere other than the obituaries for once.

http://www.htrnews.com/article/20090315/MAN0101/903150336/0/varsity

The web version only has one picture, but the print copy has more. Most of the pictures are right from this blog anyways. Anyone interested in obtaining a print copy should let me know this week. As a bonus, it comes with a whole section of valuable coupons for local Manitowoc grocery stores that will be long expired by the time I can get them to you.

Disturbing Trends

Some things are inevitable. As children grow, they sometimes develop behaviors that are concerning to parents and teachers... seemingly out of nowhere. My children must be no exception. We have been accustomed to dealing with the "terrible twos" and have conceded that they sometimes extend into one's third or even fourth year. Tessa, however, has recently demonstrated behavior that seems well outside the norm.

Warning! The following photographs may be disturbing to young children (wait... they are the work of small children... and their deranged fathers).

Tessa has always had a keen interest in Elmo, a popular Sesame Street character. She has books on Elmo, multiple stuffed Elmo dolls, and has even had a singing Elmo at her second birthday party. We thought all was well with their relationship, but recent activities have suggested otherwise. We fear Tessa may have felt threatened by Elmo (can he really be trusted?) Is he really just an imposter, winning us over with his cute voice and bad grammar? Tessa, apparently, thinks so, and has taken to bizarre interrogation methods to squeeze the truth out of him.

Things began playfully. At first, she would just make him wear funny outfits. But then she would force him to do things like eat parts of other toys, or humiliate him by making him wear diapers made of feminine hygeine products. Once these methods failed, she has taken to more direct techniques... things bordering on torture. This evening, I caught Tessa red handed, waterboarding Elmo (along with a naked Barbie doll) in the downstairs bathroom (GuantanElmo Bay, as it is now known). He looked exhausted and hypothermic when we found him, but he was rescued in time by some activists from AmnesToy International as Tessa was apprehended and sent to Time Out for three minutes. AmnesToy is protesting such a lenient sentence, but we don't think toddlers are subject to the Geneva Convention (nor are stuffed toys protected by it).

Elmo was finally able to tell his story (referring to himself in the third person, as usual) once he was brought to a warm, secure location. We are working on placing him in something akin to the witness protection program, but this is admittedly tough given his distinguishing features of red fur and disproportionately large eyes. We fear what might happen to him were he to be discovered.

As for Tessa, she has already served her sentence as well as some community service work (cleaning her room), but we are unsure as to whether or not she has been adequately rehabilitated.

An Evening with Daddy

Having been back home for a few weeks now, I am fully settling back into life in America. Work is back in full swing, the kids remember who I am (though Tessa was confused for a while after a recent haircut), and Wendy wants her life back. This evening, she got her chance. She belongs to a book club, and though she may not have actually read the book (details, details...), I was not on-call, so she could actually go. This, of course, leaves me alone with the girls.
Thursdays tend to be busy, so I didn't make it home until about 6:15. The girls had already eaten, but they at least had a burrito waiting for me which I scarfed down in the kitchen while getting the preparatory debriefing before Wendy cut loose. The girls would need baths (no problem), Emma left her mermaid barbie outside (it's 10 degrees out - and all she has on is a bikini!), and Wendy took apart Tessa's crib and put the toddler bed in her room (some assembly required). Having been involved in the disassembly of the toddler bed 9 months ago (it was Emma's at the time), I immediately headed upstairs to work on this. Wendy offered to rescue mermaid barbie from her icy abandonment and put the girls in the tub. Tessa decided to have a potty accident (#1, mercifully) and Emma offered to "help" her (no worries, at least it's bath time).
Five minutes later, I'm upstairs ratcheting the "bumblebee bed" together and I hear a blood-curdling wail from downstairs. Wendy has retrieved mermaid barbie, but found her head frozen to the driveway. Upon picking the doll up, she proceeds to decapitate Emma's prized toy (and Emma was present to witness the assault!). Emma is inconsolable, tessa is naked, I'm on my hands and knees looking for a missing washer, and Wendy is late to book club (I'm sure they start promptly). Now I'm all for providing the wife with a girls-night-out, but did she have to disassemble the furniture and behead the toys right before leaving?
Somehow, I manage to finish bathing the girls (things go much quicker once they get a little soap in their eyes) and get them into their jammies. I manage to find all the parts and get the bed assembled (almost to OHSAA standards) all while Emma is begging me to attend to the more-urgent task of reattaching Barbie's head. Wendy was at least nice enough to lay out some suture before she left. While we attempted "recapitation", Tessa managed to make a diaper for Elmo out of some feminine hygeine product and managed to spill water on her new bed. We finally gave up on Barbie (for now), read some stories, brushed teeth, and got the girls tucked in bed (sentence encompasses 45 minutes of sheer bliss). I then proceeded to operate in peace and was able to bring barbie back to health without so much as a stiff neck. She is now tucked in bed with Emma, ready to brave the elements again tomorrow.

