Humbled

There's a pervasive idea that we should give/help only when we have more than we need/want. When we have an excess, sure, we can give to others. 

Here at the camp I see how wrong that idea is. All you need is a generous heart. The people I am meeting here are teaching me so much, I'm starting to doubt that I came here to help them. They are the ones helping me! 

I started a project to screen all the residents >40 and the pregnant ladies for diabetes and high blood pressure. That means I have been walking around the camp visiting the rooms and talking to them (through a translator) to ask them to fast for 12hrs and come see me in the morning. And they smile at me, invite me for dinner, for a cup of tea, the kids jump in my arms, or follow me around everywhere. They left everything behind, fleeing for their lives. They have nothing, but what little they have, they're willing to share. 

I'm humbled by their generosity, and I only hope I can learn from them. 

A few general pictures of the camp to give you all an idea of how things are:

Entrance to the abandoned factory converted into living quarters

Corridors

Corridors

Some families closed up little corridors and use adjacent rooms as rooms in a house

Cooking facilities 

The delicious food provided by us by some of the refugees, who insisted we all come to dinner, then actually came back to the clinic the next day and brought us another plateful! 

Here they are! I asked them to teach me how to make it. Hopefully that will work!! 

The tents outside -- it's too cold now, so they're being moved in, but some don't want to, because the rooms are all close together. In the tents they have more privacy

The UNHCR is responsible for registering them and also provide the tents, blankets and other necessities

There's even a little library!! 

Oinofyta Refugee Camp - Greece

First Impressions: I arrived late last night, and was taken directly to the volunteer house. It's a normal house down in the village, with all the amenities you'd expect. Today, after breakfast, we went to the camp. I was given two jobs: go through the census and make a list of all the residents above 40 years old, to do a screening for diabetes. Then a second job was added, to make a list of the pregnant women, also to screen for gestational diabetes, blood pressure and proteinuria, to screen for preeclampsia. There are about 650 residents in the camp, and about 65 people in total, combining both lists. Now I have to find them all, and somehow communicate to them that they have to fast for 12hrs and come the next morning so I can measure their glucose levels + blood pressure, etc. Communication will be the fun part, but I've already met some kids who speak English, so I think I'll just enlist their help as translators, at least until I learn enough to pronouce things right. 

Now it's friday evening, rainy, cold. Most people have been moved into an adjacent empty factory for the winter, but some are still out in tents. Even in the factory, it's pretty cold (no heating). I had my big jacket on most of the time (except in the clinic, there's heating in there!!), but saw kids walking around with flip-flops. I don't know if they didn't have shoes, or just didn't put them on. There's a warehouse full of donated clothes, but maybe not the right sizes, I don't know. 

All in all, it's a bit overwhelming. They were smiling, the kids were playing, I got some hugs and kisses even, but I can't imagine living in such close quarters with hundreds of people. I can't imagine having to leave your home and flee to find safety so far away from everything that was ever dear to you. Nobody would choose to risk their lives on the way and come here, if they had any other option. They don't. So all I can hope to do, is make it a little bit easier on them. A little bit safer. To smile, to play, to talk. To do any little thing I can to make it better. It'll never be normal. It'll never be good. 

Good would be to wake up tomorrow in their own home, in their own city, in their own country, and realize the war was all just a nightmare--not reality. 

And the Countdown begins!

Hi friends!

I've been enjoying a few days of a well deserved vacation. The weather is beautiful (it's summer here!) and Watson (the kitty) and I have been lounging around, reading books for fun, taking care of the garden I created on my balcony and hanging out with friends. Today I got to eat the first 2 homegrown strawberries!!

However, this is all about to change very soon. In 6 days I will be on a plane, flying over the Atlantic and heading first to Paris. I have to stop there in order to request my visa for Chad, as there is no embassy here. I also get to see my friend Nadya for a couple of days, and that's a nice bonus.

Then I fly to Athens, and take a train to Oinofyta, a sea-side town in Greece, where I will be volunteering for 2 weeks at a Refugee Camp. This is with an organization called Adventist Help, and I have a few friends who have volunteered with them in the past and told me some incredible stories. Since the beginning of the refugee crisis, I wanted to do something to help, and when I heard their stories and the opportunity to help, I had to do it. I can't think of a better way to spend Christmas then helping people who really need it.

