Surgery on steroids

Thursday we did two mastectomies, two hernias, a hydrocele, a lipoma, drained a neck abscess and I don't remember what else. Today we did a prostatectomy, two hernias, a tube ligation, sutured an eyelid, saw a kid eviscerated by a bycicle (seriously!) and put it back together, and sutured an arm that was hacked to pieces in a machette fight. Not to mention the consults. And rounds. 

I get to practice my subcutaneous sutures on every patient, my LPs while doing the spinal anaesthesia, and generally have a great time sticking my hands inside patients, looking for a prostate here, a fallopian tube there. To me, this is kinda like Disneyland: you stand around for hours but you have fun anyway. My legs and back are always killing me at the end of the day, I'm basically standing up from 8am-6pm straight.* No pause, no lunch, no bathroom break. And I love every second of it. I don't even remember I'm hungry until we finish the last case. Then my stomach wakes up and screams at me, demanding to be filled. 😂😂😂

We saw a baby with a meningocele on the lower back and hydrocephalus. He already had trouble opening his eyes. And there's nothing we can do. We sent them home. The baby will get worse and worse, without any way to relieve the pressure on his brain, and he'll die. There's no neurosurgeon here. No imaging (beyond ultrasound). No instruments or materials to insert a shunt. 

Neurosurgery is not an easy specialty to practice in Africa. At least, it seems impossible in Chad. Hence why Danae is trying to convince me to do OB just like Dr. Scott tried to convince me to do general surgery. But just touching that baby's soft spot, knowing his brain was right there, gave me a chill. I really don't think I'm gonna change my mind (although the only thing that could possibly do it, is cardio). 

We also saw a little one with a hemangioma on the left hand. We're going to operate on Monday. Should go well, but we might lose the little finger. Hopefully we can save it though. 

Anyway: lots and lots of work, every day, from morning 'till night. I'm not complaining. 😊😊😊

*I guess surgery rotations in the US are worse, you have to be there at 4-5am. We start rounds at 8am here and OR after that, usually around 10am, until 6pm and doing consults in between surgeries.

Mastectomy for advanced breast cancer. Non-curative, her lymph nodes were already involved, but hopefully this will give her more time.

Loosening a prostate with my fingers. There's no way to do transurethral prostatectomies here, so it's still done old school, through the bladder.

That was only the first half of the prostate!! 

Concentrating on my sutures! :) 

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! 

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

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! :) 

A year ago...

A year ago, I was in Paris, getting ready to go to Chad for the first time. I was excited and scared at the same time. I didn't know what to expect, but I was certain the experience would change my life forever. It did. 

It's impossible to convey the range of emotions I experienced in those 2 months. Joy, anger, happiness, helplessness, sadness, awe, excitement, gratefulness. I learned a lot on those two months, not only about medicine, but about life, about myself, my limits, my capabilities. 

I left saying I would go back. I know some people didn't believe me, but I always keep my word: today I bought my tickets. I am going back to Chad for 2 months, January and February 2016. 

I can't wait!! 

If you're the praying kind, please pray for me on this journey through medical school, and for Dr. Scott and Bekki, who are there on the frontlines, giving their all to serve others. 

Two places at once...

"When you travel far, give your soul time to arrive." African Proverb

My soul is confused. I think it stayed in Chad. My body was torn from Chad, from a place where my emotions were tried every single day, where electricity was only by generator (which sometimes didn't work) and cold water, "supermarkets" with only the bare minimum, and most importantly: sick people that needed me-- to Paris-- arguably the height of civilization, with abundant food, wifi, hot showers, starbucks coffee and chocolate-- to Kathmandu-- a magical place, that somehow confers peace just by being here. 

Nepal is wonderful, this is my second visit, and I am incredibly happy to be here. 

But my soul is confused. 3 days ago I was working in a hospital in Chad. How did I get here? And those 14hrs in Paris, was that a dream? Did that really happen? That was a giant culture shock...

I miss Chad. It's weird, I know. It'll take me a while to let go. I asked for news, and Dr. Scott told me that Blaise and Gombo are doing "really well" and another of my patients also got discharged. 

I will enjoy the hustle and bustle of Kathmandu for another couple of days, before heading to Pokkhara and the Annapurna Mountains. 

I hope my soul have arrived by then... 

Bitter-sweet

You know you did something right when every single one of your patients tells you they don't want you to leave... :) I went around this afternoon and took pictures with them and with the staff. I'll post some later... 