Culture Shock - Readjusting to life in America

It's been four days since I returned home. I apologize for not posting sooner, but I'm just now getting over the jetlag and I've been at a loss for source-material. Frankly, I've been nearly catatonic from Ethiopia-withdrawl and I've had a few other things on my plate (something about a job and "doing my part to help around the house... blah, blah, blah").

The trip home added up to around 48 hours of total travel time from when we pulled away from the hospital until pulling into my frigid driveway in the arctic tundra. During this time, I slept a net three hours and drank a total of 8 cups of coffee (I'm sure these two facts are entirely unrelated). We managed to do some souvenir shopping in Addis Ababa and I spent an equal amount on chocolate in duty-free shops on three continents (nothing like paying a 50% markup to avoid 5 or 6% in taxes).

The girls were very cute and clingy when they greeted me in the airport. It was great to see tham once again. We went out for dinner in Milwaukee, and I was reminded of what dinner with cooped-up toddlers is like (I had fewer bruises from two weeks of soccer on a dirt field). We got home late on Saturday evening and I unpacked souvenirs for the girls and gave Wendy my very dirty laundry. Here is a picture of her carting them to the local laundromat.

I returned to work on Monday with a renewed perspective on how nice things are at home. I was asking questions about all the equipment in the OR (is this stuff new? Are you sure? Everything is so clean and shiny!). I also was reminded about the most prevalent features of the American medical system... acronyms and the paperwork that accompanies them (JCAHO, HIPAA, etc). It sure was nice, though, to be back with my partners, my office staff, and the nurses and scrubs that I am used to working with. You folks are wonderful and are way too kind to me.

I have been in somewhat of a state of withdrawl since coming back from Soddo (I'm sure zero-degree windchills have nothing to do with this). 95% surgery and 5% paperwork is somehow preferable to 10% surgery and 90% paperwork. I miss a lot of things about Africa (see previous post). I have coped by spending lots of time with my family, looking through my pictures again and again, and by attempting to reproduce the authentic Ethiopian coffee experience (I will post a tutorial once I have mastered the technique... for now, I'm just trying to get the smoke and carbon monoxide out of the house). Here are some photos of our helper Yeta brewing us a pot in Soddo.

Thank you to all who supported me on my journey and who feigned interest and followed my blog. It was fun to write and was hopefully entertaining to read (I would say enlightening, but that would be giving myself way too much credit). Hopefully, there will be more trips and more stories to come in the future, but nothing has been set in stone quite yet. I'll keep y'all posted.

-Matt

I will miss Soddo

This will be my last post of the trip (unless I fork over some serious Euro in the Frankfurt Airport).  We'll be piling in the LandRover in about 30 minutes and heading out onto the Ethiopian Superhighway/ cattle sidewalk.  We'll drive 5-6 hours, do some shopping in Addis Ababa, then head to the airport for a 10:45pm takeoff.  This time, Harry (the Optometrist) will drive us instead of the "Red Jackal" taxi service. 

 

Though I am truly excited about going home (I miss frostbite, chapped lips, and cabin fever.  Really, I do.)  there are many things I will miss about Soddo and that will probably bring me back to do this again.  I'll try to keep the list reasonably short and readable.

 

- I will miss the sunrise over the mountains as the only alarm clock I need

- I will miss fresh-baked bread in my kitchen almost daily

- I will miss doing the thing I love every day with one of my best friends and mentors, John/ Steve Foor (I was a premed and he was a med student the last time we did this together.)

- I will miss the fact that I can round on 40 patients a day and still make it to the OR on time

- I will miss the trusting faces of brave children who let me change their wound dressings every day

- I will miss fist-bonks with the kids in the ortho-ward

- I will miss nurses who usually understand what I'm saying (and always claim to)

- I will almost miss Gyn rounds (almost)

- I will miss the operating room staff who laugh at my jokes search for the weird instruments I ask for (like suture)

- I will miss playing with the babies I delivered the night before

- I will miss hyperventilating on the soccer field at 7400 feet

- I will miss the well-conditioned nurses, orderlies, and gardeners who occasionally let me score a goal or even pick me for their team

