An Oasis in the desert...

Everybody is leaving tomorrow, at 5am. I will be the only one standing, along with a Chadian doctor who I met today, Samedi. Yes, his name is Samedi = Saturday. I guess he was born on a Saturday, I don't know. 

Anyway, tonight we went to "La Residence", which is a nice hotel just down the street, with a French chef, air conditioning and decent food. 

That's all of us, from left to right Nick and Kelsey (nurses), me, Bekki (Dr. Scott's wife), Dr. Scott, Lindsay (their daughter), Joleen (dental hygienist) and Will (physical therapist). 

Lindsay, Joleen and Will are leaving for good, Dr. Scott and Bekki are leaving on vacation for a month, and Nick and Kelsey are going to do a 3-week anaesthesia course... 

But now I know that "La Residence" exists... so every time I'm missing civilization and western food, I'll go over there for dinner... :) The food was delicious and the plate was ginormous... 

After a pretty tough week, it was a well deserved little break, and a nice way to say goodbye... 

A hard day's night...

I'm feeling more powerless than usual right now... 

I am winning the fight against infection in Irene's leg, and that's good. (my amputee lady)

I'm trying to win the fight against infection in Taira's leg (the 11 year-old boy) and it seems to be going well, except for the ridiculous amounts of pain I have to inflict on him every morning...  

I am losing the fight against infection in Blaise's leg. He still has his leg, but every day, there's pus pouring out of it... I'm afraid he's going to get septic and we'll have to amputate. He's a young, strong guy, and if he loses his leg, he'll have no way to work and will probably be reduced to begging. 

There's very little I can do about it. I am squirting betadine straight into his bone, and upgraded him to 2 dressing changes a day, to see if it helps... 

If you're the praying kind, please pray for him. If you're not the praying kind, pray anyway... I'll believe for the 2 of us... 

The truth about Chad...

I have been hearing and reading blog posts about medical workers in Chad since 2006, when I met the doctor who had been leading the hospital I'm at until recently. He is now in Monrovia, Liberia-- the center of the ebola outbreak. But that's another story. 

My point is this: I was sort of prepared for how things were over here. Or so I thought... But really, nothing can convey the reality in an accurate way. 

Chad is without a doubt the most infuriating country I've ever been to (and we're at about 40 countries by now). They don't grasp the concept of honesty (we had to fire two nurses in one week because they were *stealing from the patients!!!*). They have no critical thinking, and do everything in the *one* way they were taught, without stopping to think that some things should be adapted to some situations. 

They are ashamed of the foley bags, so they hide them under the covers, and no matter how many times you tell them it needs to be lower than their bladders, it doesn't seem to matter. (I finally solved that problem with the brilliant idea of using pillow cases as pouches to tie to the bed and hide the foleys in!) 

However, here is the actual truth: I am loving it. It is infuriating, and it's really hard, and it's tragic sometimes, and not a day goes by without me wanting to cry at some point or another (I don't though.) 

But I get to scrub in on surgeries every day, and see the insides of people. I get to talk to patients and their families, explain procedures, battle infection and see progress, every day. I get to make a difference, even if it's in a small way, in the life and well-being of my patients. For example, remember my amputee lady? Her name is Irene. She was basically the only patient who always looked at me like I was evil, because I always do her dressing changes, which means I literally insert my entire index finger into her wound and wash it out with bleach, causing her inmeasurable pain. Her wound is healing nicely though, and I got rid of all the infection!! :) :) :) 

Well, yesterday afternoon, I came by and told her we were going to get her up and walking. AND SHE SMILED! I almost broke down... So sure enough, I get a walker and she stands up... in pain, a little light-headed, but she's vertical for the first time in 3 weeks!!! 

This is Irene, taking her first steps after losing her leg. I told her to look up and smile, and she actually did! 

We followed her with the wheel chair just in case she got tired, but yesterday she walked about 100 feet, and today she did 165 feet! 