After Greece I fly to Chad. I can't wait to get there!! I have just now finished my 2nd year of medical school, so besides our rural family med clinic (where I started going once a week last year and continued this year), I don't get much patient contact. I definitely don't get any OR time, and I desperately miss the OR!! So it'll be a nice change, to be in the OR all day, every day again. :)

Stay tuned and check the blog periodically (or subscribe!) so you can keep up-to-date with my latest adventures. Also, if you're the praying kind, please pray for my trip, and for every patient I will come in contact with.

Thanks for your support! 

Dreams

                   

It seems impossible. I can barely believe it, and I'm the one living it! I'm 10 days away from finishing my 2nd year of medical school. 

It seems like it was only yesterday, that I was living in Berlin, having a crisis about my future and talking with a good friend about the fact that the only thing I had really ever wanted to do was medicine, but the chance had passed me by. I was too old. I couldn't drop everything now and start over. 

Or could I? 

The phrase on the picture above is so obvious, but so hard to see sometimes. Medicine is a long term goal. It takes a lot of time and effort. You might have to give up other things, and you'll definitely have to make sacrifices in order to achieve it. But if it's what you really want, you owe it to yourself to go for it. Because if you don't, the time will pass anyway, and you might look back and realize that if you had started then, you'd have accomplished it now. 

So do it. Whatever your dream is, run to it. Be brave. The first step, the decision, is the hardest. After that, nothing can stop you. Nothing should stop you. 

Life in Chad

I was talking to a friend this week and realized it's hard for people to imagine what day to day life in Chad is actually like. So I went through my pictures and did a little research to get some data to share with you guys.

First off, some numbers about the healthcare situation in Chad, taken from the Human Development Index compiled by the UN (click to see better):

I put together the top 10 countries and the bottom 10 countries. For easier comparison, I highlighted the United States and Chad. (All info can be found at http://hdr.undp.org/en/content/human-development-index-hdi ) 

Some other interesting information gathered from the same index: 

Percentage of the population with some high school: 95% in the US  -- 5,5% in Chad

Percentage of the population with access to electricity: 100 % in the US -- 6,4% in Chad

Chad hasn't moved forward in time, and people still live as they did 2000 years ago. No, that's not a typo, I mean 2 thousand years ago. The men work the fields, the women gather wood to cook, fetch water from a well/river, take care of the children, cook, sell vegetables in the market. The meager 6,4% who have electricity, have their own gas fueled generator (like the hospital). There's absolutely no sanitation or waste disposal systems. What little trash they produce which is not biodegradable, they burn. 

Mode of transport of the RICH -- most people just walk

What the villages look like

A little closer

The houses are single rooms build from mud bricks and straw. The "kitchen" is in the center of the yard, where they build the fire to cook over. You might remember the story of Adamah (beware of the photos!) who had extensive 3rd degree burns over large portions of her body. This happens very frequently and I know of 4 people (2 adults, 2 children) who died due to burns from cooking fires. 

Carrying a ridiculous amount of wood on their heads

Cooking on burning wood

The school

If they want flour, they have to make it themselves, plant and reap the grains, let them dry, and then pound the heck out of them until it becomes flour. (The women do this, the man in the video was just showing off *because I was filming.*

The market in town

The pharmacy (yes, meds straight out in the sun with temperatures of up to 35-40 Celsius)

With the exception of the main highway which connects N'Djamena (the capital) with Moundou (the second largest city) there are no paved roads, and even the conditions of that highway would make you cry if you saw it. 

And lastly, a little view of the hospital where I worked the previous two times: 

The men's ward (there's an equivalent female ward)

The central yard where family and patients hang out

The OR

And below is the hospital I will be working at this time, which is different from the previous 2 times. It's a much bigger hospital with a little bit better infrastructure, even though it is *really* in the boonies instead of the city and it takes 7hrs on a bus plus 1hr in a moto-taxi through dirt roads to get there from the capital.

Chad - Round 3

The last time I went to Chad, in January this year (not even a year ago!) I thought it would be my last time. The day I left, I remember watching the city of Moundou going by the window of the bus, and feeling sad that I would probably never see it again. It was weird, because part of me felt like Chad was home. It had won a little piece of my heart.

Well, it turns out that *I am* going back!! Dr. Scott is no longer there, he moved to a different hospital in Sierra Leone. But the Bere Hospital has some great doctors, whom I met for a weekend, and they were happy to have me come and volunteer with them. So I bought tickets!

