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! 

Pus

We had a couple of really long, full days. One of those days, Dr. Scott had to cancel consults because we had too many operations, a couple of which were urgent. As the name of this post suggests, there was a lot of pus involved.

We had one elderly man with an old femur fracture that had only a small hole on the skin. What was weird was that he was very skinny, and his other leg was very thin, but his broken leg had a huge thigh. Dr. Scott made an incision starting from the hole and as he widened it, pus just started pouring out. We suctioned about 2 LITERS of pus from this guy's thigh. As you can imagine, there was not much muscle or bone left, it was just mush. How in the world he wasn't septic and dead yet, I have no idea.

So we called the family and said there was no way to save the leg and asked if they were ok with an amputation. Well, the patient himself, who was semiconscious*, heard it and said he did NOT want an amputation. So we closed it back up and wheeled him out to get ready for the next patient.

But now the family talked to him, and explained that really, there was no leg to be saved, it would never be functional again, and on top of that, he was going to get septic and die. So he agreed to it, and we had to take him back to the OR.

Then, we had a guy come in with a huge dental abscess. His family almost took him home, but thank goodness, they didn't. The abscess was so big, once he was anesthetized, his muscles relaxed and it actually blocked his airway. He stopped breathing for a moment and I actually had to do CPR while they secured his airway with a nasal tube and administered O2.

Again, Dr. Scott made a small hole and pus just started pouring out. It's incredible!! I can't imagine how he could take days and days of pain before coming in!!!

So today I got to do 3 things I had never done before: made a skin incision and superficial suture on a leg (the amputated one), and did CPR on a real person (not the dummies we use in class).

What a day!!!

*our anesthesia is a combination of epidural, ketamine and diazepam. Sometimes the patients are knocked out, sometimes they're awake, talking, sometimes even moving. We have no respirator, so we cannot do full narcosis.

Before amputation

After amputation

Miracles

Most of our patients get post-op infections. It's a fact of life. In Tchad, if you get a paper cut and don't soak it in alcohol several times a day, it will get infected.

We have a patient who was in a house fire. Her buttocks, lower back and thighs suffered 3rd degree burns. She came to us 6 weeks after the fire, clearly in a lot of pain, but somehow not infected. Not septic. Not dying.

We did 2 small skin grafts on her, and they took beautifully. It covers only a tiny portion of her burns, but it's progress. Her back has some granulating tissue. Incredibly and against all odds, she is healing.

If that's not a miracle, I don't know what is.

Male Anatomy - part 2

Apparently there have been a few cases of flesh-eating bacteria, with very particular tastes. They don't eat everything, just skin. 

If you're a boy and/or a little squeamish, I suggest you stop reading now. Continue at your own peril. 

It so happens that this very unfortunate guy had flesh-eating bacteria eat away at the skin of his scrotum. Not his penis, not his legs, just his scrotum. He showed up with completely necrotic skin (1st photo). 

So Dr. Scott debrided it, put him on massive doses of antibiotics, and left the wound open, with his testicles free. Luckily for him, the bacteria were not interested in his testes. 

But now comes the question of what to do with his testes! There's no way to grow that much new skin, and the tiny amount of skin not eaten by the bacteria was not enough to cover the testes. So Dr. Scott went back in, separated the two, made a little pocket under the skin of each thigh and inserted them. 

This ensures their safety from the elements, but has a particular side-effect. You see, the reason why the testicles hang in a pouch outside the body, is because sperm need a cool environment. The 37C of normal body temperature is too hot for them. So this guy has not lost the ability to produce sperm, and all his hormones will still work properly. But his sperm will likely die of heat, from being confined inside his thigh. 

The lesson of the day is: when you scratch your balls, make sure your hand is clean and don't break the skin!!! 

Necrotic skin

After debriding

The next day

Separating and inserting into thigh

Male Anatomy -part 1

I actually wrote a post about this last time I was here, but for the new comers, I'll explain it again. 