I feel like I'm going around in circles, but what I wanted to say is this: don't think I'm a martyr, or that I'm amazing, or anything like that. I'm not. I have simply waited my whole life for this and being here, despite all the hardships, is actually a dream come true. I am here as much for myself as I am for them... 

...although I might rethink that next week, when ALL the westerners including Dr. Scott leave (there are 8 of us) and I stay here holding down the fort with only one Chadian doctor for help, guidance and company... I guess we'll see. 

The day I did everything I shouldn't...

I actually had a different blog post planned for today, but it turns out I did everything a medical professional the world over ***should not do.***

Before I get into the specifics though, let me just say that I had good reasons on both counts... but you can judge for yourselves. 

Case 1: 

Remember Taira, the little boy I mentioned earlier with the femur fracture? Well, he was doing great, we had him up and walking, he got crutches and was basically ready to come home. That's him, with me and Will, the first day we got him up. 

Except today during dressing changes, pus started pouring out of his leg. Not much, but enough to show it was infected. Surprise, surprise. So Dr. Scott took him back to the OR to open it up and clean it out... 

I walk in the OR when they're prepping him, and there are two nurses, one on each arm, trying to start an IV. Admittedly, I don't know much, but I do know how to start an IV. And I know that on an 11-year-old boy, you don't take a large IV needle. We have pediatric needles for that. They were poking the boy full of holes, starting in the ante-cubital fossa and moving toward the hand, not missing the veins, but exploding them because the needles were too big. 

At one point, one of them sets a needle on the counter, repositions the stopper, and picks it up again. That was my limit. I jumped in and yelled out "No! Stop! You just can't do that! You can't keep using the same needle over and over again! And why are you using such large gauge needles and exploding this kid's veins??" 

He turns to me and says "if we get new needles, they have to pay for them again..." so I said "Fine! I'll pay for it then!" 

Stormed out of the OR, bought pediatric needles, came back and gave it to them. Sure enough, they got it in the first try without exploding the kid's veins... And I yelled at them again for not using smaller needles to begin with!

Case 2:

There's a little girl (about 3 years old) whose dad is a patient. I have already won her over and she smiles and shakes my hand. A couple of days ago, her dad told me she wasn't feeling well. This morning I asked about her, and he tells me mom had taken her to the city hospital. This afternoon I go over to the ward and she's sitting there on mom's lap, struggling to breathe... 

Now, there are a lot of little kids who come in with one foot in the grave, mostly malaria, and I have made the decision that I would stay away from them. They come in so advanced, that try as we may, most of them die...so I didn't want to have my heart torn out time and again, kid after kid. Call me a coward if you will, but I know my limits. 

However, this little girl, I know her. I saw her healthy and playing. I know her name, I talk to her parents every day, and I would see her just deteriorate and die. No way. 

So again, I jumped in and told her dad to get her in to the consult that I would be responsible (financially) for anything she needed. 

She is now on IV quinine and blood (she was severely anemic) and hospitalized right next to her dad. She should be ok, because she wasn't on death's doorstep yet. One more day, and she probably would have been. 

So there you have it. I broke all the rules. I pissed off the nurses and got too involved with my patients. 

I dare you to come over here and do anything different. 

Fractures

The most wide spread form of locomotion here is the motorbike. You're either walking and trying not to get hit by a motorbike, or you're on a bike trying to avoid the people and goats everywhere. There are some cars, but they are by far the minority. 

People also like to climb trees to get fruit. And they also seem to fall off trees and break limbs, quite frequently. 

The result of those two facts, is a steady stream of fractures that trickle into the hospital every day. 

They're also not simple fractures, set, cast, go. No sir! They're compound, spiral fractures, some open fractures, most old and already infected. Today someone came and asked me if there was anything we could do about his limping. I asked him when did it start and he said 8 years ago, after he had broken his leg. Clearly it healed wrong, and 8 years later, there's absolutely nothing we can do about it... 