I'm a little sad, but 4 of my patients have been discharged and Dr. Scott said Fatimah will probably get discharged Wednesday. That makes 5 of my patients discharged. The two I fought hard for (Blaise and Gombo) are doing much better, and there's only one who is still in danger of losing her leg (2 year old baby girl!!) but she has osteomyelitis and there's not a whole lot I can do for her anyway... :( 

Tomorrow I take a bus back to N'Djamena and tomorrow night, a plane to Paris. Then I'll spend 12hrs in Paris, stuffing my face with croissants and stinky cheese, then get on another plane to Nepal. 

Tuesday: Tchad

Wednesday: France

Thursday: Nepal

3 continents in 3 days. That's a record for me! :) I'm excited about the next phase of my trip. It'll be fun! :) And I am at peace with my decision to leave. 

Ecclesiastes 3:1 "For everything there is a season, and a time for every purpose under heaven." 

All good things...

Irene got discharged today. Finally. She gave me a huge hug, her mom smiled and shook my hand, and we took a picture together before they left. I told her I was going to print it out and when she came back for her check up, she could pick it up. Something to remember me by.

It's been exactly 8 weeks since I first saw her. Since her amputation. 

She left, and so will I. 

The decision is made. There will always be more patients. I will come back. But it seems that the cycle has ended. Two of my other patients were discharged todayas well. Blaise is officially free of infection and not taking antibiotics anymore. Gombo also seems to be doing better and no more pus is pouring out of his leg. Tahir (the 11 year old boy) went from dressings to steri-strips. He's almost ready to go home too. 

I don't know if my patients will miss me. They have missed me during the week I was gone, but once they leave the hospital, I guess they'll want to forget everything about their stay. 

I will miss them. And I will miss all the blood and guts part of it, the right to walk into the OR and scrub in any time I want, having the keys to the entire hospital and actually knowing exactly what to do and when. 

This has been an incredible adventure. It has been harder than anything I've ever done, but I have also learned more than I could have ever imagined possible in 2 months. 

Today I helped put a humerus back into place, in an arm that was pretty much torn apart in a car accident. 

I have had my hands inside various body cavities, seen intestines, bladders, prostates, hernias, hydroceles, etc. etc. etc. 

That's Dr. Scott's hand this morning, nuckle deep in Gombo's thigh. I did that dressing change twice a day for a month. To reach inside someone's thigh far enough to touch their femur--that's pretty incredible... 

I'm going to miss all of that. Sticking needles into people's veins or muscles, putting on gloves and snapping them off, the smell of alcohol and waving my hands in the air so they dry faster between patients, so I can put on a fresh pair of gloves. 

Might seem silly, but I will miss all of that. 

In a few months though, I will be thrown back into the world of medicine, and I will be the best freaking med student this world has ever seen! 

So I am leaving. In 48hrs I will be in a plane to Paris, and after 12hrs of eating stinky cheese and taking the longest, hottest shower of my life, I will be on another flight to Nepal. 

I have another day in the OR tomorrow though. I'll enjoy every last second of it. :) 

Should I stay or should I go?

For the last few days I have been struggling to decide what I should do next...

On the one side, I have a plane ticket to Nepal in 5 days, and the incredible opportunity to realize a trip I've been dreaming about for 12 years, to trek the Annapurna Mountains, see Mt. Everest base camp and cross from Nepal overland into Tibet. When I started dreaming about this, it was not even possible to do it, the border was still closed between Nepal and Tibet (China). 

It has been possible for a few years, but I didn't have the means/time to do it. This is my chance, specially because the correct time to go is October, and once I start Medical School, I will never again have vacation or free time this time of the year. 

However, a few things have happened lately that make me think I should stay in Chad for another 3 months. A couple of nurses from the US who were staying for a year had to leave due to unforseen family circumstances. Our general nurse supervisor is leaving to go train as a mid-wife in Cameroon. Our *only* anesthetist has not renewed his contract and also wants to leave. 

Yesterday I had decided that despite all of that, I was leaving, that I am not indispensable, cannot do anesthesia, and they'll simply hire another nurse. There's also another nurse volunteer from Mexico who will be coming soon and can take my place. 

Today I arrived back at the hospital, and the faces of all the patients when they saw me, the smiles, hugs and handshakes, were enough to make me want to stay. 

But then, it was time for evening dressing changes. I left **very** specific instructions on how they should be done, and to one of the patients, Blaise (the one who almost lost his leg a couple of weeks ago), I told him to scream at the top of his lungs and not stop until someone came. 