When a baby boy is born, the testicles descend into the scrotum and the little orifice which allowed them to pass down from the abdomen closes naturally. Most of the time. 

However, sometimes the hole remains open and allows fluid to trickle down and accumulate in the scrotum. This is called a Hydrocele, for those of you who want to read up. In the western world, mom realizes something weird is going on and takes the baby to the doctor. The liquid is drained, the hole is closed, and the problem is over. 

In Tchad, they don't come in until they can't walk anymore, and that usually takes years. So we get a lot of grown, sometimes elderly men, with giant scrotums full of fluid. In other words, giant balls. 

We drain it, sew it up and they can go home. With normal sized parts...

Children

(Surgical pictures at the end of the post, scroll slowly if you don't want to see them.) 

It's a recurring theme in Tchad that nobody seeks medical attention until they're about to die, or whatever ails them becomes unbearable. And since they are extremely resilient, sometimes that means years.

Today we had 3 surgeries, the first of which was a 4 year old with an exposed femur fracture for 1 year. The exposed bone was dead, of course, but surprisingly, he had no infection.

So Dr. Scott cut off the dead bone and put the 2 ends together, put them on an external fixator and closed. The hope is that the bone will actually grow enough to compensate for the loss and he will have legs of equal length. In any case, he will definitely get to walk. Again, something that isn't possible with an exposed femur fracture...

Then another little kid, from yet another motorcycle accident. That one was 10 days ago, but the arm had gotten stuck on something and almost completely ripped from the torso. Almost, but not completely. Except the nerves, ligaments and blood supply was part of what got ripped... and the result is a child attached to a completely dead, cold, putrefying arm. I'll let you imagine the smell. So it was an amputation, leaving the wound open because of the infection.

The third was a woman with a large, hard mass on her thigh. It looked like a giant mole. It was deep into her sub-cutaneous fat, but had not reached her muscles. Besides a little bleeding, it was removed without complications. Of course, we have no way of knowing if it spread somewhere else, and that thing was massive. 7cm by 5cm at least.

Anyway, I had been craving surgeries, and it felt great to scrub in again, but that little kid who lost his arm made me really sad.

Things that happen in Tchad that you have to get used to but probably never will...

Living arrangements

A lot of people have asked me how the living conditions in Tchad are, so I thought I'd make a post with some pictures to give you guys a better idea.

The first time I came to Tchad, I didn't know what to expect when it came to my living arrangements. The hospital and the living quarters are located in the same walled complex, and separated from each other by a brick wall. The house is pretty modern, with everything you would expect in a normal house, normal bathroom with shower (cold water but you don't really need it to be hot) and flushing toilet. The only exception is wifi which doesn't exist. Electricity is provided by a generator and internet from mobile phones. I got a little bedroom with a lockable door, a nice bed with mosquito net and a dresser. I was beyond happy, as I had expected a lot worse.

This year, when Bekki wrote me to say they were excited for me to arrive and my room was ready, I had expected the same room. What isn't my surprise when Bekki takes me to my own little apartment!! When I was here last, it had been a shipping container used for storage. They converted it into a full apartment, with full kitchen and bathroom! And it was just for me!!

Here are some pictures:

That's the door on the wall that separates the hospital from the residencial area

That's the outside of the house I live in

My very own kitchen!! 

Bedroom

Bathroom

Garden at sunset 

So there you have it. I really had not expected to have all the comforts we expect in other countries. Coming to Tchad is hard in many ways, but the living conditions are not one of them. Of course, this is not how the general population lives... but I'll have to write another post about that. :) 

Tchad- round two

I am sitting on a bus, crossing Tchad from the capital, N'Djamena, to Moundou in the south. I'm really excited, and can't wait to get there and see Dr. Scott and Bekki (his wife) again.

The first time I was here, it was the unknown. Arriving in the middle of the ebola epidemic, there was fear it would come to Tchad (it didn't). And like this time, I was arriving at 11pm in N'Djamena and leaving at 6am on a bus to Moundou. It was certainly an adventure and I won't deny, there was a little bit of fear mixed in with excitement. I knew that trip would change me. I was afraid I wasn't up for the challenge.