This is a bigger hospital at a very rural area. Some people travel for days to get there and receive medical care. The work they're doing there, against all odds and against all reason, is incredible. I can't wait to become a part of the team, to help anyway I can, and to learn as much as possible.

To make my trip possible, I have started a crowdfunding page. For those of you who want to and are able to help financially, every dollar counts and it will be greatly appreciated. Otherwise, every prayer,word of encouragement and positive thought is also very valued and much needed!

Watch the blog for more stories from med school and from the upcoming trip. Oh, yeah! And here's the link for my page, feel free to share it and help spread the word!!

https://www.gofundme.com/medical-volunteer-trip-to-africa-2v983vnw

That time when... med school kicked my butt

Second year of med school has been a blur so far. I arrived back from my trip to Africa on the day my classes started, literally dropped my bags at home and went straight to class. I do not advise doing that and will not be doing it again.

My brain was not ready to jump from Chad straight to classes. So while I tried to adapt to being back, I started running behind class materials and felt like I was playing catch up. The entire semester. My stress levels went to record highs, and I even had insomnia, something that, with rare exceptions, I had never had. I passed all of my classes, but my class ranking suffered a bit and I'll have to work extra hard to recover.

The result is that I finished the semester utterly exhausted. But since I'm an overachiever at heart, instead of taking advantage of winter break to recuperate before second semester, I went ahead and signed up for an elective. Because I'm insane. I did escape for a week to go to the beach, because I felt that I could simply not start 2nd semester without recharging my batteries at least a little bit. I'll talk about that on the next blog post, suffice to say, it worked! A week in paradise was just what the doctor ordered. :)

However, I realized that I need to cut myself some slack, and not be so hard on myself. This semester was pretty tough, but I passed. Beating myself up because of class rank is stupid, and I know I can do better next semester, when I won't start out stressed and already playing catch up. Plus, we start out with Neuro and I love neuro!! So it should be fun.

So the two lessons to take home are: 1- don't come back from a stressful trip to Africa (or elsewhere) the same day your classes start. Give yourself some time to arrive and adapt before classes start. 2- do your best and don't beat yourself up if the results are not exactly what you expected. After all, it was just 1 semester and I passed!!

Mentors

Even before I started med school, I knew that I would need a good support system. And I knew that was going to be a little complicated, because I was moving to a country where I knew nobody at all. I have good friends, but the closest to me geographically, are still in the next country. It's 4hrs away, so it turned out ok and I get to see them on a somewhat regular basis (money and time being short and all.)

I also knew I'd need mentors. I had never actually had a mentor, so I didn't know where/how to find one.

Then I went to Africa and worked with Dr. Scott. Before I went, I had no idea if we'd get along, I was even a little aprehensive. But we got along great, he taught me a lot, trusted me, and told me to come back any time. So I went back, and learned even more. I know he'll be there for me if I need help or encouragement, and I'm lucky to have him.

Last year, I had also contacted a Neurosurgeon from the US about an article he wrote, and to my greatest surprise, he wrote me back, gave me his phone number and told me if I ever had any questions, to feel free to contact him. I am planning on working with him in the near future, so we've emailed a few times, and even though we haven't met yet, I feel like he's also becoming a mentor, and I'm grateful for that.

To finish, I recently went to a neurosurgery congress and met another great neurosurgeon. It was a small congress, and I ended up talking one-on-one with him on numerous occasions, about medicine, but also about philosophy, injustice and traveling. He gave me some great advice and also invited me to do a rotation with him when the time comes (I'm still an MS2).

I can't believe how lucky I am, that without even trying to, I have found myself 3 mentors. Three great surgeons and great human beings, to look up to, ask advice from, and generally have "in my corner," should I ever need help or get discouraged.

To all of you pre-med, med students and residents out there, find a mentor. At least one. Someone you can trust and who can help keep you motivated, inspired and give you a little push once in a while. We all need it. :) 

Neurosurgery

I'm on cloud 9 right this moment. Sorry it's been a while since I wrote, but I got back from Chad on the day my classes started, had a friend come visit, then my mom, and between studying and trying to get my life organized, time got away from me.

But I just got home after being out of the house for 15hrs, and had such a fantastic day that I had to come and share. Let me explain: today was my 1st ever medical congress, and it happened to be a Neurosurgery Congress.