Well, turns out they did his dressing changes 4 times and my other patient, Gombo, only ONE TIME during the entire week I was gone. 

I am furious! The night nurse saw me coming and asked if I was going to do the dressing changes (meaning she knows they should be done) and I said yes, because if I don't nobody else will. Why did it not get done? "Oh, we get busy and we forget" which is a blatant lie, they barely have anything to do at night, even if there are plenty of sick kids, after they start the IVs and put them on oxygen, there's nothing else to be done and they can certainly take half an hour to take care of the other patients. I asked her what if it was a question of life and death, and the patient died because she hadn't done her job, what then? This is not a question of life and death, but now he might lose his leg. How do you feel about that?!?!! --No answer. 

So now my resolve is all gone down the drain, and I predict another sleepless night as I wrestle with this decision and try to figure out what I should do... 

Any thoughts? Come on people, help me out here... Comment!! 

N'Djamena in black and white...

I'm still in Chad, but N'Djamena feels already like a different world. When I arrived in Chad, my flight came in at 10pm and I had a bus to Moundou at 6am. I didn't get to see any of the city.

On Friday, after rounds, after saying goodbye to my patients, giving some instructions to the nurses about specific patients, and telling one of my patients that if nobody came to do his evening dressing change, his job was to scream at the top of his lungs until someone came, I went to find myself a minibus to N'Djamena. The buses here don't leave at specific times, they leave when they're full... and it seems not many people wanted to go to N'Djamena on Friday, because I was sitting in the bus for 2 hours before we started to move. They also said it'd take 6, maximum 7hrs... Well, it took more than 8... So I was in that bus for a total of 10hrs... 

In the middle of the journey, they make a stop in a city called Bongor, so people can eat, go to the bathroom, whatever. I decided to get off the bus and get some food. This was already 3pm and I had not eaten yet. So I got a whole grilled chicken and a baguette. Granted, the chickens here are a lot smaller than elsewhere (no hormones!!) but I still devoured an entire chicken by myself, with my hands, while sitting in a bus, somewhere in Africa. 

Anyway... I eventually made it to N'Djamena at 8pm, and Kristin, my German couchsurfing host and friend picked me up and immediately took me to a concert at the French Institute. It was fun. There were a lot of white people there, and I realized that I hadn't seen that many white people in almost 2 months! In Moundou, at least for the last month, I've been the only white person... It was a little weird to see so many again. I met another German guy who is married to a woman from cameroon, and he mentioned they were going to a museum on Saturday and invited me along.

So the next day we took off to look for this museum, lost in a village, somewhere in the outskirts of N'Djamena. We finally found it, and were treated to a private tour to look at utensils, vases, shoes and clothing dug out by a French archeologist. They represent a little bit of the Sao people, rumored to be giant warriorrs of up to 4 meters, who could "kill an elephant and carry it home on their backs". Well... probably not, but legends are fun... :)

After that, I went to CLAC, a community center where Kristin and Emery organize cultural activities for the kids. They had a show planned for the end of summer vacation, and it was awesome. From babies to teenagers, they were all there, singing, dancing, laughing, having a grand ol' time. And man alive, they can dance!! They have an incredible control of their bodies, and seem to have joints and muscles I didn't know could move... :)

Then it started to pour, and rained monsoon style for a while. We were trapped for a while, but left when it let out a bit, because we had a barbecue to get to...

The barbecue was organized by ex-pats that work for a construction company, and live in a very nice complex with a pool. There was a lot of really good food, a fussball table, and a bunch of white people... I keep bringing this up because I got so used to seeing only black people with their big smiles worthy of colgate adds, that it's weird to see a lot of white people together. 

Anyway, we ate, talked and played fussball until the rain finally stopped and everybody jumped in the pool. It was more like a giant bathtub, it was really warm and just wonderful. I was the second person in, and the last to come out. We went home at 2am, after a really full day. I was tired...but...

Got home and couldn't stop thinking about my patients and how they're doing... Couldn't wrap my head around the fact that I had just been to a party in a nice complex, with a ton of food, and they probably spent more money than most people here make in a lifetime. 

I feel I'm in limbo, caught between two worlds... A world of stress and indescribable pain and suffering, but where I am needed, appreciated, and can do something to improve people's lives every day. And a completely different world where nobody dies, and nobody goes hungry. Where life is easy, and there are things like fussball tables and pools. But where I end up crying in the pool when I think about the girl that died last week and I did nothing. 

