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. 

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).

Infection

You know all the advances made in medicine when we discovered sterilization and the concept of keeping things not only clean, but actually sterile? Well, that phase in human history skipped Chad entirely. 

We do our best to sterilize instruments, but there are flies *inside* the OR. They're not quite as cooperative as interns when you yell at them to keep their hands off the sterile field. 

Yesterday, a lady who had a tib-fib fracture was getting septic, so the only thing to do was to cut her leg off. The infection had spread far above the fracture site, so it was an above-knee amputation. 

Another discovery that skipped Chad entirely was the concept of full-narcosis. We don't have a ventilator (or the appropriate drugs) so the amputation (and all other surgeries) are done under ketamine, but the patients are awake and moving around. Talking. Watching. 

The lady with the amputated leg had an abcess going even further up from the amputation site, so today we had to unwrap her, poke around and wash it out. Our only desinfectant is a preparation of water and 25% bleach. 

The only pain killer is Tylenol. 

Take a few moments to digest that last phrase... 

I did the dressing change on her today. We have sterile gauze, but the patients actually have to go buy it at the pharmacy, because we don't have enough funding to give them all the gauze they need. So as a family member went to buy more gauze, I was standing by the bed to keep the flies off her wound and trying not to look at her face. 

I washed it as best I could, with an audience, as all the other patients (there are 16 beds per ward, we have 2 wards) watched. Tomorrow, I will do the same thing, and pray that the infection can be kept under control so that we can eventually close her wound and she won't die of sepsis. 

I took a picture, so you can have a better idea of what I'm talking about, but you might not want to look if you have a weak stomach... 

...and just in case you were wondering, no, that basin is not sterile, neither were my gloves or the instruments I used (we keep those strictly for surgeries).

If you got this far and you're horrified, welcome to the club. Unfortunately, this is the best we can do. The hospital runs entirely on donations, and we have barely any equipment at all. Stuff that the hospitals in the US and Europe throw away, we would be over the moon to get. A surgery runs somewhere between $30-$50 dollars. If anybody feels inclined to help, ANYTHING helps. $5 dollars would buy enough sterile gauze for one patient for a week. Might not seem much, but that could be the difference between life and daeth from sepsis... and some patients literally cannot even afford that... 

Alright, I'll stop talking, but please, please, please: HELP! 

Here's a link where you can donate: http://www.ahiglobal.org/main/donate-now/

(Just make sure you specify that your donation it is for the Surgical Center of Moundou, Chad). 

Thank you. 

Traveling across Chad

After my arrival and first night in N'Djamena, I woke up at 5:30am and was out of the house by 6am, to get on the bus that would take me to Moundou and the "Centre Chirurgicale."

The bus ride takes 8hrs, and I admit, I slept through most of it. However, I did wake up enough times to have a glimpse of the countryside. It's monsoon season, so everything is of a bright green, luscious color. The dirt is very red. The sky is very blue. It might seem like a stupid description, but it is very beautiful and hard to describe. No billboards or ads anywhere, just dirt, vegetation, and every once in a while, little huts and villages. Just tiny little huts made of mud-bricks and thatched roofs. I will try to sneak some pictures, but foreigners are not allowed to take pictures in public without a permit from the government... 

I did snap one surreptitious picture out the window at one of the stops... ;) 

Anyway, I arrived at the clinic, took a quick (cold) shower, and jumped straight in. When I got to the wards, Dr. Scott was still busy with surgery, so I joined Bekki (Dr. Scott's wife) and Will (a physiotherapist who is also volunteering for 3 weeks) and did their rounds of physical therapy with the patients. Will doesn't speak French, so I started translating for him and thus interacting with the patients and getting to know more about their situation. Most are here for broken bones due to motorcycle accidents. Some have had open fractures FOR MONTHS before they get here, and at that point, infection has spread to the bone and it's very difficult to do anything... The pain threshhold of these people is incredible!! This one patient, we were trying to mobilize his knee, and I asked if it hurt. He said "yes" in a very calm, steady voice. So we continued to move his leg, focusing on the knee. Not a peep from him. Then I looked at his face, and he was literally rolling his eyes and sweating from the pain. They won't say a thing. They don't cry out and yell at you to stop. They trust that you, "the nasara doctor"* knows better... 

*Of course, I'm not a doctor (yet!), neither is Will or Bekki, but to them, it makes no difference. They trust us just the same... 

(Nasara=white)

Strangest shopping trip ever...

Hi everybody,

I didn't post in the last few days, but if you're following me on twitter, you know that I've been enjoying a wonderful few days in Paris. What a contrast it will be when I get to Chad!!

Yesterday I went to the Embassy of Chad to request a visa, and lo and behold, they were closed! It was their independence day. Not very cool, because they say it takes 3 days to get the visa. My flight is on Thursday at 4pm...

So I went back today, and they said no problem, it would be done Thursday morning. I'm gonna trust them and hope for the best...

After the embassy, with the assurance of the visa, I went on the weirdest shopping trip ever. I had searched online to find a store that sold medical supplies. It's in the outskirts of Paris, "la banlieu" if you know the region. I got there and started grabbing boxes of latex gloves, bottles of hand-sanitizer, seringes, needles, gauze packages, surgical masks, alcohol wipes, desinfectant wipes, and of course, mosquito repellent.

This is the kind of stuff most people never ever get to buy. Even those of us in the medical professions, we (or at least I) just take it for granted, you show up at the hospital, there are gloves, alcohol, needles. Buying this stuff somehow brought it home to me: I'm going to Africa. In 2 days. A place where the simplest medical supplies are scarce at best, and they make do with what they've got.