- I will miss playing Catan almost every night

- I will miss movie night on the patio in January

- I will miss leaving my pager and cell-phone in a suitcase for two weeks

- I will miss the smiling ICU nurse who walks to my house every time he needs me to see a patient

- I will miss Ethiopian coffee (of course, I am taking 6kg home with me - unroasted baby)

- I will miss daily Injerra in the doctors lounge (and trying to convince John to eat it)

- I will miss the fact that I can feel clean, even though I'm coated in red clay dust at all times

- I will miss hanging out with people who can spend years (even a lifetime) doing what I can only pull off for a couple of weeks at a time

 

but I can't wait to see my family (who all got haircuts while I was gone), friends, co-workers, and church; I have missed them all dearly.  Thanks to all who have kept up with this blog (and suffered through my verbosity) and chatted with me late at night.  Can't wait to see you folks in person again. 

 

 

 

Soddo Speak - A Lexicon for visitors

Terms I wish I had known or understood a couple of weeks ago.

 

- Ready (adj):    1. I'm getting around to it.

                        2. It will be the next thing I do...when I next do something.

                        3. I am standing in the room where I will next do something...once I do it. (why are you still staring at me?)

 

- Single use only (phr):    - This does not translate into Amharic

 

- There is a patient in Gyny ward (phr):  - "You need to do a C-section yesterday"

 

- Yes (n):  1.  Yes (if spoken with brisk nod and direct eye contact)

                2.  I will do my best to guess what you just said (spoken with brisk nod and some eye contact)

                3.  I think I understand and will ask someone else when you are gone (spoken with slow, deliberate nod and two raised eyebrows)

                4.  I have no idea what you just said, but can't bear to have you explain it (spoken with slow, deliberate nod and no eye contact)

                5.  He's out of his freaking mind (spoken with slow, deliberate nod, one raised eyebrow, and knowing look given to other Ethiopians in room)

                6.  No (spoken without any eye contact)

               

- No (n): - rarely used in Soddo (considered rude)

 

- Saline (n): - An extremely valuable substance used sparingly in contaminated operative cases and kept the farthest possible distance from the operating room (in the same place as the gauze, tape, bandages, and exam gloves). 

 

- Stat (adj): - also without Amharic equivalent

 

I am sure that I could add more terms to this list, but these are at least the bare essentials is one is to participate in healthcare.  I hope you find it useful, or at least enlightening.

 

-Matt

 

 

 

 

Lost in Translation

Just thought I'd post some of the best "communication moments" that I've had (with or without interpreters) while here in Soddo. 

 

- I was interviewing a trauma patient who had been beaten over the head with "pieces of wood and stone" (you'd be shocked to see how frequently this is written on someone's chart).  I asked the nurse/ interpreter if the patient knew where she was.  Per routine, they talked together for about a minute, after which time the nurse told me that the patient was unconscious. 

 

- We saw an emergency patient for abdominal pain who ended up having a ruptured spleen.  We asked him what he did right before the pain started.  "Eating lunch" he said.  Wish he would have mentioned that right before eating lunch, he was being beaten with a metal pole. 

 

- Soddo math:     Coffee pots are 7 Birr a piece.  If I buy two coffee pots and pay with twenty Birr, my change is two Birr, right?

                           Lattes are 3 Birr each, Tea is 2 Birr.  Mango juice is 4 Birr.  Therefore, 4 lattes, 4 teas, and 2 mango juice are 20 Birr (we left a tip).  

                           Soda is 3.5 Birr each, I buy six.  I am told 24 Birr.  I pay 30 birr and get one Birr back. 

 

- I am seeing a trauma patient who has been beaten over his head with a machete by his son.  He speaks a different tribal language, so I ask the nurse to get a family member who can interpret.  "Let me get his son" 

 

-  "You have discharge on the Gyn ward."  -  I do? 

 

- "You know this man's penis?" - context.  It's all about context

to Market, to Market

    I've been meaning to post these stories to the blog for a few days now, so please forgive my delinquincy.  Things have been somewhat busy lately, or at least unrpredictable. 

    On Saturday, after our morning rounds, we had opportunity to go into the greater Soddo metroplex for coffee and some shopping at the "mall."  We walked the route that Dr. Bowers (Harry) and I had driven a couple days earlier ... It's amazing how much more you see on foot.  There appears to be a lot of road construction going on in Soddo right now, not that anything is going to be paved anytime soon, but there will at least be decent gutters and sewers to keep things passable in the rainy season.  There are a lot of dusty roadside stands, offering everything from the ubiquitous "Miranda" orange soda, to shoe shines (hope springs eternal), to a game of ping pong or fusball.  We reached the mall and climbed the stairs to the fifth floor to the rooftop coffee shop - home of 30 cent lattes!  This time, I was able to watch the barista work an ancient looking, puke-green, Italian Faema espresso machine.  It was complete with the hand-crank pistons - old school espresso.  I must say, he brewed some fine shots and can froth powdered milk better than most Starbucks robots. 

