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.