The other day I mentioned I got to scrub in on a patela fracture reconstruction. This was a big, strong man, and he actually fell off a moving bus with his knee into the asphalt. It broke his patela in 3 places and kinda looked like a jigsaw puzzle, trying to put the pieces together. 

Then I also got to see a sign-nail intra-medular tibia repair, and that was incredible! 

I never thought ortho would be so interesting, but we really get lots of broken bones here. 

Anyway, the last few days have been a blur of surgeries and patients, also doing mobilization and getting patients out of bed and walking. 

Sorry if this was a somewhat boring post, but I have to get some rest... After 10 days, it seems my stomach finally lost the fight and I've been on rehydration solution and toast all day. Oh well... part of life, I guess! 

(I got tested, it is NOT malaria! Woohoo!!!) 

Balls the size of Texas...

WARNING: if you're a boy, you might want to stop reading right now... 

I have been in Chad for a week. So far, I have seen 2 prostatectomies, 2 hernia repairs (one bi-lateral), a femur fracture repair, an amputation and a really cool patela (knee) reconstruction that I actually scrubbed in and assisted on (awesome!!)

That's a lot of surgeries for one week. I am LOVING IT! 

But today, I walked into the OR to ask a question, and this is the first thing I saw: 

They weren't lifting it quite that high, so for a moment, I wasn't sure what I was looking at. So I asked what was the surgery, and they explained it was a http://en.m.wikipedia.org/wiki/Hydrocele_testis

A recurring theme in Chad, is that they don't come looking for a doctor until whatever it is that ails them, becomes unbearable. And they are very resistant to pain and discomfort. 

So this particular man didn't come in until... you guessed it. He had balls the size of Texas. Actually, it was just one testicle. The surgeon, table, floor, drapes, were all drenched, and they still suctioned almost 600cc out of his testicle. 

Honestly, I did not even know that existed, but that was pretty impressive. I wish I had seen it before it was drained! 

So the next time I hear someone say that expression, I'll just chuckle, think back on this patient, and say "naaah... not even close!" 

:) 

Little black children and big nasara people

To say there are cultural differences between Chad and everywhere else I have ever lived is a gross understatement. 

One of the things I learned on my first afternoon here was that most children are TERRIFIED of white people. The parents tell them that if they're bad, the white people will come get them and drink their blood... so they see us coming and literally start screaming. 

This was sad for me, because I love kids, and usually, kids love me too. 

When they start getting older, they start losing fear, probably because they realize we're not really going to drink their blood. 

Anyway, so there's this boy, who is about 10 or 11. The first day I saw him, he looked at me with big, scared eyes, answered my questions with yes or no, and seemed anxious for me to leave. He had a femur fracture as you can clearly see in the x-ray below: 

On Sunday, I asked his name, and he told me: Taira. 

Monday morning comes along, I walked into the room, looked at him and said "Bonjour Taira!" and man, oh man! His face lit up like a Christmas tree. He smiled so big, I almost cried. So I went and talked to him, then his mom came and talked to me too, and asked me questions about his operation, which would be on Tuesday. 

Yesterday I got to spend the entire day in the OR. Dr. Scott plated and fixed his femur, and it looked amazing!! 

However, like I mentioned earlier, the patients are awake during surgery. There's a drape covering the surgical area, but they can still see the Anesthetist moving around, injecting things into their arms, etc. They can also hear everything we say. The kid was terrified. He was shaking with fear... So I went there and started talking to him, held his hand, told him it would be ok, just tried to calm him down...

He now knows my name, smiles everytime I'm around, and his mom also really likes me. He has two younger sisters, and although they're still keeping a safe distance, they have started to smile as well. I will still win them over! :)

Yesterday was a great day... I will share more stories and photos later... :) now it's time for bed! 

P.S.: For those of you who were wondering, my amputee lady is still alive. She developped a fever last night, so we started her on malaria treatment (they all have it, as they don't have mosquito nets or repellent) and she was better this morning. Her wound is still infected, but we're keeping the abcess open and it actually looks ok... 