    After coffee, we sampled the offerings at the mall.  I didn't buy much... it was mostly window shopping and grabbing a few essentials in the grocery booths.  I did try to buy some shoes - Ethiopian Skechers knock-offs.  Word of advice: try on both shoes, as not all size 43's are built alike.  After this, I hit the grocery booth for some over-priced, but refreshing Coca cola ($1.30 a can?  there goes my latte savings.)  After leaving the mall, our group split up, some heading back to the tranquil hospital grounds while four of us decided to brave the local market.  This is the one that burned down a couple of weeks ago - apparently economic recovery is a bit more swift in Soddo than it is in the States.  I gave everything of value (except my camera) to Harry to take back to the compound (apparently, pickpockets are a birr a dozen at the Soddo market). 

    The market was organized chaos - a sprawl of tarp tents and blankets spread out on a sloping dirt (and ash) hillside teeming with hopeful merchants and bored, unattended children... bored until we showed up.  There was a massive section filled with identical looking hand-woven baskets - apparently these are for tourists and we are the only ones today.  We were mobbed.  We ducked our heads and almost ran to the next section, which was all the locally grown food.  Apparently, 90% of Ethiopian caloric intake is in the form of hot chili peppers, garlic, shallots, and onions (I see a market for antacids and Scope here).  Stephne (Harry's wife) was with us and had a full time job shooing away all the kids begging us for Birr (I just thought they were cold).  We passed "Chinatown" (that's where they sell all the plastic stuff), and finally made it to the section I had been waiting for... Coffee Pots.  I had been hoping to find one of the round clay long-neck pots that Ethiopians use for their traditional coffee ceremony.  I was told that if I tried to purchase it myself, that I would be overcharged, but the lady only wanted 7 Birr (70 cents) for them.  Shoot, even Wendy isn't that much of a tightwad! (Sorry, Hon).  I bought two, in case one doesn't survive the flight. 

    The marketplace, however chaotic, was a true testament to human resilience.  This place was an ash heap only two weeks ago.  No help has come yet from the government, the NGOs, or anyone.  But there they are, rebuilding their stands and still selling their wares all at the same time.  Sitting on one's insurance payout simply isn't an option, and no one is counting on a government bailout.   Against all odds, their life and their business will go on... ideally with shiny shoes (if only until the next dust storm). 

    After the market, we headed to Stephe's orphanage.  She works with Christian World Adoption - I think there's a link to her site somewhere on this blog.  I can't post any pictures of the kids since they are all potential candidates for adoption.  This is a bummer (the picture, not the adoption thing) because they are all so cute.  There must have been 10 babies or so all under 6 months of age.  They each have some sad story of abandonment and a harrowing tale of rescue, and it's amazing the progress a baby can make given nutrition and loving attention.  Stephne runs a pretty tight ship.  I guess you have to with 51 kids under one roof (I can barely handle two!). 

      That's all for now.  So much has happened surgically since then, but for 90% of you, that would either be excessively boring or grotesque, so I will spare you and make those a separate blog post. 

 

Update from Soddo Trauma and Obstetrics Center

So, it's been a few days since I updated the blog.  We've been busy, though it hasn't been a break-neck pace.  We've essentially had one emergency every night - no more, no less.  The weekend has been nice for catching up on rest (except I'm still staying up 'til 2am to email and IM people at home) and spending some time out of the hospital. 

    From a surgical standpoint, things are still going well... I'm still being stretched operatively and in managing disease processes which are usually part of other specialties at home.  It is sheer irony that the textbooks I keep referring to are "Campbell's orthopedics" and "Campbell's Urology."  There is also a book called "Short practice of Surgery" - it's 1523 pages long and dwarf's a New York phone book.  I'd hate to see the long version.  On Friday, I did a pediatric hernia, a bilateral hydrocelectomy, a urethral dilation, changed out a suprapubic catheter, and John and I reduced a compound humeral fracture.  It was nice that they have fluoroscopy (live x-ray) here, because our first attempt was way off.  John excised a sarcoma-looking mass off a kid's back and some other gyn procedures (I'm thinking he drew the short straw on that one).  We had a trauma patient that evening that needed to go the OR to wash out some deep wounds, but she really didn't need surgery.  She should be okay.

