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).