I am a lowly 2nd year medical student, and even though I've done and experienced a lot more than your average 2nd year, none of it was in my country and my university doesn't know anything about it. I get no brownie points for going to Africa and assisting in surgery, or doing internships in hospitals in Germany. Therefore, I am really, just a lowly 2nd year med student. Who happens to be fluent in French.

The guest of honor and main speaker for this congress, was a heavy weight French neurosurgeon. I had obviously googled him prior to the congress. This morning when I got there, imagine what isn't my surprise, when the 1st person I see, standing alone close to the door of the auditorium, is The Man Himself! So I smiled and said "Bonjour" to which he replied "Vous parlez Français?" To which I replied in French and we somehow immediately fell into conversation. It was just 30 seconds, but it was enough.

A little later, we had a coffee break. This is a small congress, so most people already knew each other and I was the only med student, lost in the crowd, nursing my cup of coffee. The Neurosurgeon guy comes, all by himself, talk to me. We end up talking for about 10 minutes, I tell him a little about myself, ask for advice, and walk away with his card and **an invitation** to come do a rotation with him, once I get into the clinical years! YES!!!!!!!! I am over the moon!!!!

As if all of that wasn't enough, I later met a team of Neurosurgeon/Neuroradiologist/Radiotherapist from Brazil (and I also speak Portuguese!) and one of them said casually that if I wanted to come do a rotation, I'd be more than welcome. I didn't let that pass and immediately got their contact info and even went so far as to suggest a possible date (winter break, I have 3 weeks off!).

You'd think the day's riches had been exhausted, but they weren't. The French Neurosurgeon *comes back* to talk to me, and we start talking about travel, philosophy, and of course, Neurosurgery. The guy is simply awesome. Not only is he a great surgeon, but his holistic philosophy of care and his emphasis in Quality of Life above Overall Survival is something I had always thought about.

Just to sum it all up:
- I befriended a world renowned Neurosurgeon and got an invitation to do a clinical rotation with him in France.
- I befriended an entire Neuro-onc team and also got an invitation to do a rotation with them in Brazil.
- I learned A TON about the latest treatment options and diagnostic imaging for brain tumors + made a list of things I don't know/didn't understand so I can read up and catch up.

Today was a really, really good day. The only thing I didn't do was make any local friends in Neurosurgery, which is kind of a downer because they're the ones who can let me into surgeries here and now. But hey, there's still tomorrow!! :)

Back home

Sorry guys, I got busy and sad and then in a whirlwind I was back in Berlin for 4 days, in Paris for 14hrs, then flying home. I arrived Monday at 11am, went home, ate, showered and *went to class*!!

I am exhausted. It's Thursday evening, I got back from class a little while ago and all I want to do is sleep. But I have to study. And my mom is still here. So I'm procrastinating and writing a blog post. Mom leaves tonight.

I only had 4 days of class, but I feel like I'm so ridiculously behind already. One of the profs definitely loves the Socratic method, and is pimping us hard. I also met the 1st gunner and wow, she's annoying.

I guess I better get my act together, or this semester is going to kick my butt!!!

I'll write more about Chad later, there are still many stories to tell. :) 

Leaving Chad

I'm sitting at the brand new, air-conditioned airport, remembering the 1st time I left Chad. The airport was little more than a hot and humid warehouse, with bad lighting and lots of mosquitoes. They had a turnstile gate-like thing, that you had to push and be pushed, to show your passport, pull your luggage and attempt not to lose a limb in the process. It was crazy.

Now it's organized, squeaky clean, with air conditioning which actually works. Today was 45°C and I was dying. Now I'm almost cold. *Almost.*

I'm sad to be leaving. Last time, I knew I was coming back, and even then, it was hard to leave. Now I know that I will probably *not* be coming back, or at the very least, not to Moundou. You see, Dr. Scott is leaving at the end of the month, moving to Sierra Leone. The hospital will be managed by a Chadian family practice doctor and a nurse/surgeon who will do the operations. No more western doctors or volunteers. If I do come back to Tchad, it will be to Bere, our sister hospital. But I'll feel like a guest there. It's not my hospital. It's not my African home.

Weird, I know. But I have too many memories at this hospital. Good and bad. Tragic and funny. Profound and silly.

I'm gonna miss Tchad, the hospital, the patients, and the people I worked with. I leave you with a few pictures of random moments.

Life in Chad.