   Yesterday, we were able to make rounds pretty efficiently and discharged a bunch of patients.  The babies from the first two c-sections were doing well too.  Their fevers had broken and they were eating better, although one of them had butter caked on its head (? tribal thing ?).  We wish the butter had been there before - maybe the c-section wouldn't have been necessary.  After rounds, we headed back to the houses to change and go out for a day on the town.  I'll put that in a separate post, lest I be acused of being a bit verbose.... Hey, no comments from the peanut gallery!

    John came back from town earlier than I did and was rewarded with a few consults.  One of them involved placing a chest tube for a hemothorax which had resulted from trauma three months ago.  They guy can breathe now, but I'm sure we'll be doing a decortication on him come Monday.  This morning, we slept in.  We had well-laid plans to hit the wards and make speed-rounds, but were met half-way to the ward by Addis, the OB nurse (nice lady, great nurse, but NEVER the first person I want to see in the morning).  She had a lady who needed a c-section - she'd been laboring for almost 40 hours before she even got here.  I ran to the OR to notify anesthesia and the nursing staff.  They were already there and ready to go.  Apparently, we are the last ones who need to know... this may be true.

     All went well.  We got this one done much faster and with much less bleeding than the first two.  Either we are getting better at this, or this kid was just smaller and more aerodynamic (the last one head a head like Sputnik).  Again, we were thanking God for a living baby, a healthy mommy, and that the generator didn't poop out until we had the uterus closed (a very unforgiving organ in the dark).  We finished rounds, and now it's time for brunch!

 

 

Trauma; Life in the ER: Soddo Edition

Every evening seems to bring a new adventure.  I'm not complaining, though.  I'm just glad we've gone over 24 hours without a stat C-section (and now I've totally jinxed myself).  The day started out with some new operative challenges.  John and I resected a nephroblastoma (freaking huge kidney tumor for you non-medical types) from a 4 year old.  I think the tumor was half the kid's body weight.  It was stuck to a 4cm segment of his vena cava.  That's God's country because really, only God should know what the back side of someone's vena cava looks like.  Unfortunately, we found out what the inside of his vena cava looked like, but John is a super vascular surgeon and fixed that, so all is well.  The tumor is out and the kid looks great (albeit a bit smaller and less lopsided).  Hopefully, he will be able to get the chemotherapy he will need in Addis Ababa.  I did a few more minor procedures before heading to the surgery clinic for the afternoon.  As expected, I recognized little of what I saw, but at least there are few subtle diagnoses in Soddo.  People live far away and therefore wait until things are REALLY bad before taking the long trek to the hospital.  The tumors are big or the wounds and infections are quite advanced by the time they get to us.  There was also a lot of gyn stuff - my favorite!  Dr. Morad, the OB/Gyn doctor is back, but we're trying to give her the rest of the week off because she is exhausted from her travel and is also moving into a new (not quite completed) house. 

        After clinic, I was hoping to join up with the OR staff for another game of soccer.  I am getting acclimated to the altitude and thought I might make it a whole 30 minutes before requiring intubation.  All this got tabled, however, when a nurse from the OR asked me when I was bringing the "new patient" to the OR.  I wasn't quite sure who the "new patient" was.  She said, "You know, the bleeding skull fracture from the car accident."  Actually, I didn't know, but she showed me to the ICU where there was a very bloody man who wasn't quite conscious.  He had been admitted from the outpatient department/ emergency room with an order to consult surgery to close his scalp lacerations.  He had more urgent issues.  He was bleeding from his mouth and tongue and was struggling to breathe through the blood and around his swollen tongue.  His jaw was obviously broken in at least two places.  He was going in and out of consciousness, his blood pressure was too low, his oxygen saturation was way too low, and who knows what his cervical spine looked like.  He was too combative, however, to tolerate any attempts to secure his airway.  I resorted to the ABC's of trauma - A is for airway, because without that, nothing else is going to matter.  We decided he would need to go to the OR for a tracheostomy before his tongue could swell any further.  I stabilized his cervical spine, lifted his jaw a bit to open his throat up, and tried to examine the rest of his body (with my third hand).  John had arrived to help, and we were able to get some fluid into him and raise his BP above 90.  The we went to the OR, placed a tracheostomy and did an ultrasound of his abdomen to evaluate for any bleeding or injuries to his liver, spleen, or kidneys - everything looked okay, his BP was better, and his oxygen levels were 100% now, even just breathing room air through the tracheostomy.  We sewed up his scalp lacerations and got him back to the unit.  It's at this point (or earlier) that I would normally be CT scanning his head to look for intracranial bleeding, CT scanning his neck to look for fractures, and consult facial plastic surgeons, neurosurgeons, and orthopedic surgeons to assist in managing him.  Apparently, however, there is no CT scanner and I AM the facial plastic surgeon, neurosurgeon, and orthopedic surgeon.  We'll just try to get him through the night, then worry about defining and fixing all his injuries in the coming days and weeks.  I think we've gotten to all the life threatening stuff for now.  I just hope is brain is okay. 

