Pot(s) with a purpose...

So this has nothing to do with my surgical adventures, but much to do with Ethiopia.

Shortly before we left for Soddo, my friends Jeremy and Leslie Edwards announced that they would be trying to adopt a girl from Ethiopia. In their particular situation, time is of the essence and international adoption doesn't come cheap. They decided to put together a chili cook-0ff and silent auction to help them raise some of the funds necessary. That event is tomorrow night (Saturday 3/19/11) at Faith Evangelical Free Church in Manitowoc - 5:30pm for anyone interested.

I am somewhat short on creative outlets of my own and it's hard to auction off an appendectomy, so I decided to outsource my contribution to the auction. Dave Martin (of Martin Pottery Studio and Gallery - 1304 Memorial Drive in Manitowoc) has a reputation for throwing some beautiful pots that contain sand from the Lake Michigan shoreline or from other destinations. I asked him if he would be willing to throw some pieces containing sand from both Soddo, Ethiopia and from the Manitowoc shoreline. Though the dirt I tried to bring home was confiscated at the airport in Addis, some pottery I brought home broke, so Dave was able to pulverize it back into sand and use it in his pottery. I expected him to make a pot or two, but Dave's creative juices started flowing and the results are beautiful (and numerous). Everything from bowls to mugs, to cups and vases, there are 30-some pieces in all - each containing the sand mixture and each with an inscription on the bottom noting the origin of the sand.

These items will all be up for auction tomorrow night. Some support a great cause by helping a great family provide a great home for a little girl. Pick up some great looking custom made pottery at the same time. Eat some great chili too and vote for your favorite. Hope to see you there. If you can't make it and are interested in purchasing a pot/mug/cup/vase - let me know and maybe I can bid on your behalf.

Saying Ciao to Soddo

Packing up and saying Ciao (you might want to grab a cup of coffee)

This will likely be my last post from Soddo. We are packing up the bags for the 5h drive to Addis tomorrow morning (hopefully free of any mango-vomit this time). We just had a wonderful evening of fellowship (including food) on Harry's lapa (grass-thatch patio that is essentially public property), even though Harry is already in Addis awaiting us. Most the foreigners (ferengi) in Soddo who have any sort of affiliation with the hospital were there. This included long-term servants like the Grays, the Karnes (OB-Gyn from Muskegon, MI), Stephanie (Hail, another OB from MI), Sophie & Angela (do-everything nurses from Idaho & Illinois) as well as short termers like ourselves, John, Will (a urologist who just arrived yesterday from Muskegon, here for 2 weeks), Luke & Christina (IM-Peds resident and ICU nurse from Rochester, NY who have been here for a couple of months), and others whose roles I still haven't quite pinned down (not everyone is working within the confines of the hospital compound). As you can imagine, the conversation is incredible and wanders all over the place. We had a Mexican buffet (including multiple renditions of home-made guacamole and salsa), then coffee and smores for dessert. We could have stayed for hours longer if we didn't need to pack. Though we miss our friends and loved ones (not that we don't love our friends) at home, we have not struggled with loneliness on this trip.

Earlier in the day (Thursday), John and I enjoyed our last operative day on site. What at first appeared to be a slow day, actually became quite busy. I started out in the burn room changing dressings and getting one last look at how the wounds and skin grafts are healing. It is a mixed picture for sure – some things getting better, some sites stalling or getting worse, even on the same patient. We struggle with infection due to a lack of adequate topical antibiotics (thanks to Greg and Jerel in the HFM pharmacy, this will soon be remedied – thanks guys). The infection causes skin grafts to fail and stalls more shallow burns from healing as quickly as they otherwise would. Burns also require good nutrition to heal, and we are in a country who's name is synonymous with malnutrition. In spite of these barriers, things seem to be progressing overall in the right direction. I am left with the faces of some of these patients seared into my memory... there is the young epileptic girl, unable to afford her seizure meds, who convulsed while boiling water on the stove – she burnt ~14% of her body surface area, including parts of her face, both arms, and both legs. Her hair was shaved when we found her to have headlice. Most notable are her eyes – they constantly give a look of sobering resignation made only worse by the haze of mild sedatives (required for her wound care) and anticonvulsants. I pray she has brighter days ahead (her wounds will ultimately heal qutie well with the care she is receiving), though the reality is that she will at some point find herself unable to afford her medicines once again.

There is also the resolute face of the father who rescued his children from his burning home. Though they escaped unscathed, he suffered extensive (though shallow) burns to his head and face. At first, it did not appear to be all that severe, but as we first washed his head, most the skin came off even with gentle wiping. His eyes were spared, giving him the look of a pink racoon. Thankfully, we could see the hair follicles still intact all over his scalp – this meas the burn is superficial (akin to an open blister) – if we can hold off infection, it should heal without the need for skin grafting and without marked disfigurement (though his complexion will be permanently changed).