The OR crew

Tite, our dressing changes expert!

We did a first-aid refresher course

Surgery w/ Dr. Scott

Suturing

Cute patients learning 

how to walk again

Riding a donkey

Football/soccer game

Hanging out under the mango trees

Patients with cute kids 1

Patients with cute kids 2

Amputations

Puzzle with peds patients

Lesson of the day: Brush your teeth!!

This was originally supposed to be a funny post. We've had several people come in with dental abscesses, and I always joke with the OR nurses and ask them "What have you learned today?" To which the answer is "Always brush your teeth!"

The 1st time I ever performed CPR on a live person (not the dummies we practice on) was a guy who came in for a dental abscess and stopped breathing on the table. Luckily, it was only for a few seconds and we got him back.

Then we had a lady who had a track of pus going all the way up her cheek and to her skull above her ear. We opened it up and pus just kept coming. Her aponeurosis was necrosed and we had to dissect it out. This is a dental abscess, and here I am, looking at her cranium!! She's an elderly lady, and I was actually afraid she wasn't going to be able to kick the infection. Amazingly, she's doing well.

However, yesterday we had another dental abscess. Young, otherwise healthy female. Huge amount of pus. She aspirated. She desatted, and try as we may, she just kept going south. We were trying to suction the pus out of her lungs, and giving her O2, but nothing seemed to help. After about 15 minutes of having O2 sat between 60-70% and a heart rate above 150bpm, she arrested. I jumped on the table and started doing compressions. I looked at her eyes and her pupils were fixed and dilated. I knew her brain had been without oxygen for too long. She died.

(Here is Dr. Scott's blog about what happened, in case you want more details: https://gardners2koza.wordpress.com/2016/02/25/death-in-the-or/ )

So what was going to be a funny post about the importance of good dental hygiene, became a tragic post about the 1st patient who I've seen die on the table. Because of a stupid dental abscess. It seemed totally surreal. I'll never forget the look on her mother's face.

So if you're reading this, thank your lucky stars that you have access to a dentist, a toothbrush, and toothpaste. Make sure you use it. It may quite literally save your life.

(The pictures below are from the 2nd case described, the elderly lady with pus tracks going up to her skull.)

During the procedure

During dressing change

Call me surgeon!!

I think there comes a moment in every med student's life, when they feel like their dreams are coming true, that they're in the right path, that all the effort (past, present and future) is worth it.

My moment happened when I performed my first surgical procedure (minor!) on my own, from beginning to end. I was supervised, of course, but I did everything. Local anesthesia, incision, disecting the lipoma out, suturing. It was removing a lipoma from someone's thigh, so nothing transcendental, but it was awesome. And it was a pretty big lipoma too!!

I feel like a surgeon. Of course, I have *many* years of hard work ahead before I am really a surgeon, but I'm getting there.

Here's a picture of me, grinning from ear to ear, with the lipoma I just removed!

It's not only about the medicine... just mostly!

Life in Chad is hard, in particular when you work at a hospital. So once in a while, you kinda have to get away. The first time I was here, I went to Gore, a city in the south. This time, I went to Bere, a little to the northeast of Moundou (where I work). There's a sister hospital there, from the same organization, so they also have volunteers and American doctors (3 of the!) It's a bigger hospital, so more volunteers!

We had a feast at a local woman's house, played lots and lots of games, laughed until tears were running down my face and I could barely breathe, and even got to ride on a donkey! Oh yeah, there was some surgery too. :)

Pictures!!

 Traditional Chadian Boule

 There was SO MUCH FOOD!!

 You put everything in a platter and people eat with their hands, from the same plate.

 Me riding the donkey!

 Selfie in the back of the pickup on the way home!

After the pickup stopped...

There was also a little surgery... :) Saturday morning Dr. Roland asked if I wanted to scrub in on a laparatomy with him. Of course!! It turned out to be a bowel resection. The guy had about 2 feet of dead bowel inside, about to rupture. Luckily, it didn't, and we were able to repair it cleanly. He'll do fine! And I got to do my first subcutaneous sutures!!

Dead bowel

I was concentrating on my sutures!

Not bad for a first try, hey? 

It was a good weekend. Which I finished by coming back at 10pm, on my own, taking a moto-taxi after dark for over an hour, plus a shared taxi car ride for another 2hrs. Crazy, I know. Kind of exciting. Kinda stupid. I made it though! :)