        We eventually made it back to the house - later than usual, but not too late to prevent us from playing a game of Catan.  It's even popular in Ethiopia, and the Foor family is pretty good at it.  Sarah, the eleven year old, is RUTHLESS.  She cleaned my clock AND ate all my beef jerky while doing it.  Oh well.

        This post is getting a bit wordy. I would attach photos, but my hands were too busy to take many today.  Those will come later as patients recover.

 

Altitude training

   Tuesday and Wednesday were both long operative days.  The experience has stretched me because diseases present so much further advanced than I am used to (the tumors are bigger, the wounds larger, etc) and I am working in disciplines that I don't have specialty training in.  It has been a lot of fun, though - like a kid in a candy shop, we say.  I would love it if I could do this much surgery at home with so little paperwork and without having to wear a pager. 

    After work, I was able to get into a game of pickup soccer with the OR staff for the second day in a row.  Maybe they were kinder to me, or maybe I'm getting used to the altitude, but I was able to go about 30 minutes this time.  I took the hint, though, when they offered to let me be the keeper.  I know I'm out of shape, but I'm sure the altitude is playing some role.  It takes forever to pay off my oxygen debt, because there ain't much flowing in. 

   After soccer, we had a traditional Ethiopian dinner with Injerra (acidic flatbread rolled up like an ACE bandage), Doro Wat (chicken stew with hardboiled eggs and incredible spices), lentils, onions and potatoes.  It was awesome - even better than the Blue Nile back in Columbus.  I have to wait until this weekend, however, to enjoy a traditional Ethiopian coffee ceremony.  I can't wait.  I may even adopt it as my morning ritual at home.

    Sharon, the OB/Gyn Missionary returned today from a trip to visit her parents in Kenya.  I can't tell you how glad John and I were to see her.  We were thankful that we were able to go a few days without any obstetric complications while she was gone.  We still might do some C-sections while we're here, but at least we know we have backup now in case things don't go so well. 

    Later in the evening, John and I got called to see an acute abdomen.  The guy said his belly started hurting after lunch, but so did his shoulder.  We took him to the OR and he ended up having a spontaneous splenic rupture.  He had lost a ton of blood, but was actually quite stable.  A spleen is a heck of a lot easier to deliver than a 10lb baby, so we had it done in no time.  He may need a blood transfusion or two, but he should be fine. 

    Overall, things have been a great experience so far.  I'm being stretched as a surgeon and I'm getting to work with some incredible people.  It's a bummer I won't get to cross paths with Paul Gray, the full time surgeon here.  He hasn't been here long, but his mark is already on the place in a very good way.  May God sustain his passion for what can be an exhausting job (and I'm only doing half of it for only two weeks!). 

here we go again

So, all my prayers that the babies would stay in their mommies' bellies kind of backfired on me.  They woke us up at midnight to tell us that a lady had been laboring since 4pm... the day before, with no descent.  We rolled out of bed and went up to see her, and it looked like she didn't have much fight left in her.  The fetus was a transverse lie and firmly impacted in the pelvis, and it wasn't going anywhere.  We booked the case, then re-read the atlas, just to be sure we hadn't missed anything the last time. 

    This case went a bit more smoothly at first.  When it came time to deliver the baby, however, it was still pretty stuck.  It's shoulder and hand came out first, which left less room for the head.  We ultimately got it out okay, but it left the uterus a bit traumatized and it tore through one of the uterine arteries, which tends to bleed a lot.  We managed to get it controlled and all ended well.  This lady was less anemic to begin with  than the previous one, so I think she'll be okay too.  We got to give the baby to her mother while she recovered.  One proud grandma.  We finished up around 2:30am.  Satisfying, but this every night OB call is for the birds.  I don't think I'll volunteer for that duty when I get home. 

