Pandemic

It seems I've started a few posts with "I haven't written here in a while..."

Sorry. I have completely neglected this blog, and it's too bad. A lot has happened since, and I sort of doubt I'll ever update everything or anything.

I came here today for catharsis. Lately, I've done most of my catharsis through Twitter, but there's too many people who follow me over there now. It could be a source of hate and bullying, or I could be a source of panic, and that's not what I want. But I need to vent. I need to tell someone how I feel, and unfortunately, I literally have no one. Like a physical person around me that I can open up to.

So if you read thus far and you want to keep going, do it at your own risk. I don't even know what's coming, but I know how I'm feeling, and that's definitely going to spill onto the page. I'm terrified. So if you don't want to be terrified, stop reading now. You have been warned.


Here we go:
I feel like we're living through world war 3. Except in some ways, it's worse. We have no way of stopping this. It will take its course, and it will be a while. We've just been hit with our first cases of Corona virus, or SARS-Covid-19, and I can already tell it's going to be catastrophic. And it's not going to be a few weeks or a few months. We'll be lucky if this thing gets contained in a couple of years. And the economy? we're fucked. And mind you, I am not at all worried about myself. I have a secure form of emergency income in the form of my mom's pension, and she will not let me starve. And I have my own house and my garden, which, even if not enough to sustain me, does produce some things. I'll have a roof over my head and some food to eat. And my mom will be fine too, at least if she listens to me and stays at home (so she doesn't get infected).

But the rest of the world? The everyday people who need their jobs? who have to pay rent? buy food and medicine for themselves and their children?

I'm not sure. I think the biggest devastation of this virus is not going to be people dying as a direct result of the disease. Sure, that will be a high number, and I'm terrified of that too. But what about the aftermath? all the businesses that will go under? all the people who will (or have already) been laid off because the company can't keep them? because they can't work remotely?

I can't stop thinking about all the awful, awful things that will happen in the wake of this pandemic. My heart is breaking. I don't want to talk talk, because I don't want to scare anyone.

Also, I AM PISSED OFF. Because, you know what? I had plans. I have things that I wanted to do. I had friends coming to visit. And damn it, I want to go to the hospital (ironic, isn't it?) and do my clinical rotations and graduate sometime this century. But I may lose an entire year. Classes have been canceled. So yeah, I am also human and I also want my little world not to fall apart, even if in the grand scheme of things, I know that I am privileged and will be one of the least affected.

Also, I'm bored. I've been quarantined for a few days, and even though I don't exactly mind that, it would be nice to have someone around. I'm lonely. I HATE the fact that I feel lonely and I wish I had someone here with me. And on that note... mistakes were made (as I write this thing, actually). A boy wrote me, and I should not have answered. But I did. I guess we'll see. Quarantine text message romance? or heartbreak? Only time will tell.

Anyway. I hope I'm wrong and this will not last that long, and we will get out of it soon. And the entire world economy won't go belly up. And millions of people will not die of disease or hunger. But I guess that's stupid of me to say: millions already do die of disease and hunger.

I gotta stop. At every turn, this gets more depressing. Sorry. I'm gonna shut up now, and not actually share this post anywhere, so if you made it here, thanks. And again, sorry for the depressing post. I had to pour my heart out somewhere. 

Merry Christmas!!

I haven’t written here in forever. This year was one of the hardest years of my life, and I had too much going on trying to keep my head above water, to think about writing. 

But now that the year is almost over, I figured I should write something. Because I survived. Not only that, I’m actually OK. 

This year started with me buying a house-in-ruins, that I planned to finish demolishing and rebuilding it as my house. While I rebuilt it, I moved in with a friend who kindly offered to host me (for free!) while I made my house habitable. 

In med school, I started rotating through OB/GYN. If you remember my traumatic experience in Chad from last year, you can imagine this was not easy. It brought back memories. There were times I had to distract myself, or literally leave the room, in order to not start crying. 

Med school is a full time job. Building a house, is also a full time job. And I was also working as an English teacher, a few hours a week. I was physically and emotionally exhausted. 

Then I moved, while the house was still a construction zone. And started rotating through pediatrics, at a hospital 1.5hrs away. Then I ran out of money for the house. So now I was getting no sleep (because I had to get up at 5am) and I was very stressed and regretted buying the house. 