I hadn't even started med school yet, and my only training was what I had learned in a nursing's assistant course and the basics of giving shots, drawing blood and putting in IVs, that I learned during my internships in hospitals in Germany.

Now, after a year of med school, my practical knowledge hasn't changed much, except for all the things I learned my first time in Tchad. This is such an incredible opportunity, I am very lucky and blessed to be able to do it. I hope to learn a lot more, maybe even suture and catch a baby or two! (The hospital where I will spend most of my time does not have maternity/gynecology, but I will spend 2 weeks at a different hospital, where they have it!)

It's funny how the unknown has become familiar, and I can feel like I am going back home, in the heart of Africa.

I'll leave you with a picture of the sunrise. It's bad quality, but it will give you a small idea of the beauty I am lucky enough to see. Enjoy!

Tchadian Flashback

I am back to Uruguay now. That's where I live, despite my 6 months of traveling last year. I had to find a new apartment, because obviously there was no way I was going to pay rent for 6 months without actually being here.

But I did. I found a great place and I'm super happy about it. Hopefully I'll be able to stay here until I can buy my own place.

Moving sometimes is complicated though, and this time had its ups and downs. Today was the first day I really felt like I lived here, and I went to the grocery store and bought all the things I needed to stock up the cupboards and the fridge. Then I thought I'd make myself a nice little dinner. And I remembered something...

Back in September, a friend of mine took me to a restaurant in Tchad, to eat chicken. That's all they had,  rotisserie chicken. Which you eat with your hands. And they give you a metal tray, like cafeteria tray, with a bit of bread, a bit of salad, and some spices. You're supposed to dip the chicken on the spices and eat it.

I had one bite, and I was hooked. It was fantastic!! Not the chicken, the spices! Well, both. I had to know what that was. I asked, but the guy who knew what it was wasn't there, so I came back a few days later and asked him. He told me it was a mixture of several things that he made himself.... I was a bit disappointed, I had hoped it was something I could just buy and take home. He said: "Wait here. I'll be back!"

I waited for maybe 15 minutes, until he came back with a ton of little packages full of different spices. He dropped them all on a table, then started picking up one by one,  smelling it, and telling me what it was, while I wrote it down.

Then he opened them and mixed a bit of this, a bit of that, all in front of me, showing me how to do it. And if all of that wasn't enough, at the end, he put the entire mixture into a little plastic bag and handed it to me.

 Incredible!!! And so nice! And delicious!

So today, when I thought about cooking, I remembered those spices, brought all the way from Tchad. And my food tasted like a little bit of Tchad.


I miss it.... 

News from Tchad!

I may be physically far away, but my mind is never too far. I have not forgotten my patients. Or Tchad. And as weird as that might seem, I miss it... 

So every once in a while, I ask for news... 

And I am happy to report that Irene came back for her check-up, her stump is all healed up and Dr. Scott sent her to the handicapped center to get a prosthesis. It'll probably be a peg leg (above knee amputations suck!) but it'll be enough to free her hands from the crutches, so she can carry her babies again. :) 

Gombo, one of the patients I was doing dressing changes twice a day and who kept producing pus and more pus, has also been discharged, healed, without infection. Hallelujah!! 

But the best news are about Blaise. He's the one I thought was going to lose his leg. The one I pumped full of antibiotics and also did dressing changes twice a day. When I left, he was off antibiotics and infection free, but still had 2 giant wounds which could get infected again any time. 

Well, he is doing great! He's still at the hospital, but the wounds are almost completely closed, and he has both legs and no infection. He will walk again. He will lead a normal life. A young, strong guy like him, would have been reduced to begging if he had lost his leg. Now he's got a chance at life. 

There are no words to describe how happy that makes me... :) it was not in vain. The fight payed off. 

That's Blaise, on my last day there... 

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).