Please keep her, Taira and all the other patients in your prayers... And again, if you can help, please do!!! http://www.ahiglobal.org/main/donate-now/

(Don't forget to specify that it's for "Centre Chirurgical de Moundou, Chad).

Infection

You know all the advances made in medicine when we discovered sterilization and the concept of keeping things not only clean, but actually sterile? Well, that phase in human history skipped Chad entirely. 

We do our best to sterilize instruments, but there are flies *inside* the OR. They're not quite as cooperative as interns when you yell at them to keep their hands off the sterile field. 

Yesterday, a lady who had a tib-fib fracture was getting septic, so the only thing to do was to cut her leg off. The infection had spread far above the fracture site, so it was an above-knee amputation. 

Another discovery that skipped Chad entirely was the concept of full-narcosis. We don't have a ventilator (or the appropriate drugs) so the amputation (and all other surgeries) are done under ketamine, but the patients are awake and moving around. Talking. Watching. 

The lady with the amputated leg had an abcess going even further up from the amputation site, so today we had to unwrap her, poke around and wash it out. Our only desinfectant is a preparation of water and 25% bleach. 

The only pain killer is Tylenol. 

Take a few moments to digest that last phrase... 

I did the dressing change on her today. We have sterile gauze, but the patients actually have to go buy it at the pharmacy, because we don't have enough funding to give them all the gauze they need. So as a family member went to buy more gauze, I was standing by the bed to keep the flies off her wound and trying not to look at her face. 

I washed it as best I could, with an audience, as all the other patients (there are 16 beds per ward, we have 2 wards) watched. Tomorrow, I will do the same thing, and pray that the infection can be kept under control so that we can eventually close her wound and she won't die of sepsis. 

I took a picture, so you can have a better idea of what I'm talking about, but you might not want to look if you have a weak stomach... 

...and just in case you were wondering, no, that basin is not sterile, neither were my gloves or the instruments I used (we keep those strictly for surgeries).

If you got this far and you're horrified, welcome to the club. Unfortunately, this is the best we can do. The hospital runs entirely on donations, and we have barely any equipment at all. Stuff that the hospitals in the US and Europe throw away, we would be over the moon to get. A surgery runs somewhere between $30-$50 dollars. If anybody feels inclined to help, ANYTHING helps. $5 dollars would buy enough sterile gauze for one patient for a week. Might not seem much, but that could be the difference between life and daeth from sepsis... and some patients literally cannot even afford that... 

Alright, I'll stop talking, but please, please, please: HELP! 

Here's a link where you can donate: http://www.ahiglobal.org/main/donate-now/

(Just make sure you specify that your donation it is for the Surgical Center of Moundou, Chad). 

Thank you. 

Traveling across Chad

After my arrival and first night in N'Djamena, I woke up at 5:30am and was out of the house by 6am, to get on the bus that would take me to Moundou and the "Centre Chirurgicale."

The bus ride takes 8hrs, and I admit, I slept through most of it. However, I did wake up enough times to have a glimpse of the countryside. It's monsoon season, so everything is of a bright green, luscious color. The dirt is very red. The sky is very blue. It might seem like a stupid description, but it is very beautiful and hard to describe. No billboards or ads anywhere, just dirt, vegetation, and every once in a while, little huts and villages. Just tiny little huts made of mud-bricks and thatched roofs. I will try to sneak some pictures, but foreigners are not allowed to take pictures in public without a permit from the government... 

I did snap one surreptitious picture out the window at one of the stops... ;) 

Anyway, I arrived at the clinic, took a quick (cold) shower, and jumped straight in. When I got to the wards, Dr. Scott was still busy with surgery, so I joined Bekki (Dr. Scott's wife) and Will (a physiotherapist who is also volunteering for 3 weeks) and did their rounds of physical therapy with the patients. Will doesn't speak French, so I started translating for him and thus interacting with the patients and getting to know more about their situation. Most are here for broken bones due to motorcycle accidents. Some have had open fractures FOR MONTHS before they get here, and at that point, infection has spread to the bone and it's very difficult to do anything... The pain threshhold of these people is incredible!! This one patient, we were trying to mobilize his knee, and I asked if it hurt. He said "yes" in a very calm, steady voice. So we continued to move his leg, focusing on the knee. Not a peep from him. Then I looked at his face, and he was literally rolling his eyes and sweating from the pain. They won't say a thing. They don't cry out and yell at you to stop. They trust that you, "the nasara doctor"* knows better... 