Pediatrics was, in a way, worse than ob/gyn. I had PTSD from my time in Chad about ob/gyn. But I want to have children, and seeing and interacting with these precious kiddos day in and day out, and seeing many of them being mistreated or simply needing so much more (anything, love, food, education, care) than they were getting, just about broke me. I kept thinking I could do better. And maybe I couldn’t. But my brain and my uterus kept yelling at me that I could do better and give me those kids and let me take care of them, damn it! 

I was about to break. And then, my 7-month pregnant cousin died of an aneurysm, the baby survived but had to be in the NICU for a few weeks, the family lived far away, and it fell to me, to go see her (the baby) and give her all the love and affection I could, until she could go home. Far away. Far away from me. 

So I did. I took care of this tiny little human, and loved her, and gave her my heart, and then... her dad came and took her (rightfully) away. And I broke. 

I was still rotating through peds. It was almost exams time and I could barely force myself to get out of bed and keep moving. 

But somehow I did. 

I kept going, managed to get honors in peds (I have no idea how!!) and get the house almost finished (with a LOT of financial help from my wonderful mom, who paid for my kitchen, among other things). 

And now, it’s Christmas. I am currently sitting at an airport bar, waiting for a flight to Mexico, a place I’ve already been, so I can turn off my brain and do nothing, but lie on the sand, bake in the sun, drink margaritas and eat tacos. 

Moral of the (very long) story: we are stronger than we think. If you’re going through a rough patch, know it, in your heart and soul, that it will be ok. YOU will be ok. I promise. 

Merry Christmas. 

Neonatal resus, or how not to kill a baby

I haven't written here in quite a while. The 3rd year of med school was really hard, and after my last time in Chad, I was not in a good place emotionally, which made it all even more difficult. At the end of the year, we have an exam that is the equivalent of Step 1 in the US, which allows us to pass on to clinical rotations during 4th year. Here med school is 6 years, 3 basic sciences and 3 of rotations.

It was hard, but I passed, bought a house (no joke!) and went on vacation for 5 weeks through Central America (Mexico, Belize, Costa Rica and Panama) which did wonders for my mental health. I came back rested and feeling better than I had in a while. Ready to start rotations.

However, as luck would have it, my 1st rotation was OB/GYN. And I started to have flashbacks from Chad. From hemorrhaging mothers and ruptured uteruses, and dead babies. More than once, I had to force myself to think of something else, look out the window and distract myself, so as to not start crying. Nobody here, the residents, attendings, fellow students, know that I've been to Chad and have seen more tragic outcomes in 6 weeks than they will see in their entire careers. As an inexperienced med student with no way to process any of it, and in a setting so poor in resources, than even if I had known what to do, I wouldn't have had the materials necessary to do it.

But let's skip over my 4 months in OB/GYN and jump forward to today. I have now started a 3-week rotation in Neonatology, before moving onto Pediatrics. And today we had a class and sim-lab for neonatal resus. I held it together by forcing myself to concentrate and actually learn everything I could, practicing manual ventilation and intubation, and learning all PEEP and PIP parameters.

At the end of the class, I walked out quickly, trying to hold back the tears. I couldn't stop thinking of one baby in particular, in Chad, who was born alive but died while I auscultated his diminishing heartbeats. That moment will be etched in my memory forever. The feeling. The shock. The numbness that followed. The only ambu bag we had was pediatric, which the nurse was trying to use but I don't think our efforts at ventilating were at all successful. The OB/GYN was busy trying to save the mother's life. I had no idea what to do, and there was no one else. I *know* that there was nothing else I could have done. But right now, I feel like I killed that baby. I feel like I should've been better prepared. And I'm fairly certain that, had that baby been born in a hospital with a NICU, or at least a neonatologist and better equipment, that baby would not have died.

THE UNFAIRNESS OF THIS WORLD MAKES ME INCREDIBLY ANGRY AND SAD.
(Sorry for yelling, but I can't help it.)

The world in 2018 is a disaster, and instead of improving, everything is going to hell. Instead of having a better division of resources, we're polarizing more and more. The rich are getting richer, and the poor are struggling to stay alive. The feeling of impotence and the anger at the world, at the leaders, at the greed of the richest and the apathy of...pretty much everyone (myself included) is getting to me. We need to do better. *I* need to do better. 

Puzzle pieces

I've been back home for over a month. The first few days I had moments of crying hysterically for no reason, but then it stopped. As usual, I pushed it all down. Classes were starting, and 3rd year of medical school is no joke. 