After burn care, I proceeded to do a hernia repair (Segni, the intern, really did the whole thing quite well and I just assisted. I think he will be a bright spot here in the training program in future years). I also did a startling case on a 10 year old boy who had a bleeding rectal polyp. Those in medicine will know that 10 year olds have no business having rectal polyps or even hemorrhoids for that matter (shoot, with all the lentils, beans, hot peppers, parasites, and whole grains they eat, no one in Ethiopia has any business having hemorrhoids). Once under anesthesia, a more thorough exam revealed that he had innumerable polyps – a condition known as Familial Adenomatous Polyposis (FAP for short). He will need to have his entire colon, rectum, and anus removed (this will require a permanent ostomy here in Ethiopia) or he is guaranteed to develop colon cancer at a young age (he would likely get it before age 20 given the extent of his disease). Though his survivial with surgery should be excellent, the need for a permanent ileostomy is a bitter pill to swallow in rural Ethiopia. Most people with ostomies must manage them with a combination of rubber bands and plastic grocery sacks – it can lead to social ostricism merely because of the leakage and odor.

After this, I staffed clinic with the residents. We saw everything from urinary retention (a lot of big prostates here in Soddo), thyroid nodules and goiters, hernias, to elderly people (here that means 50's or 60's) with difficulty swallowing. I did an upper endoscopy on one lady and found a nearly obstructing stomach cancer. She is already emaciated and anemic. The tumor can be felt when I press on her abdomen and it is quite unlikely to be resectable. She will have an operation to bypass the blockage, but will likely not survive the year.

Her case brings up the sad reality that we are unable to "save" many of the patients that come to us. In a country this vast with such poor infrastructure, low per-capita health spending, and lack of screening initiatives, most cancers present when they are quite advanced and, barring a miracle, incurable. We do what we can (or must) surgically to alleviate symptoms and to allow patients to return home and die in peace with their families. Even today on rounds we talked and prayed extensively with three people with terminal malignancies, helping them make arrangements to go home. This point is reached much sooner here, as the patients are quite reluctant to consume their meager remaining financial resources on end of life care when their families could instead use it to feed those who will keep on living. I was impressed by the bravery with which these patients receive their news and direct their concern towards their families, barely shedding a tear for themselves. In each scenario, Paul and the residents have gentle but direct conversations with them and their families concerning the spiritual realities of their situation. The gospel is laid out in plain terms and time is taken to make sure that people understand what they are being told. No one is forced to make decisions they are not interested in, but nothing brings one's standing with God to the forefront like being confronted with a terminal diagnosis in rural Southern Ethiopia.

After work, John and I were able to pull Paul away and take him to the FantaVision for one last round (or three) of machiatos. We talked about many things, including our potential future here in Soddo. There are to be two new full-time general surgeons starting over the course of the next year, which will leave much less of a need for us to fill. Though I'm sure there will still be opportunities, they will be less often and will come about less predictably. I do hope I can return, though, as I'm really getting to like this place and its people (both native and expat) for so many reasons. It will be hard to leave tomorrow.

Before the party, John and I managed to walk our loop around upper Soddo one more time, pausing to take in the beautiful scene over the valley as the sun was setting – mountains beyond mountains as far as the haze would let one see. My camera lens had malfunctioned earlier in the day, so I am left only with the pictures in my mind. I guess I'll have to come back anyways.

Tuesdays cases had been somewhat similar in nature, but I did manage to do a laparoscopic gallbladder case with the hodge-podge of equipment that Paul has been able to assemble. It was one of the more difficult ones I've done, both because equipment failures/ limitations and also because the gallbladder was quite diseased. I was teaching Segni to run a camera for the first time also, but he did quite well with it. When I had gotten back to the house, Wendy was still away on her rural clinic adventure, so I picked the kids up from Becca and we played around in the yard and kicked a soccer ball with Nathan.

Wednesday was a national holiday, so we didn't do much medically. We rounded, and did some burn care, but then I went and joined Wendy and the girls for a field trip to see the work of the Mossy Foot program. Mossy Foot, also known as podoconiosis, is a common condition in Ethiopia caused by walking around barefoot for too long. The feet absorb the fine silica particles, which eventually clog up the lymphatic system and cause a sort of elephantiasis of the lower legs and feet. The feet swell terribly and develop thickened skin and painful nodules. They then develop infections in the crevices between the nodules. Many of the patients become bedridden because of it (usually the women). The men who continue to work the fields in spite of it often develop infections so severe they are fatal. It is sad that this disease can be entirely prevented simply with footwear (even flip flops will do). Once it has developed, it is a chronic condition that requires much in the way of hygiene and specialized footwear to manage.

