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)

Chad--first impressions

We landed. They opened the door. We got down the airplane steps to the ground, and started walking to the terminal: "Aéroport International Hassan D'Amour." However, before we reached the terminal, there's a queue forming, and 2 guys with masks and gloves, pointing something at everybody's heads. 

They were taking everyone's temperature, screening for Ebola. 

No, that is not a joke. 

Welcome to Africa. 

--//--

After that, immigration, bags, customs, and I go outside, where Abraham (a Tchadian man) and Kristin (a German girl) were waiting for me. 

I will be spending the night at Kristin's house, who I found through Couchsurfing. (If you don't know couchsurfing yet, this is the time, look it up!!) Abraham will go to pick me up at her house at 6am and put me in a bus to Moundou, in the south.

Abraham had arranged a sim card for me, so I was able to send a message to my mom saying everything was ok, I had arrived safely and had already met my contacts in country. 

We drove to Kristin's house to drop off my bags, and then she took me to the house of an ex-pat, where I met a bunch of ex-pats who live here and work for different NGOs and humanitarian agencies. A Brazilian (!!!) who works in the refugee-camps in the border with Darfour. Another German girl who works with press and information releases. Kristin herself works as a hydrogeologist, figuring out the ground-water and reserves for the country. 

So here I am, it's my first time in Africa, and in my very first night, I meet a bunch of wonderful people, all of whom are staying here for years, doing whatever they can to improve the situation of Chad. 

I felt humbled, and proud of humanity somehow. There's a lot of bad in this world, but there's also a lot of good. We just have to know where to look... :)

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!!!!!   :) :) :)

Homeless...

I've never been completely homeless... I mean, living on the streets and not having a place to sleep. But I have often ended up homeless for a time... living a nomadic life, moving from one place to the other, traveling around, meeting new people, experiencing new cultures... and I love it!!!

However, maybe I'm just getting old, or something, but the idea of not having a home, not knowing what to write in forms when they ask for a "permanent address" is getting to me. Don't get me wrong, I love to travel and will never stop. But I long for the day when going on a trip means packing a backpack, locking the front door and going. Knowing that if I come back 2 days or 6 months from now, it will all still be there. My home. A place to come back to.

I returned the keys to my apartment today... This was probably the nicest place I've ever lived, and I can only hope I can find another apartment like that when I get back... but that's more than 5 months away, so I won't worry about that yet. I only hope the next one will be a little more "permanent", even if not "forever".

I leave you with a picture of what I saw out the window this morning when I woke up...

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... :)