So every once in a while, I find myself staring into nothing, feeling numb, wondering why. Then I remember. Chad. Dead babies. Hysterectomies. Faint heartbeats getting slower, then stopping, while I listened, knowing there was nothing I could do. 

These memories haunt me. I'm not thinking about them all the time, but one word, one picture of a healthy baby, and it all comes rushing back.

I'm not planning on going back to Chad, at least for a long while. And if I do, I'll try and steer clear of Ob/gyn. I can't handle it. It's too much for me. And like the advice on airplanes say, you have to put on your own oxygen mask before you can help others. I'm no good for anybody if I'm broken. 

So now I'm slowly putting myself back together. 

Maternal/fetal mortality and the wonders of modern medicine

I got called in at 2:56am for another c-section for a dead baby with a ruptured uterus which ended up needing a hysterectomy. I have lost count of how many of those I've assisted on in the 6 weeks I've been here. I bet most OB-GYNs in the developed world have never even seen one. (Feel free to correct me if I'm wrong).

I read somewhere recently that late fetal/newborn death rates were around 40% in the 1800s, and only with the advent of modern medicine, pre-natal care, ultrasound, etc., has it decreased as much as it did (to something like 4% globally-- I can't find the article now). According to Unicef data: "The lifetime risk of maternal death in high-income countries is 1 in 3,300, compared to 1 in 41 in low-income." http://data.unicef.org/topic/maternal-health/maternal-mortality/

Well, you might remember from an earlier post, that I said Chad was stuck in a way of life from 2000 years ago. And that means, maternal/fetal/newborn death is still ridiculously high. Unacceptably high.

Call me a wimp, call me a weakling, call me whatever you want, but it's been really hard for me, dealing with it all. Last week I only went to the OR one day, and dedicated myself to teaching at the nursing school. This is my last week, and honestly, I'm glad it is. 

Since I have been trying to push it all down and not think about it, I guess my brain decided to make me deal with it at night, in my dreams. So I've been having terrible dreams, waking up crying, and sleeping badly. Consequently, I'm tired all the time.

I'm glad and always in awe of people  like Dr. Danae, Dr. Olen (her husband), Dr. Bland (her dad), but I don't have what it takes to be a full-time doctor in a place like Chad. I'd last a month, maybe two, run away screaming and move to an island in the middle of the pacific, preferably populated by only nuns and cats (therefore no ruptured uteruses, dead babies, ectopic pregnancies, etc., etc., etc.).

So for those of you who might be wondering if I intend to be a full-time doctor in Africa someday, the answer is no. I couldn't handle it. I'm not strong enough. And that's ok. 

(That's a ruptured uterus, so badly ruptured that it was impossible to save. I think this is the one we gave 5 bags of blood cuz she just kept bleeding)

An Ode to Nurses

An ode to nurses

For the past 2 weeks, I've been giving Anatomy and Physiology classes for the nursing school attached to the hospital. It's just 2hrs a day, before I go to the OR. 

I love it. It has helped take my mind off things for a little while, and preparing the classes has been a great way to review stuff. 

But today, at the end of class, I stopped everything, turned off the powerpoint, and told them to pay very close attention because I was going to tell them the most important thing they need to learn about nursing: 

The doctors see a patient at rounds, for maybe 5 minutes a day. The doctor is the detective, that discovers what is wrong, and decides the treatment. But the nurses are the ones who actually treat the patients. The nurses are the ones who realize if something is wrong, and the patient is getting worse. Or if the treatment is working or not. 

If something goes wrong, the nurse is the first one to notice, and it is their responsibility to tell the doctor. The doctor can't guess or devine what is going on. The nurse is the eyes, the ears and the hands of the doctor. 

Nurses: don't underestimate the importance of your work. The doctors could never treat patients without you. 

Doctors: never forget that. Treat your nurses well, because the quality of patient care depends on your interactions with them.

Sadness

I'm not sure what to write. I think I'm a bit numb, pushing it all down, so I don't start crying every day. So many dead babies, ruptured uteruses, hysterectomies. Here, the value of a woman is measured in pregnancies. Some will agree to anticonceptives, because they know it's just for a while. Few want to tie their tubes, and that only if they've already had... 7-8 kids. We had an uterine rupture back to back with an ectopic, both women in their 13th pregnancy. One had 7 alive, the other 4. Can you imagine being pregnant 13 times and have only 4 living children? I don't know if they were all to term, some might have been miscarriages. But truth is, a lot of them die in their first week, or before they turn 5. The prevailing culture is that it's good to give water to newborn babies. We hammer into their heads that they cannot, under any circumstance, give them water before 6 months, but it happens. And the babies who are born at home (by far the overwhelming majority) don't have us hammering into their mom's heads not to give them water. 