The Mossy Foot program, however, was a true joy to behold. This is public health work at its finest. They had 15 rural clinics each with two staff. There, they wash feet all day and teach the patients to do the same. They wrap those with swelling with tight wraps to reduce the edema. They care for open wounds and treat the infections. They have a staff of cobblers who make specialized shoes for the swollen and fragile feet. The people are ministered to emotionally and spiritually as well. We then got to visit a group of women who have all had marked improvement in their condition – the swelling is minimal, their wounds are healed, and they are able to venture out again. These women are being awarded "micro-loans" of ~$25-50 USD with which they will start small businesses in their village – either baking and selling injerra or running a fruit stand. Most are able to pay the interest free loans back in less than a year and thereafter they are much more self sufficient.

After this, we went to an even more remote site where the program is teaming with local village church members to build mud hut housing units for the older women who have been widowed by the disease. The program provides a tin roof, nails, a door, and a window while the local villagers provide the labor. They were having so much fun as they hauled in the water, straw, and dirt and made the mud wall-paste with their feet. The old women were there watching and expressing their gratitude repeatedly.

Emma and Tessa came along on this trip. It was such a blessing for them to witness service at such a basic level. Foot washing, clothing of the naked, housing of the widowed, – it doesn't get much more biblical than that, really. Tessa really seemed to take it all in.

Well, it is now Friday morning (almost 7:00) and the girls are getting up. Our van leaves the grounds in about 2 hours, so I'd better get packing. I thank those who have persisted in reading this blog, even though every post gets longer and longer. As I reflect more and more on the trip, I could keep going I assure you, but out of mercy I won't.

Ciao.

-Matt

Not for the faint of heart

Not for the faint of heart (I refer to the length of this post)

Where to start? Much has happened since I last was online. The internet, or at least our access to it, went down sometime Sunday. We moved to a new house on Monday and just didn't have the time or energy to get back online until today. Much thanks to the Grays for lending us their access today so we could catch up.

Saturday, Wendy and I managed to go to the open market while Becca watched the girls (they had not yet left for their weekend away). We wanted to buy some locally made souvenirs and the market is only open on Saturdays. One of the hospital staff graciously went with us as a guide, translator, and bargaining agent. Wendy bought a bunch of hand-woven baskets and I bought two traditional Ethiopian coffee pots. It was amazing to see how far the market had come along since I had last been there. Two years ago, the whole thing had burned down in a fire and all the merchants were just sitting on tarps selling their wares. Now, all the stalls have been rebuilt – I could barely recognize the place. Coffee pots have gone up in price from about 80 cents up to 95 cents, but I still splurged. I was frequently mobbed by boys in the marketplace who were intrigued by my arm-hair (they don't have much if it themselves). I was equally intrigued by their lack of an idea of personal space, but it was all friendly and I was refreshed at how little begging went on. Everyone seems anxious to strike up some sort of a conversation and try out what little English they know. Someone started to speak to me in their local dialect, but all I could say was "no habla Wolaittinia." I don't think he understood (yet he understood perfectly).

After market, Paul held his weekly Bible study with the residents. They are studying some very thick systematic theology – Paul has selected a textbook almost as thick as Schwartz. Still, Paul manages to keep the discussion quite relevant to their lives, their work, and to the gospel. We finished with a neat time of prayer for one another. The Grays then left for their weekend getaway near the lake at Awassa.

That afternoon, I took a walk back into town with the girls to our favorite local hangout, the cafe at the FantaVision hotel. They were out of soda, so the girls had hot milk with sugar and a dash of dad's espresso. I, of course, had a couple of macchiatos (now a full-fledged addiction) and we watched part of an episode of Ethiopian Idol (no joke) on the cafe television. One of the numbers was an interpretive break-dance to "We are the world." Their version of Simon is this straight-faced guy with corn rows who apparently gave the Live-Aid reset a lukewarm response. Karmyn, the Bowers' 14yo daughter, came along for the walk and served as a valuable interpreter and child entertainer. Tessa walked the whole round trip and didn't complain a bit. We tried to take a bijaj back to the hospital, but all we could find were donkeys who were already carrying too much.

Saturday evening brought a sad case of a 6 month old baby so unfortunate as to have an unintended circumcision performed by the family dog. Daniel (the senior resident) had already performed some wound care and a temporary repair, so we set him up for a more definitive repair in the morning. John and Teddy started the 8am case promptly at 9:45 and I must say, once the swelling goes down the result may actually be functional. At least the kid can pee for now.