I knew Africa would be hard, and amazing, and that it would change me. I think going back into the world next week will be the real culture-shock, and readapting will be a challenge. Luckily, I get to spend some time roaming around the mountains of Nepal... I have a feeling those mountains will hear a lot of stories, prayers, and tears... 

Daily joys and struggles...

Well folks, since my phone is kaputt, I actually don't have any way to post pictures anymore. Sure, I could walk around with my iPad and take pictures that way, but that's hardly convenient. It doesn't fit in the pocket of my scrubs... 

So I thought I'd post about some of the joys and struggles I go through every day... 

I don't speak Arabic, only French. A lot of my patients only speak Arabic... so when I'm trying to tell them something, I can either find a translator or we can use sign language and try to understand each other. This usually ends in good laughs. 

This morning, one of my patients, who has a giant road rash wound on her thigh, which we had to remove the dead skin and leave it raw, was trying to tell me something when I came to do her dressing change. I couldn't understand her. She kept saying something like "beshé, beshé..." and I kept looking at her blankly while unwrapping her bandage. Suddently, she grabbed my arm and very gently caressed it. And then the light went on in my head. I have to scrub down her raw flesh to remove the layer of pus. She was saying "be gentle..." I understood. Unfortunately, I can't be gentle... I have to scrub it until it's clean... 

Well, this afternoon, with the same lady, I was doing physical therapy, and showing her with my body what I needed her to do with hers. This resulted in a few hilarious situations in which half the ward (who was watching) laughed with us. She's doing very well, and when her road rash is healed, she'll walk out of here with full range of motion on both legs! 

Another patient has a baby son, an adorable little boy of about 6 months. He was in his dad's lap when I went to do PT. I simply picked him up and he started giving me the most adorable belly laughs! Told his dad what to do, and just kept playing with the baby... :) I asked his name, and dad told me it was "Donné par Dieu" which means "given by God." I thought it was a very appropriate name...

Yet another patient has kidney stones. Very painful. He keeps asking if there's anything we can do to make it stop. There isn't. I told him this afternoon that the pain of passing kidney stones is comparable to the pain of childbirth, and asked him how many kids he had. He laughed and said: "so every time my wives* had a baby, this is what they felt? Now I understand why they screamed!" (*yes, he said wives...)

And then a last little story: when I was on my PT rounds, one of my patients didn't want to get up, she was tired. I joked that she had been in bed all day, why was she tired? Her answer cut through my heart: "I haven't eaten all day... there's no more money..." I hadn't expected that. She had an actual, legitimate reason why she did not want to get up. Why she was tired. 

I went back to my room, got some money and silently put it into her hand... Her eyes said it all. 

--//--

I've been here for over a month. The sounds, sights and smells have become familiar. It's become a routine. I start my day with rounds and dressing changes. Then I go to the OR and check what's going on: hernias, hydroceles, prostatectomies, broken bones. Then I have lunch. Then I do PT. Then I do evening dressing changes, make sure everyone is taking their antibiotics and drinking enough water. Then I have dinner, shower and hit the bed... 

But I forget that they don't have the same luxuries I do. A lot of them don't have enough money for antibiotics *and* food. Or sterile gauze. Sometimes I'm reminded... and I am shocked that I take so many things for granted, and complain about silly, stupid things. So I do what I can. I buy antibiotics, or gauze. I give them money for food. I pray. I talk to them and explain what and why we do this or that. I try to make them laugh and ease their pain. I try to help any way I can... 

I just hope it's enough...

Death...

I mentioned in an earlier post that I had seen a man die for the first time in my life here. And honestly, as terrible as it was, I dealt with it fairly well. I didn't know his name. He was elderly. The first time I saw him, he had already collapsed and was being carried to the bed where he immediately died. 

Today was different. 

This was a beautiful young woman of about 18. She had had an operation here on Wednesday. I knew her name. I had talked to her and held her hand during dressing changes. I had checked on her when I did the dressing changes in the evening.

And today, just like that, she stopped breathing. I was a few beds away doing dressing changes when I heard the wail and saw the family start to cry. Her younger sister being carried away by the brother of another patient. The mother covering her feet, then her arms, then her face. Someone brought a guerney, and the men transfered the wrapped up body. 

It didn't take more than 5 minutes between the first wail, and the body being wheeled away, leaving behind just an empty bed.