There is no water/sewage system here. You walk around and see people defecating on the ground. Waterborne diseases are rampant, and we treat ALL our pediatric cases for parasites, regardless of presentation. Imagine what that does to a newborn baby, who should be safe and protected from any food/water borne disease by drinking only breastmilk. But isn't.

Yesterday I was out of commission myself, having eaten something someone kindly made for us, but gave me diarrhea. Today I was better, so I walk into the OR to see Dr. Danae in the middle of a hysterectomy. Ruptured uterus. The patient went to a village health center 40km away on Tuesday evening for prolonged labor and they referred her here. Who knows how long she had been in labor up to that point. Today is Thursday, and that's when they brought her here. The baby was dead, she was hemorrhaging, and a little longer, she would have died too. The baby was long dead, skin peeling off, flacid, like jelly. 4.2kg worth of a baby boy, who would have been big and strong, if only... so many things. 

She asked to see the baby. I wrapped him carefully, trying to cover the worst parts and took him near her face. A tear ran down from the corner of her eye. I almost lost it. 

Being in Chad is always hard. There are always cases that get to you. But the previous two times, I was working at a hospital with no OB-GYN. No ruptured uteruses, no ectopic pregnancies of 10wks with bellies full of blood, no hysterectomies, no dead babies. I've lost count how many we've had, and Saturday will be only 3 weeks since I got here.

There are good cases too, of course. To finish on a ligther note, I'll leave you with a picture of darling twin girls, born by C-section (mom had pre-eclampsia). My first (and so far only) set of twins. 

Being a doctor (or med student)

Being a doctor (or in my case, a med student) is a privilege and a responsibility beyond what I can actually fathom. I think if I stopped to think about it too much, it would overwhelm me. 

We are allowed access to people's bodies in a way nobody else, ever, is. We stick tubes down body orifices (urinary catheters, nasogastric tubes, ventilators). We insert our fingers and hands in those orifices and others that we make, by cutting them with a scalpel. We stick needles in their arms, back, groin, neck, feet, scalp. 

All of those "assaults" are allowed, because we want to make them better. Cure whatever is ailing them. Help them breathe. Help them eat. Deliver their babies. Fix that strangulated hernia. Remove that ovarian cyst. 

But what happens when medicine is not enough? When there's nothing we can do to help? 

We're there still. We hold a tiny hand wrapped around our fingers, and listen to a newborn's heartbeat slowing down, until it stops. You check your stethoscope. You reposition. You try to stimulate the baby, but you know he's gone. That tiny little life breathed only a few minutes, then stopped. And you were there. 

It is a privilege and an awesome responsibility to be a doctor (or med student). 

Babies

The maternity ward here is full to overflowing. There's people sleeping on the floor (they don't mind, sometimes they even prefer it, because that's what they're used to at home. Nobody has beds at home.)

Yesterday I finally had dinner at 9pm, only managed to sneak a couple of bites of chocolate around 4:30pm to avoid a hypoglycemic episode. We were in the OR until 8:30pm, which included a ruptured uterus where the sac was out of the uterus but intact, the placenta was in the uterus, but the baby was dead. We had to do a hysterectomy, the uterus was unsalvageable. 

Then an ectopic pregnancy with removal of fallopian tube. 

Then lots of other things (prostatectomy, giant lipoma, etc., and finished the day with a pre-eclampsia lady with twins at 33wks 4days. My first set of twinsies!! So adorable!! Mom and baby girls doing great this morning! 

But today I'm feeling like Izzie on Grey's Anatomy, when Addison has her taking care of a baby everyone knows is going to die. I'm monitoring this 1wk-old baby who probably has pneumonia, gasping for air and having very low sats even on O2. She's on antibiotics and I'm just sitting here making sure the nasal canulla doesn't fall out. The pulse ox we have is too big for little baby fingers, so it's impossible to keep it on. There's nothing else I can do, except watch her. She'll either get better or die. I can only hope and pray her little body is strong enough to fight whatever infection is ailing her. 

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! :) 

The thing about Tchad

Being here is a crazy mixture of awesome and heartbreaking sadness. I was talking to Dr. Danae today, about the fact that I don't plan on coming to work in Africa full time once I graduate, because I don't think I could take it. I would eventually just want to crawl into bed and cry myself into oblivion.