Sunday evening we had church at the Bowers house. The missionaries on the compound get together for a low-key worship service in the evening – it seems to be a much more relaxed (sabbath-like) atmosphere in the evening since there is often still clinical work to be done in the morning. Some of the missionaries also like to go and worship in the local churches in the morning as well (frankly, you can hear most of them from the compound since the megaphone seems to have a near-sacramental place in Ethiopian worship, regardless of persuasion... Evangelical, Orthodox, Muslim, Retail...). As luck would have it, the cell phone would buzz right as the service started and I headed to the ICU to see a few consults with the residents. This evening, they included a couple of cancer patients (both of whom had already had operations for what turned out to be inoperable cancers) with bowel obstructions, a 10yo boy with a depressed skull fracture (bones pressing down onto his brain), and a boy who had fallen and been impaled by a large stick (about 1" in diameter) through his thigh and all the way up to his groin, though it miraculously appeared to have missed the major artery and vein there. We decided to manage the bowel obstructions conservatively for now, but we took the boy to the OR for a stick extraction (and hopefully NOT for a major vascular repair). All went well and he went home a couple of days later.

Monday morning started out with the normal schedule for work here @ SCH. We made rounds with the residents around 7:30 and compiled the operative list for the day. This included much burn care (the dressing changes are so painful they must be done under some degree of anesthesia), reversal of an ileostomy (on a woman who require an emergency bowel resection a few months ago), an exploratory operation on a man with a bowel obstruction and an inoperable (at least in Ethiopia) rectal cancer, elevation of a depressed skull fracture, and then consultation clinic with the residents. Paul was still away (until around noon) on his much-earned weekend getaway. Daniel, our senior resident on the general surgery service informed us that his wife was laboring, so we gave him the rest of the day off. John and I did the days cases with the interns. I must say they are very hands-on in a good way – eager to learn and getting more and more meticulous with their burn care. I think this program is going to have a bright future once these guys have a few more years under Paul's training.

The cases went well, but by the afternoon I was completely exhausted for some reason. I made it back to our new house (we moved out of the Grays' guest room and into the recently vacated orthopedist's house – Dr. Anderson will still be away until late March). I attempted to crash for an afternoon nap, but the girls wanted to play, so I spent the next few hours in a haze of "Sorry" and "Crazy Eights."

On Tuesday, Wendy left early in the morning to travel to the Omo River lowlands with Sophie to observe the work of Mary Vanderkooi (sp?), a long-time rural medical missionary investingating a potential outbreak of visceral Leishmaniasis, also known as Kala-azar. She saw a whole village of anemic people with massive spleens (even the small children) and they did a lot of blood draws to make sure this just wasn't from malaria. If it is indeed Leishmaniasis, it is almost uniformly fatal if untreated (trust me, Wendy wore LOTS of bug spray). Hopefully, Mary will be able to obtain the necessary treatment or at least appeal to an NGO with the resources to do so. You can learn more on Wendy's entry, posted previously.

OK, I'll stop for now. There's still more (I haven't mentioned Tuesday's cases or Wednesday's adventure to observe the work of the Mossy Foot program), but I'm blogged out for the moment. Bonus points (worth absolutely nothing) for those who have made it to the end :)

Wendy goes to the lowlands

So, it's been a few days since we last had internet access, so we need to make up for lost (blogging) time.  Much has happened since we last posted.  Below is Wendy recounting some of her experiences.  Now that we are back online, I'll try to post again soon.  

Yesterday, I (Wendy) rode along with a couple of the missionaries to a village health clinic. Here, people from all around come to be seen by the "foringy" (not sure of the spelling, but it means foreign) doctor and nurses. They treat medical illnesses and wounds as well as run a prenatal clinic. I helped a little by using the Dopplar to hear the baby heartbeats. So cool! They did a few procedures (drained a hip abcess, rehydrated a sick little baby, removed skin from a lice infested scalp, to name a few) before they dispensed medicines (charging under a dollar for most medicines for the week). We ate lunch and then headed out to another part of the country where there was rumor of several cases of large spleens, possibly the result of a disease involving the bite of a sand fly. The area we drove to was down the mountain to the lowlands. It was a beautiful, scenic ride on a VERY bumpy gravel road and it was very hot when we got there. Made me appreciate the cooler air up in Soddo. Our team was amazed at the number of people that seemed to be affected by the disease. The nurses and doctor drew blood from about 30 people to test for the disease and they'll test the blood back at the hospital. A good public health project! While we were there, the doctor found a young man who did not look well, very anemic and had a large spleen as well so he came back with us to the hospital. Hopefully, he will get the treatment he needs there.