*Of course, I'm not a doctor (yet!), neither is Will or Bekki, but to them, it makes no difference. They trust us just the same... 

(Nasara=white)

Chad--first impressions

We landed. They opened the door. We got down the airplane steps to the ground, and started walking to the terminal: "Aéroport International Hassan D'Amour." However, before we reached the terminal, there's a queue forming, and 2 guys with masks and gloves, pointing something at everybody's heads. 

They were taking everyone's temperature, screening for Ebola. 

No, that is not a joke. 

Welcome to Africa. 

--//--

After that, immigration, bags, customs, and I go outside, where Abraham (a Tchadian man) and Kristin (a German girl) were waiting for me. 

I will be spending the night at Kristin's house, who I found through Couchsurfing. (If you don't know couchsurfing yet, this is the time, look it up!!) Abraham will go to pick me up at her house at 6am and put me in a bus to Moundou, in the south.

Abraham had arranged a sim card for me, so I was able to send a message to my mom saying everything was ok, I had arrived safely and had already met my contacts in country. 

We drove to Kristin's house to drop off my bags, and then she took me to the house of an ex-pat, where I met a bunch of ex-pats who live here and work for different NGOs and humanitarian agencies. A Brazilian (!!!) who works in the refugee-camps in the border with Darfour. Another German girl who works with press and information releases. Kristin herself works as a hydrogeologist, figuring out the ground-water and reserves for the country. 

So here I am, it's my first time in Africa, and in my very first night, I meet a bunch of wonderful people, all of whom are staying here for years, doing whatever they can to improve the situation of Chad. 

I felt humbled, and proud of humanity somehow. There's a lot of bad in this world, but there's also a lot of good. We just have to know where to look... :)

Strangest shopping trip ever...

Hi everybody,

I didn't post in the last few days, but if you're following me on twitter, you know that I've been enjoying a wonderful few days in Paris. What a contrast it will be when I get to Chad!!

Yesterday I went to the Embassy of Chad to request a visa, and lo and behold, they were closed! It was their independence day. Not very cool, because they say it takes 3 days to get the visa. My flight is on Thursday at 4pm...

So I went back today, and they said no problem, it would be done Thursday morning. I'm gonna trust them and hope for the best...

After the embassy, with the assurance of the visa, I went on the weirdest shopping trip ever. I had searched online to find a store that sold medical supplies. It's in the outskirts of Paris, "la banlieu" if you know the region. I got there and started grabbing boxes of latex gloves, bottles of hand-sanitizer, seringes, needles, gauze packages, surgical masks, alcohol wipes, desinfectant wipes, and of course, mosquito repellent.

This is the kind of stuff most people never ever get to buy. Even those of us in the medical professions, we (or at least I) just take it for granted, you show up at the hospital, there are gloves, alcohol, needles. Buying this stuff somehow brought it home to me: I'm going to Africa. In 2 days. A place where the simplest medical supplies are scarce at best, and they make do with what they've got.

I think it hasn't quite sinked in yet... but today it's started to...

And the adventure begins...

This is it folks, I'm at the airport, waiting to board my flight to Paris. I think it's actually an African proverb that says "When you travel far, give your soul time to arrive."