Through it all, I watched as if in a trance. I couldn't move. I felt completely powerless. I wanted to do something, but what? I wanted to scream that we couldn't just let her die like that. No! We had to fight! Do something! 

I can't shake the feeling that in a different hospital, in a different country, with better equipment and facilities, she wouldn't have died. That was a senseless, unnecessary death, and I watched it happen and did nothing. 

There was nothing I could do. No defibrilator, no respirator, barely any drugs. 

I felt outraged and numb at the same time... I pushed it all down. I still had dressing changes to do... there were other patients who required my attention... I would have to deal with my feelings later. 

Malaria and dead phones...

It started Thursday... After Physical therapy in the afternoon, I just felt tired. I went back to my room and literally passed out. Woke up 2hrs later, a bit confused and wondering what time it was. Got up, did the night dressing changes and went straight back to bed, didn't even eat. 

I should have known... 

Woke up the next morning and noticed I had slept with my sleeping bag. This is Chad. Lowest temperature is like 30 Celsius (or like 80F). My sleeping bag is for below freezing temperatures (I'm going to Nepal after this). Something was clearly wrong... 

But I still got up and pulled on my scrubs. I made it as far as the living room (50ft away) when it felt like my head exploded and I just collapsed on a chair. 

There was no doubt. I had malaria... 

So whenever I felt able, I pulled myself together to go back to my room and swallow 3 more malarone pills (I had already taken my morning prophylaxis dose). Promptly collapsed again, and didn't move for the rest of the day.

When it rains, it pours, so my phone choose this particular moment to refuse to charge. It still worked perfectly, it would just not charge! So when the battery died, I would have no way of communicating with the outside world. No news of ebola. No way to tell my mother I'm still alive. No blog. Nothing. 

There was nothing I could do, so I just remained in bed and watched the battery drain... 

Today (saturday) I feel slightly better. Even managed to eat a bit... After that, I felt I had a little more strength, so I braved the malaise to go find someone who could tell me if I could get a sim card for my iPad, and get me connected again. 

Clearly, that worked, and I can now still blog and email, just no more phone calls, txt messages or whatsapp... Oh well... It's better than nothing, and my new and overpriced iPhone 5s (which I paid full price for, 3 days before it got reduced due to release of iPhone 6) will arrive in 10 days, along with Dr. Scott. 

I'll survive until then... 

Sucess!!

A lot of my non-medical friends are complaining about the graphic nature of my pictures... so for today I have a different kind of post: 

Meet Ali- a kid of about 16:

He came to us several weeks ago with a femur fracture. He was in traction for a bit, then Dr. Scott did a perfect sign-nail repair. 

Ali speaks only arabic, and only understands a few words of French. The first time I met him, it was to start him on physical therapy after the surgery. His cousin was translating for me, and when I said we were going to do some exercises, his answer was a cathegoric "no way!" 

He clearly didn't know me very well... 

Of course, I didn't take no for an answer, and over the course of another couple of weeks, we exercised every day, and improved the range of motion of his knee, which at first was only about 30 degrees. 

He did NOT get infected, his wound healed nicely, and he was discharged. 

Today he came for his weekly check-up, still using crutches. 

That's his current range of motion. He's pretty good at exercising on his own, and I have no doubt he will continue doing it and regain the few degrees still missing...

So today, I had the pleasure of pronouncing him completely healthy and telling him he had no need to come back to the hospital, or to use his crutches again. 

I admit, it was weird actually saying to him "get up and walk!" 

But he did. A little wobbly at first, but gaining confidence with each stride. 

SUCCESS EXISTS!!! And it tastes good! 

:) 

A weekend away...

Hey everyone,

Sorry I didn't post anything last week, but things were just a bit crazy, I wasn't sleeping well and just felt exhausted and overwhelmed. 

A few weeks ago, I had met two people, James and Casilda, who work in a refugee camp in the south of Chad, for citizens from the Central African Republic (CAR) who have been deplaced by the war. They had invited me to come visit, and last weekend, I finally did. 

You might be thinking that going to a UNHCR refugee camp is probably not the best way to decompress, but it was actually great. 

There's no electricity there, only the big NGOs and a few restaurants have generators, so there's very little light pollution. The sky at night is incredible... 

The children are not afraid of white people (they probably weren't told that we come to take them and drink their blood) so they all smile and come shake hands. 