As the bowel churns

It's been a packed couple of days here in Soddo.  

On Thursday, I (Matt) had a full morning at the hospital with a variety of operations.  With three surgeons (Paul, John, and I) we were able to knock cases out pretty efficiently - I took out a huge goiter and drained a weird pelvic/ proximal thigh abscess while John did a mastectomy and then helped with an exploratory laparoscopy on a young girl (25) to confirm inoperable gastric cancer.  I am surprised by the young ages of some of our cancer patients here - a 25yo female has no business with bulky gastric cancer, nor does a 26yo female usually get recurrent breast cancer (already at least at stage IIIb).  With a scarcity of chemotherapy and/ or radiation in the country, their prognosis is quite grim.  We literally had the "come to Jesus" talk with a 30-some year old Muslim Somali man with a large thoracic esophageal cancer - his prognosis would have been poor even with all treatment options available to us.  Alas, it was best for us to do nothing but inform him of his situation and earnestly pray for him.  His friends expressed to us that they still consider Christians to be polytheists.  We attempted to explain otherwise and to present the gospel to him, but since his friends were serving as his interpreters (he speaks a different dialect, not Amharic or Wolaitinya), we are not sure how accurately the message was conveyed.  

Wendy and the girls went to a women's bible study with many of the missionary/ expat wives in the area.  The home where it is held is the one with the pet Dik-diks (Tazzle and Izzy) that the girls like so much.  

When I got back from the hospital, Emma and I took a walk with John up to the café on the roof of the local bank builing.  It was a long, hot walk and I ended up carrying Emma for about half of it - we got a number of strange looks from the local kids (who are obviously accustomed to walking much farther distances without parental assistance).  Though I have fond memories of getting 20 cent lattes at this place last time I was here, this time their machine was broken - they, of course, were too embarrassed to admit this and instead attempted to piece together some sort of replacement out of instant coffee, cocoa, and water.  It actually wasn't half bad, but it was nothing compared to the Macchiatos we have had elsewhere in the city.  

Friday was the most interesting day so far from a surgical standpoint.  The three of us and the residents banged out a good number of cases all before 1:00.  This included a prostatectomy for BPH, a appendectomy, another mastectomy, repair of a depressed skull fracture, an endoscopy for suspected esophageal cancer (thankfully negative), an ex-lap on a two year old suspicious for intussusception (negative), a scrotal debridement (lovely), debridement of a tropical ankle ulcer, and what we thought would be a repair of an inguinal hernia (it wound up being a resection of a hair-filled mass called a teratoma instead).  We did our daily wound care on the burn patients as well before heading up to the library for Friday afternoon educational conferences.  We had M&M and then Segni, one of the interns, presented a power point presentation on transplant surgery (they take turns each week teaching through the standard surgical textbook chapters).  Even though they will likely never see nor do a transplant, they still take it upon themselves to learn what they can about all the surgical disciplines - it is quite an extensive curriculum.  Paul gave them each oral examinations afterwards.  

Friday evening brought the weekly Pizza night at the Bowers.  Harry has a gigantic concrete wood-fired pizza oven built into the corner of his patio (called the lapa).  Everyone on the whole compound assembles their own pizza and brings it over for baking, then we all (about 20 of us) eat out on the patio and shoot the breeze.  It is an experience as rich in Christian community as it is in calories.  We had people from Madison and Manitowoc, Ohio, Texas, Norway, Spokane WA, Idaho, Michigan, and South Africa - a mix of short-term and long-term servants.  The conversations, as you could imagine, were also all over the map.  

After dinner, Paul asked if I wanted to cover an emergency case on a three year old with a severe intussusception.  This is when the intestine starts to telescope upon itself, causing both a complete bowel obstruction and also threatening to kill the segment of intestine involved.  Ideally, this can be undone without any intestine dying or bursting in the process.  If either of those events (intestinal death or rupture) occur, however, the operation becomes much more extensive (with long-term repercussions) or the patient can go into septic shock and die.  The patient was a three year old boy, though this is always hard for me to tell.  His arm and legs would suggest that he is two, but the look on his face was almost that of an adult (as if he has already suffered much).  His abdomen was bloated, enlarged way out of proportion to his pencil-thin extremities.  It was tight as a drum and one could feel the loop of bowel to blame quite firm and distended on his left side.  He had not had any bowel movements or even passed any gas for five days due to the obstruction.  This had been preceded by some bloody diarrhea, an ominous finding in a three-year old.  Now, one could feel the involuted portion of his GI tract, possibly even his small intestine, on rectal examination.  This indicates that it is quite a long segment of intestine involved.  If this much bowel dies, the results could be catastrophic at worst, debilitating a best.  