Putting the general back in surgery

Today was another whirlwind day at Soddo Christian Hospital.  John and I stayed up late organizing our patient list to make morning rounds more efficient.  It's been a few months since I had to manage 34 inpatients at once plus handle a full operative schedule.  Rounds got interesting right from the start when we didn't recognize the first eight patients.  Why?  Because they were admitted overnight in anticipation of their scheduled operations the next day (no one bothered to inform them).  They included 5 prostatectomies, an Abdominoperineal resection, and Esophagectomy, a 6cm scalp squamous cell carcinoma, and an excision of a recurrent cystic hygroma.  That may not mean much to many of you, but suffice to say that these are not small cases, and only two of them are in my specialty (or lack thereof).  We postponed the esophagectomy, the sqamous cell, and one prostatectomy because we had already booked the schedule with semi-urgent add-ons:  Knee arthrotomies for septic arthritis, excising an infected extremity sarcoma, and doing burn dressing changes under sedation.  In all, I did six (five and a half, really) cases today.  I bailed on the last one (cystic hygroma) 30 minutes in when the power went out and the generator ran out of fuel.  It was getting dark, and I had the anesthesiologist holding a flashlight while I tried to control neck bleeding without suction or cautery.  Thank God I wasn't down to the big vessels yet.  I was able to close and schedule a re-attempt in a day or two.  I hope they get more generator fuel before the next C-section hits.  We're sitting on a lady (not literally) who is three days overdue.  The real obstetrician gets back tomorrow afternoon. 

    The lady from last night's emergency section is doing great, if not a little pale (I didn't mention blood loss, did I?)  Her baby is having some feeding difficulty, though.  Keep him in your prayers - I heard he was doing a bit better this evening.  Oh yeah, we're somewhat responsible for the newborns too.  Please add "neonatologist" and ENT to the hats I'm wearing this week. 

     In spite of the challenges, it is still a rewarding experience.  There's nothing like cramming through the atlas while they prep your patient for something you've never done before.  The real reward, of course, comes if and when the patient does well.  I did a knee arthrotomy for a 15 year old with horrid septic arthritis.  By evening, she was tolerating 90 degree range of motion and her fevers were gone. 

    After work, I did take opportunity to play some pickup soccer.  The OR staff plays just about every evening.  I was quickly reminded that it has been a long time since I really worked out, even longer since I played competitive soccer, and that I have never done either at 7400 feet.  I'm still paying back my oxygen debt.  Tomorrow promises to be another busy day - who knows what unannounce preop patients will be waiting for us.  We have a number of sequestrectomies for osteomyelitis scheduled, we have to wire a jaw shut for a mandibular fracture, and there's that esopagectomy and prostatectomy that we postponed as well.  I'm going to get some rest and pray that all the babies and mommies do as well. 

First Case - a doozy

    My hopes of making it until Wednesday with no babies did not come to fruition.  We had a relatively stressful, yet uneventful day (meeting 34 inpatients and consulting on 10 or 12 outpatients) and had finished eating dinner with the other missionaries.  We had just changed out of our scrubs (that was our first mistake) when a messenger from the hospital told us we were needed; someone was in labor.  It was a woman we'd seen earlier in the day - due today but without any signs of labor yet.  We find out this evening that she has had eight stillbirths in the past and has walked 15 days from a distant village, timing it so she would get here on her due date.  It was clear she would need a c-section to avoid stillbirth number 9. 

    We booked the case and sent people to round up the anesthetist and OR nurses.  John went to help prep the patient while I ran to the library to grab an old version of Williams' Obstetrics... you know, just to be sure (we were cramming in the surgeons lounge and made sure to note the part where it says not to cut the baby).  Then we just did what we had to do.  It wasn't pretty (really, c-sections are never pretty), but we got that baby out and John patted it on the butt until it started to breathe.  Then we had to control the bleeding (the pictures in the atlas didn't show so much blood).  In the end, the baby, mom, John, and I all made it through the case alive with stable vital signs.  Lori dragged Sarah out of bed (well past her bedtime) and took photos while Sarah awaited the baby in the hall.  When all the dust had settled, we headed back to the house and toasted the last can of Mountain Dew (it's all Crystal Light from here on out) and savored a few precious jalapeno pringles. 

addis ababa and the red jackal

Addis Ababa and the Red Jackal

                We have finally arrived at our final destination after a night's stay in Addis Ababa.   After having my flight out of Milwaukee cancelled (wonderful Wisconsin weather!), the remainder of our travels were smooth.  We made all our connections, our flights were more or less on time, and customs was a breeze.  We met our driver at the Addis airport – the Red Jackal taxi service.  They took us to a mission guest house where we had a hot shower, a good night's rest, and a warm breakfast this morning.  We then went grocery shopping before a 6 hour drive through the Great Rift Valley to Soddo.   