I think it hasn't quite sinked in yet... but today it's started to...

And the adventure begins...

This is it folks, I'm at the airport, waiting to board my flight to Paris. I think it's actually an African proverb that says "When you travel far, give your soul time to arrive."

It's funny, but my soul is already in Paris. Usually, that proverb is correct and it takes me about a day (sometimes more) to realize I'm actually there. This time, I think my soul never left Berlin, so it just floated over to Paris and is sitting in a café sur les Champs Elysées, having an espresso and a croissant, waiting for my body to catch up. :)

I already have a little list of the things I want to do when I get to Paris. I have the entire weekend free, and only have to go to the Embassy of Chad on Monday morning. Then it's wait for the visa, and fly to N'djamena on Thursday. This means that in exactly one week, I will be in Chad.

I'm excited!!!

I travel a lot, and have been to places with strong cultures, completely different than my own. I've been to Thailand, and India, and Nepal, and Kyrgyzstan. They were all wonderful experiences, and I enjoyed and learned a lot from them. But this is different. First, this isn't tourism. I'm not going to travel around in Chad. I will be living there for 2 months. I will be treating people, and trying to help them. I will be living the way they do, without proper running water, electricity, or basic sanitation. And I think, for the first time ever, I will be in a place where there's an actual risk to my healh, well-being and life. Chad is surrounded by countries in violent civil wars (Cameroon, Libya, Sudan, Central African Republic). Chad itself is being flooded by refugees, mostly from Darfour. The chances of me contracting malaria and being very sick for at least a few days is very high (prophylaxis, DEET and mosquito-nets can only do so much... it's monsoon season).

However, all of those things don't worry me ver much. It's an adventure, of course, but I'm sure I will probably be ok, health-wise. What worries me is the emotional toll of seeing people dying left, right and center, and not being able to do very much to help them. I guess we'll see.....

But there's no turning back now! Africa in exactly ONE WEEK!!!!!   :) :) :)

Preparations...

If you know me at all, you know that I've moved around a lot. I have lived in 7 different countries, in 3 different continents, and we're not even talking about different cities in each country. I have to pack often. But I HATE DOING IT! It is the worst thing in the world for me...

Well, now I have less than 1 week to:
- Pack my entire house (not the furniture, luckily)
- Cancel all services, internet, phone, etc.
- Get all the necessary vaccines and medications to take to Chad
- Take all my things to a storage unit
- Meet with the owner of my apartment to inventory everything (it's their furniture) and give the keys
- Go to the bank with the owner to get my deposit back
- Spend a night in a hotel
- Fly to Paris

This might seem like not such a big deal... It might not seem like a lot. But it's very time consuming... specially the packing part. And the inventory. I would do it in 3 minutes, but the owner is very meticulous and when I got the apartment, it took 2 1/2hrs... this time it will probably take longer. So the part about the inventory and the bank will take all of Wednesday (banks here take forever). This means I have no more than 3 days to pack everything and take it to storage.

But today, when I went to get my vaccines (yellow fever, tetanus booster), the nurse asked where I was going, and when I said Chad, her first question was "hmmm... sorry, but where is that?" And when I showed her on the world map conveniently posted behind her desk, she asked me what I was going to do there. And I realized that very soon, I will get to poke people with sharp objects again. I will be involved in patient care again. I will be seeing blood and guts and everything in-between. It's been 6 months since I saw my last surgery, and you know what? I MISS IT!

So all the packing and drudgery involved in getting me to the Surgical Center of Moundou, Chad? -- it's worth it!!

And that makes all the difference in the world... :)

This is getting real!!!!

I mentioned in the previous post that 3 years ago I decided to bite the bullet and go for medicine. I haven't been just sitting around doing nothing in that time. I have actually worked in a hospital and learned everything I could learn, basically doing the work of a nurse, and asking to see surgeries, following doctors around during rounds, and reading everything I could get my hands on.

I will do a few blog posts in the future with some of the things I got to do while working at a hospital in Berlin, Germany.

But now I have big news:

I just got my letter of invitation and bought my plane tickets to go volunteer in a Surgical Clinic in Moundou, Chad. It's the middle of nowhere in Africa. According to the World Health Organization, Chad has the worst health system in the world. In 2006 they had 0.4 physicians for every 10,000 people. That's INSANE!

Take a look here for more details: http://www.who.int/gho/countries/tcd.pdf?ua=1

Anyway... I will be going in TWO WEEKS to spend 7 weeks there. I will be doing everything from providing basic sanitation talks to assisting in surgeries. No joke! (I guess all those years of living in France and speaking fluent French finally come in handy. :) )

The doctor I will be working with is Dr. Scott Gardner, a doctor born, raised and trained in the US. He has moved to Chad just 7 months ago, so he's relatively new at this post. The doctor who was there before him, was there for almost 10 years...

I am **very** excited.... but I would be lying if I said I wasn't also terrified. There's so much death, so much misery, so much suffering, and so little that we (or anyone) can do. The resources are non-existent. There's a very urgent need for everything, from basic meds like Ibuprofen all the way to chemotherapy drugs to treat Burkitt's Lymphoma at $100 dollars per gram!

If you read this and Dr. Gardner's blog, and your heart is touched and you would like to donate anything at all, money, time, resources, drugs, please let us know. You can contact Dr. Gardner directly through the blog posted above (the entry about Burkitt's Lymphoma).

And if you're the praying kind, please pray for them and all the work they're doing, and for me, as I embark in this incredible adventure. I'm not ready. But then again, I don't think you can be ready for this...