Dejene, the intern, had done a good job taking the history, doing the exam, and making the correct diagnosis.  He gave the proper IV fluids and antibiotics, prayed with the child's grandmother, and we took him to the operating room.  Towodros (the chief resident) and I did the operation with Dejene providing exposure.  We were thankful immediately upon making the incision because the fluid in his abdomen was not bloody - if so, that would indicate that the bowel had likely died.  For those who care, the intussusception wound up being in an odd location (splenic flexure) caused by a congenital band adhesion of the transverse mesocolon.  Though odd, this was good news as these can be caused by tumors and his thankfully was not.  

Reducing (undoing) an intussusception is a slow and gentle maneuver.  The bowel is quite swollen and fragile.  If one tears a hole in it, it is difficult and often unwise to repair - this would likely obligate us to remove the entire segment involved.  Towodros and I, however, took our time as we gently massaged and milked the bowel back into its normal configuration.  Thankfully, it all appeared to be viable and there were no perforations.  Towodros said a prayer of thanksgiving and then we closed.  This morning, to add to the miracle, the kid was already sitting up, sipping orange Fanta and eating his boogers - back to normal sooner than any of us expected (I know where he got the boogers, but I'm not sure who gave him the soda, though).  

Today (Saturday), we made rounds, then had resident Bible study before Paul and Becca took off for a weekend getaway.  Wendy and I (okay, mostly Wendy) will be watching their kids (3yo Nathan and 1yo Lydia) while John and I cover the hospital.  Even though Paul is a little under the weather, it will be nice for him to get away… hopefully he doesn't have too many nightmares about me doing a prostatectomy by myself.  

Congratulations to anyone with the stamina to still be reading at this point (I eschew brevity).  I will now put you out of your misery and wrap this up.  We'll have to let you know how our weekend of zone-defense childcare went.  

Venturing out

Venturing out.

It's been a busy couple of days here in Soddo. Where to start...

Tuesday and Wednesday started to get busier in surgery – of course it always seems that half the cases cancel for one reason or another – financial problems, a change in condition, or maybe the patient just decided to eat lunch (because they had only been told not to eat breakfast). At the beginning of they day, it seems like we'll never get everything done, but we always manage to finish at a decent hour. At some point, the cancelled/ postponed cases will likely all come out of the woodwork on the same day. For Paul's sake, it would be nice if that happened while we are still here.

I'm finally getting a little more used to the flow of things and am feeling a little more emboldened to teach and correct the residents. It's just another element of awkwardness which I'm getting used to. Add that to doing unfamiliar operations, familiar operations with different equipment, or operating on more advanced diseases (had to operate on a very advanced breast cancer in a 26yo female today) – there is plenty of opportunity to trust in God to come through in my weakness. I think I'm beginning to embrace awkward, but Wendy (and many others) would probably tell you that it's been my style for a while now.

Had a chance yesterday afternoon to go out for coffee with John (Foor) and Harry (Bowers) – there are more options in Soddo than the last time I was here. In short, we went to a place called "Fanta Vision" which is a combination hotel, quicky-mart, coffee shop, bar, and construction zone. They served us espresso machiatto for about 3.5 Birr apiece (that's around 22 cents). The espresso was literally so thick that John's spoon stood up in it (this may also have had something to do with the shape of the cup, I'm told). I had two and vowed to come back, often. I'll post pictures to facebook at some point since I can't post them directly to the blog.

Today, Wendy and the girls had the chance to go to a large food distribution event today near the future site of Dr. Bowers "Wolaitta Village." (I'll try and link to his blog if you'd like to learn more – you really should). It was the girls most adventuresome cultural experience yet. The local church here hands out grain to those most in need once a month. They feed them spiritually, too, before the distribution. The girls were fascinated by the process and met several new friends. At first they were very shy at all of the stares, but they soon warmed up to them and let them touch their arms and hair. Tessa was the first to "be brave" as she told Wendy. They played a few games (Duck Duck Goose, etc) but did reach a point where they were tired and hot enough to need some space. They experienced their first taxi ride (it's an enclosed 3 wheeled motorcycle) called a bijaj (not sure on the spelling). Prior to the food distribution they visited another missionary in town who has two pet dik dik's (small antelopes), Tazel and Izzy. Emma was able to feed Tazel some milk from a bottle. She liked that very much.