The food at the market is pretty darn good, and the meat is from a cow/sheep/goat who roamed the fields freely, was alive that morning and was immediately put on the fire after slaughter, so it's as healthy as it gets... 

I went for long walks by the river to watch the sunset--

I met handicapped refugees who got parts so they could fix their tricycles (no wheelchairs here)- 

That's Paulin, his legs are completely atrophied, but he gets around great on his tricycle, even going about 40km to the nearest city and back!

That's a beautiful African mama, also handicapped, holding her adorable baby...

James taking a fixed tricycle for a test drive...

It was an intense weekend, but very relaxing. I met people from several NGOs, people whose job is actually improving the lives of the refugees. I got into great discussions about how to organize health campaigns and teach the people what they should do if a child gets sick (**immediately bring them to the hospital and not wait 3 days until they're almost dead**). 

I also watched a Muslim funeral, for the father of one of the refugees who is a friend of James. He probably had a massive stroke, from what I gathered about how it happened.

Then we were invited for a genuine feast by another refugee, a man who was an architect, had worked and traveled to several African countries, had 2 houses and his own business in Bangui (capital of CAR) but was persecuted and almost killed for speaking against the government. Today he's a refugee living in a camp, with almost nothing. He still honored us with a 3-course meal of salad  fried plantanes, fried potatos, lamb in a delicious sauce, and watermelon for desert. 

That's Rodrigue on the right, with his sister-in-law, another refugee and James.

That's me holding Rodrigue's adorable baby...! 

All in all, it was a great weekend. Of course, coming back to the hospital, I had a horrible pain in my stomach, wondering what awful things had happened in my absence. Luckily, everything was ok, everyone was still alive, and **all** of the patients were happy to see me, wanted to shake my hand, said they missed me and were happy to see me back. 

It's hard to be here, but it's also good to be back where I know I can make a difference. It's good to know I'm appreciated and missed. And I like the fact that everybody knows my name and smiles big when they see me... it's kinda like being home...

The thing about Malaria...

A couple of days ago, when I went in the evening to do the dressing changes of the two patients who are on twice a day dressings (one who is improving, one who is not), I saw two little babies in our "ICU" brought in with Malaria. 

Again, one had a hemoglobin of 2g/dl and the other 5g/dl (at that age, normal values are 11g/dl - 14g/dl).

The malaria parasites (mostly P. Falciparum in these parts) invade and destroy erythrocytes (red blood cells) causing anemia. 

The hemoglobin in the red blood cells is what carries oxygen in our blood. Without it, you can have all the oxygen in the world available, you're still going to slowly suffocate because there's not enough hemoglobin in your blood to carry oxygen to your cells. 

Hence why we immediately check hb levels and give blood transfusions, along with drugs to kill the parasites in the blood, and the hypnozoites which are maturing in the liver cells waiting to be released into the blood stream. 

Malaria, if diagnosed and treated early enough, is curable and you should feel well again in about 3 days. 

Here, these kids come in when they're already so sick, they're barely alive. The percentage of parasites in their blood is so high, it takes a while for the drugs to help. The transfusions improve oxygen transport, but don't fix the underlining cause. 

The drugs and the parasites damage the liver, and once they get jaundiced (sign of liver failure), there's little we can do. We have to stop the drugs, and then the parasites in the blood can once again roam free, worsening the anemia until the child is dead. 

That's what happened to one of the babies who came in Wednesday night. He was still alive last night, and I actually thought he was going to make it (when they come in that sick, they usually die in the first 24hrs)... but he was no longer there this morning. 

I broke my rule and asked what happened, and the night nurse said he got jaundiced, they stopped the quinine and the family took him home to die. 

In comparison, this is Chrystelle: 

She's the little girl I mentioned in this blog post: http://livinglifewithoutfear.blogspot.com/2014/08/the-day-i-did-everything-i-shouldn.html?m=1

For a few days after that, she would hide from me, because she knew I was the cause of her getting pocked full of holes so we could finally get her meds, fluids and blood. But it doesn't matter. She's back to her smiling, adorable self, went home with her mama, and even accepted a kiss on the cheek from me. Her parents always have a big smile on their faces when they see me. 

I might not be able to control the infection that is rampant in some of my fracture patients. 

I might not be able to save all the little babies that come in already half dead and unconscious from advanced malaria. 

But I will take heart in the story of Chrystelle. She might have been one of those who came in too late to be saved, if I hadn't stepped in. 

She'll probably not remember me after I leave. I, on the other hand, will never forget her... 

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.