Take today for example: we started with a woman who got to the hospital at 5:30am after many many hours in labor at home. Baby no longer had a heartbeat. Uterine rupture, and so badly ripped that she needed a hysterectomy. She had had 5 kids (including the baby this morning), but only 2 were still alive. After the surgery, we asked if she wanted to see the baby, and watching her hold it just broke my heart. I can't imagine going through that. 

The very next case was a 27yo with advanced breast cancer. We did a mastectomy, but only to give her more time, as it has already spread to her lymph nodes and there's really nothing more we can do. (Pictures at the end, scroll carefully if you don't want to see it).

Then an elderly man came to say his wife, who also had had a mastectomy for advanced breast cancer was having trouble breathing and was complaining of pain. Nothing we can do, except give her some pain meds. 

Then a woman with a urovaginal fistula, who had it for 10 years. Imagine leaking urine 24hrs a day for 10 years. Imagine it for just 1 day. 1 hour even! Not being able to sit down without leaving a puddle. Walking and having urine run down your legs. Your clothes, constantly soaked. The smell of urine like your shadow, always there. 

That was an incredible surgery. It took 4hrs. It was hard and physically challenging, but also very rewarding. Barring any complications, this woman will soon be able to hold urine in her bladder, and void it only when she wants to. I'm really excited for her! 

You see what I mean? It started with a couple of really sad cases, but ended on a happy note. Plus, I get to be in the OR all day, every day. The OR is definitely my happy place. I get to do stuff, like stick giant needles into people's backs (spinal anesthesia), or suture the skin at the end of a case (I'm already getting faster! Closed a hernia in 5 minutes today!!) 

So yes, I love coming to Tchad. The experiences I have here are invaluable, for my training as a doctor as well as for my growth as a person. I intend to come back every year, whenever I have a chance, but I don't see myself staying here long term. 

But then again, God might have other plans... 

My first day at the Bere hospital in Chad!

My first day in Bere

Chad is always very labor intensive. During my two previous times, there was usually little free time, and that suited me just fine. But we rarely had middle-of-the-night emergencies, if someone came in at night and wasn't bleeding profusely, the nurses dealt with it until morning and didn't call Dr. Scott (or me, of course). 

Now I'm at a different hospital which does *a lot* of Obstetrics. I arrived in Chad at 4:30am Saturday, got on a bus at 5:30am to go 7hrs south to Kelo, where Zach was waiting to pick me up for another 1h30min on a dirt road. I got to Bere at 2pm Saturday (which is our day off). 

At 2am I get a call from Danae, there are 2 complicated labors which will possibly turn into C-sections. I got up and ran, obviously! These would be my first time seeing a birth, ever! 

The first one isn't coming out, but the mom was still trying. Finally, with forceps, the baby came out and did great! So did the mom (although she had a grade 3 vaginal laceration -- if you don't know what that means, don't ask. Just know that it hurts). 

The second just needed more time, really. By the time the first one had delivered, the second was progressing nicely. No forceps or C-section needed!! 

Then back to bed at 5am. Up again at 8am, shower (cold water is great to wake up in the morning!) coffee and rounds. Which took forever. Which also included two other deliveries, one mom with a prolapsed cord (baby didn't make it😰) and one with her 6th baby, at a whopping 4,9kg! I got to cut the cord! 

Then to the OR for a C-section. She also had had several babies and the last one was a C-section. Dr. Danae (the superwoman OB-GYN) was afraid of a uterine rupture, the baby was big and she had not progressed all morning. So it was just the two of us-- I assisted on my very first C-section! And got to close the skin at the end!

We finished by 2pm, and in 12hrs I had watched the birth of 5 babies!!!! Talk about intense! 

But it wasn't over: a guy came in who had gotten on a fight against a machette and had deep lacerations on his arm and thigh, plus broken arm. Had been two days though, and he had lunch before coming, so we cleaned and packed his wounds, and will take him to the OR tomorrow. 

I also watched one woman get a birth control implanted, and immediately after implanted one myself! 

Only the. Did I go home to shower (again!), change and eat. At 5pm. 

So all in all, this was an incredibly eventful and awesome day. 

6 more weeks to go! 😊

P.S.: as fun as this day was, I am *not* going into OB and I'm also more convinced than ever that if I have a baby, it will be by scheduled C-section. My vjay-jay is *not* going through that. 😳😳😳

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.