Went to play soccer with the locals this evening. They no longer have a field on the hospital grounds (okay, they do, but it's not flat and there are too many sheep grazing in it), so we go to the local "Stadium." An OR nurse I worked with the last time we were here invited me to come play. Sophie (an adventuresome rural nurse from Idaho who friended us on Facebook) was nice enough to give me a ride on the back of her motorcycle (the "donor-cycle" as Paul calls it). When I got to the field, I could not find anyone I knew. This did not stop me from being found by many people whom I did not know. I had an instant entourage of young and old people. They were interested to see the "Ferengi" (isn't that some sort of wrinkly alien from Star Trek?) play soccer. They were intrigued that I would take off my flip flops and put on soccer shoes as for many of them, flip flops ARE soccer shoes. I had a couple of willing volunteers to guard my sandals and water bottle while I played.

I didn't last long on the field. Between my atrocious physical condition (haven't had much time for exercise leading up to the trip), the altitude (around 7600 feet, I think), the cloud of dust called a soccer field (I think I need a lung transplant for acute silicosis), and my age relative to my competitors, I had soon confirmed most of the peoples' impression of America's soccer prowess. My apologies to those at home who are actually good at this game. I had fun, though, and had a nice walk back to the hospital with Hasabu – I even made it in time for a late dinner.

Well, the kids are in bed and the laptop battery is dangerously low. Lest I lose the whole post, I'll sign off for now. Until next time. Ciao.

Jetlag recovery program - 2/21/2011

Jetlag recovery program - 2/21/2011

The first stage of jetlag is denial.  I thought I would have an easy run of things as I stayed up a bit late (~11pm local time), slept well, and started to stir around 0430 - not much different than my normal sleep pattern at home.   I dutifully laid there for another hour but was unable to doze back off.  A shower and a cup of strong coffee were good for, at least temporarily, another 3 hours of sleep or so.  So energized, I snuck out of bed (Wendy and the girls were still comatose) and walked up to the hospital for rounds with Paul - about 7:00am.  I'll separate out the medical details below so that those of you who don't care can spare yourselves the shop-talk.  

The workload was uncharacteristically light.  I got to meet the four residents:  Towodros (the chief), Daniel (3rd year), Segni and Dejene (the interns).  They did most the presenting of the patients while Paul mostly asked questions to draw out the necessary information and lead the residents to the proper conclusions.  He is a very calm but direct teacher - well suited for his role here.  Makes me miss at least that aspect of residency training.  Rounds are different, of course, than in the states.  It is thin, but not entirely devoid of paperwork.  Also, malaria figures into the differential diagnosis of pretty much everything… fever, anemia, malnutrition, tachycardia - where a patient is from winds up being important as those from areas with endemic malaria may have this additional malady to contend with.  Hemoglobin values are suspect, so an exam of one's palpebral conjunctiva is  a critical gaugue of whether or not a patient has ample red cells to tolerate an operation.  We also pray regularly on rounds, especially if someone is having a difficult source or appears to be struggling emotionally.  It is neat to see the residents do this with genuine caring and without a hint of awkwardness.   

After a few cases, we returned to the house for lunch - Injerra and Wat (that's Amharic for culinary heaven, if you didn't know).  After that we headed back up to the hospital.  That's when I hit the wall.  There was a period of relative inactivity (something that was quite rare the last time I was here).  The residents handle much of the pre and postop work.  Our role in the clinic, much like on rounds, is more supervisory.  This relaxed pace, though nice in some ways, served to unmask how truly tired I was.  I went back to the house for a fifteen minute nap and wound up taking 10 of them in unbroken succession.  Hopefully it will translate into a resurgent work ethic in the coming days as the workload is expected to increase.  

Rounds were much shorter (and more organized) than I remember them being the last time I was here.  The surgical load was to be light for a Monday - just a few scheduled cases.  We started in the ICU (no one was bagging themselves this time through) and saw a trauma admission from the night before - a man hit by and then run over by a car - he had stable pelvic fractures, a proximal tib-fib fracture (he had already been put in traction), hematuria, and generalized abdominal pain.  We performed a bedside ultrasound and it seemed that the foley catheter balloon wasn't necessarily in the bladder, though the catheter itself clearly was.  There was no free fluid in the belly, but we were rightfully suspicious for a traumatic bladder rupture.  Short on other diagnostic means (no CT scanner, only barium available for cystography), we decided on laparotomy - suspicions would be confirmed and Daniel, the 3rd year resident, completed a nice two layer repair.  In the afternoon, it was mostly dressing changes on skin graft patients.

The girls were a bit crabby today, but on the whole did quite well.  They took a walk around town with Wendy and Becca Gray - Tessa said that was her favorite part of the day.  As expected, Tessa dove right into the Ethiopian food while Emma picked at it.  Dinner was a bit more western and Emma managed to make up for her lean lunch.  The girls are in bed now (again, not necessarily sleeping, but at least pretending that it is possible).  I'll be heading to mine soon enough.   We expect tomorrow to be a but busier for today - hopefully we'll all be through the jetlag by then.