It's funny, but my soul is already in Paris. Usually, that proverb is correct and it takes me about a day (sometimes more) to realize I'm actually there. This time, I think my soul never left Berlin, so it just floated over to Paris and is sitting in a café sur les Champs Elysées, having an espresso and a croissant, waiting for my body to catch up. :)

I already have a little list of the things I want to do when I get to Paris. I have the entire weekend free, and only have to go to the Embassy of Chad on Monday morning. Then it's wait for the visa, and fly to N'djamena on Thursday. This means that in exactly one week, I will be in Chad.

I'm excited!!!

I travel a lot, and have been to places with strong cultures, completely different than my own. I've been to Thailand, and India, and Nepal, and Kyrgyzstan. They were all wonderful experiences, and I enjoyed and learned a lot from them. But this is different. First, this isn't tourism. I'm not going to travel around in Chad. I will be living there for 2 months. I will be treating people, and trying to help them. I will be living the way they do, without proper running water, electricity, or basic sanitation. And I think, for the first time ever, I will be in a place where there's an actual risk to my healh, well-being and life. Chad is surrounded by countries in violent civil wars (Cameroon, Libya, Sudan, Central African Republic). Chad itself is being flooded by refugees, mostly from Darfour. The chances of me contracting malaria and being very sick for at least a few days is very high (prophylaxis, DEET and mosquito-nets can only do so much... it's monsoon season).

However, all of those things don't worry me ver much. It's an adventure, of course, but I'm sure I will probably be ok, health-wise. What worries me is the emotional toll of seeing people dying left, right and center, and not being able to do very much to help them. I guess we'll see.....

But there's no turning back now! Africa in exactly ONE WEEK!!!!!   :) :) :)

Homeless...

I've never been completely homeless... I mean, living on the streets and not having a place to sleep. But I have often ended up homeless for a time... living a nomadic life, moving from one place to the other, traveling around, meeting new people, experiencing new cultures... and I love it!!!

However, maybe I'm just getting old, or something, but the idea of not having a home, not knowing what to write in forms when they ask for a "permanent address" is getting to me. Don't get me wrong, I love to travel and will never stop. But I long for the day when going on a trip means packing a backpack, locking the front door and going. Knowing that if I come back 2 days or 6 months from now, it will all still be there. My home. A place to come back to.

I returned the keys to my apartment today... This was probably the nicest place I've ever lived, and I can only hope I can find another apartment like that when I get back... but that's more than 5 months away, so I won't worry about that yet. I only hope the next one will be a little more "permanent", even if not "forever".

I leave you with a picture of what I saw out the window this morning when I woke up...

Preparations...

If you know me at all, you know that I've moved around a lot. I have lived in 7 different countries, in 3 different continents, and we're not even talking about different cities in each country. I have to pack often. But I HATE DOING IT! It is the worst thing in the world for me...

Well, now I have less than 1 week to:
- Pack my entire house (not the furniture, luckily)
- Cancel all services, internet, phone, etc.
- Get all the necessary vaccines and medications to take to Chad
- Take all my things to a storage unit
- Meet with the owner of my apartment to inventory everything (it's their furniture) and give the keys
- Go to the bank with the owner to get my deposit back
- Spend a night in a hotel
- Fly to Paris

This might seem like not such a big deal... It might not seem like a lot. But it's very time consuming... specially the packing part. And the inventory. I would do it in 3 minutes, but the owner is very meticulous and when I got the apartment, it took 2 1/2hrs... this time it will probably take longer. So the part about the inventory and the bank will take all of Wednesday (banks here take forever). This means I have no more than 3 days to pack everything and take it to storage.

But today, when I went to get my vaccines (yellow fever, tetanus booster), the nurse asked where I was going, and when I said Chad, her first question was "hmmm... sorry, but where is that?" And when I showed her on the world map conveniently posted behind her desk, she asked me what I was going to do there. And I realized that very soon, I will get to poke people with sharp objects again. I will be involved in patient care again. I will be seeing blood and guts and everything in-between. It's been 6 months since I saw my last surgery, and you know what? I MISS IT!

So all the packing and drudgery involved in getting me to the Surgical Center of Moundou, Chad? -- it's worth it!!

And that makes all the difference in the world... :)