                The landscape here is beautiful…at least once you get out of the choking diesel exhaust of the capital.  Even though it's the dry season, there is plenty of green, even at the tops of the mountains.  We were on roads as high as 10,000 feet which afforded some nice views of the valley.  My ears did more popping on the drive than they did on the flights.  We are at 7,400 feet elevation here. 

                The  hospital compound itself is beautiful and quite well maintained.  Its supplies are meager by Western standards, but as far as mission hospitals, it seems have to developed quite rapidly (it only opened in 2004).  We got a brief tour from Ruth (a GP from the  Netherlands), met some  of the surgical nurses, and confirmed that there were no urgent issues before heading back to our quarters.  We are staying in a house on the grounds which belongs to a "construction missionary" who is currently on leave. 

                We were informed that we are currently the only general surgeons, obstetricians, or orthopedists around at present.  It's a good thing they told me this, because I had no idea I was an obstetrician OR and orthopedist!   Even the Ethiopian surgeons will be away until Tuesday at the earliest and all the residents left this morning.   We were given a list of 18 patients that Dr. Gray (General surgeon who left this morning) had typed up.  It includes everything from burn patients in need of skin grafting to a 3 week old with fevers and a ventriculoperitoneal shunt  (so now I'm a plastic surgeon and a neonatal neurosurgeon too!).   

                Well, it's off to bed soon.  I think I'm over the jet lag, but we'll see in the morning when I actually have to function.  I'm just praying no one feels like giving birth tonight.  I'll be much more ready to play catch come morning.  I'll work on attaching photos later, but our internet connectivity is very poor - uber slow dial-up or bust.  I'll just be happy if I can get this e-mail sent.

-Matt

Layover in Frankfurt

Not too much time to blog here since the internet kiosks are way overpriced here. we had an adventuresome start to things as my flight out of Milwaukee was cancelled. The lady at the ticket counter said, "I suggest you take the bus." To Ethiopia? Wendy and the girls were gracious enough to drive me to Chicago, and all has gone smoothly since then.
I will update again once we are in Soddo, but that will be another day or two. Bye for now.

test e-mail post

This is just a test to see if I can post to the blog via e-mail.  Dr. Gray tells me that blogspot.com is blocked in Ethiopia for some reason.  Someone must have blogged some ill will towards the country at some point.  I should be able to post via e-mail however, and I'm too lazy to set up another blog at this point.  I'll insert a photo (unrelated) to see if that works too.

Bad News

I was just browsing the blogs of the missionaries serving in Soddo. One of them (Harry & Stephne Bowers) just posted news that the market in Soddo caught fire and was completely burnt to the ground. No news of injuries, but many livelihoods have been destroyed. Check out their blog (link to the right) for the photos. I've attached one of them here. So far, I can't find any more details on any news websites.

It's getting closer

I can't believe that it's less than five days before I get on the plane to head to Ethiopia (Milwaukee to Chicago to Frankfurt to Addis Ababa followed by a drive to Soddo). I haven't done much packing, which is only now starting to get me worried. It's nice to know that the climate (and workload) will allow me to pack light for myself. Scrubs and a fleece jacket sounds like all I'll need. I've managed to gather a suitcase of supplies from Holy Family (my hospital in Wisconsin) that they have collected for such purposes. Merilly, my retiring wound nurse, also hooked me up with a lot of colostomy supplies which I hope to leave for them in Soddo. Most importantly, I'm finding some compact obstetric and orthopedic atlases/ manuals as this trip promises to put the word "General" back in General Surgery.
I went to Wal-Mart yesterday with my brother in law Brandon who is here from California. We had fun perusing the travel section to make sure I have all the necessary items. Do you know how hard it is to find Sunblock in Northern Wisconsin in January? It's not exactly on prominent display, but I did manage to find a bottle of SPF 70 (I feel whiter already). I also got some very necessary chocolate for the plane trip.
This morning was a neat time at church. We've only been attending for 6 months (I'm not even a member yet since an emergency operation caused me to miss the congregational meeting), yet they had me come up front to pray for me and send me off. Moreover, many men in the church have offered to assist Wendy in the near-daily ritual of snow removal - We've already had record snowfall this winter. The local Orthopods and Gynecologists have also offered their electronic assistance if I run into stuff I don't recognize (as certain as death and taxes).
Well, I'm off to measure my suitcases to make sure they don't exceed the maximum volume criteria for Lufthansa. Keep me and the girls (Wendy, Emma, and Tess) in your prayers. I'll try to keep this blog updated throughout the trip as much as possible, but I've been warned not to expect too much down-time.

-Matt