A Honky on the Horn of Africa - in Soddo at last

A Honky on the Horn of Africa - in Soddo at last.

We've finally arrived.  The girls are finally nodding off  (even though it's only about 1:00pm Wisconsin time) after nearly 48hours of constant travel.  I will take advantage of the jetlag and stay up a bit to post this and update all who are following along.  I'll link to it on face book.  Disclaimers are that blogspot is technically blocked in Ethiopia - I'll have to post via e-mail, so I don't think pictures can be uploaded.  I'll try to post some pics to Facebook, but it looks like internet speed may be a limiting factor there (it is much faster than two years ago, however).  

The big blessing so far is that the girls did extremely well with the travel.  Thanks to all who offered prayers to this end, but their travel stamina was something to behold.  They got enough rest on the first flight (Chicago to London) to stay fresh - Tessa slept about 5h, Emma about 4.  The London layover (5hours) went faster than we expected, and they ended up sleeping for about 8 hours straight on the 11h flight from London to Addis Ababa via Amman, Jordan.  They didn't even know we were in Jordan.  

We landed in Addis around 2:30am local time, but it took us about 2 hours to clear customs due to haggling over duties on laboratory equipment we were bringing back into the country after some repairs.  The Ethiopian Customs people are quite meticulous, playing everything by the book.  This makes for slow going, but it all worked out well.  The amazing thing was that the girls just played with each other without making much of a peep for the entire two hours.  They just kept putting each other through the x-ray machine while I would give the other one anatomy lessons… just kidding.  They really did do well, though, and we finally made it to the van at around 4:45am.  It was about 20 minutes to the SIM guest house where we sipped some orange Fanta, then laid down for about 5 hours of sleep.  We were to pack up and leave the guest house by about 11:00am so we could do some grocery shopping in Addis before the drive to Soddo.

All that went as planned.  We pulled out of Addis a little after noon and made it to Soddo at 7:00 just after sunset.  This included a scheduled lunch/ potty break in Butajira - the culinary scene along the Addis/ Butajira road have improved substantially since I was last here (so have the toilets).  The girls did get a bit car sick, but only Tessa puked.  She had just sipped some Sprite and eaten a mango, so it really didn't smell that bad.  They slept for about half the drive and really only got whiny towards the very end.  

Had a nice evening settling in and finally meeting our hosts, the Grays.  We've been friends on Facebook, we've talked on the phone, I filled in for Paul on the job two years ago and even lived in their house before it was their house, so it was nice to finally meet them.  I think we're going to enjoy getting to know them a lot more closely over the next two weeks - more on that to come I'm sure.  

Well, I'm going to go and attempt sleep.  If I can manage to nod off, rounds start around 7:00am here (10pm CST).  That is when I will meet the residents, the patients, and find out what surgical adventures await.  Wendy and the girls will likely sleep in, though that gets hard to do here once the sun rises.  Thanks again for all the prayers and well wishes.  Remember, comments on the blog may not get to us since I can't access the site in country.  Best to communicate with us via Facebook.  We might not do much personal emailing as we want to be on the computer constantly when we need to be builing relationships here.  We'll likely stick mostly to group mails and blog posts.   Night all.

On our way

Well, I guess I'll resurrect the blog since we are on our way to Ethiopia again. Not sure if anyone will actually read this, but at least I can look it up later myself.

We left Manitowoc around noon on Friday the 18th and we're already enjoying our layover in London. The girls did remarkably well on the 8 hour flight (Chicago to London). Though we intended for them to sleep the entire flight, benadryl was no match for their excitement, nearly constant beverage service, and Secretariat as the in-flight movie. They did eventually doze off, however, and the girls probably got about 5 hours of sleep - not too bad - I only managed about two, but I'll take anything I can get on a plane. Before we knew it, the lights were back on the flight attendant was handing us a cup of yogurt and a spork for breakfast... still trying to get my mind around that one.

We are now in the airport lounge at Heathrow awaiting a 12:50 departure (I think that's around 7:00am in Wisconsin) for Addis Ababa via Amman. We land at 2:20am Ethiopian time (another three hours ahead of London) - that's when the girls real culture shock will set in. They will be disappointed with the lack of moving sidewalks at the Bole International Airport.

Thanks again to all the well-wishers. Your prayers have made for a smooth journey so far (either that or it is the calm before the storm). We'll keep this posted as often as possible, but I'm not sure when I'll next have internet access.