Sitting on the airplane, flying over the ocean right now. Love the view from up here. Islands scattered below surrounded by a sea of blue that stretches as far as I can see, and clouds like pillows floating above. We were thrown into the exit row so we could all sit together, and the extra foot of leg room is just about perfect (first class would have been nice....). It was really a great trip and I'm kind of sad to return, especially not knowing when I can return. There is a urology trip coming up in June, and potentially if I can work it out with my schedule I will try to come with on that trip. I have a radiology rotation in January and a maternal fetal medicine rotation in February. March is a lot of prep with the school for graduation and match week (find out where I'm going for residency), and then I leave end of March through April for the Congo in Africa to work in a hospital there with Jason Zimmermann (board member with Make a Change International). Come back from there and graduate from medical school in May. Residency starts in July. It's hard to know that in general, my global health trips will need to be limited for a while yet, but the most important thing right now is for me to continue to gain medical experience and become a better doctor. As mentioned in my last post, every doctor from Rush I've worked with in the DR has been an really top notch doctor, and it's been wonderful to provide the highest quality care to these people. I want to know that when I provide care in the future, that it's the same high quality. The best way to do that is to focus on my studies and throughout residency to really learn to practice medicine and increase my clinical skills. Not to say that I cannot use my vacation times to continue to go on trips and all, but as I'm flying in this airplane, I wish I could just turn around and stay in another country forever. A lot of what we talked about last night was what the future holds for me in global health....and I have no clue. Many of you know the vision I have, and through Make a Change International, my vision is starting to become a reality......but it's an exciting unknown really. Residency is going to prove a difficult time but also amazing in the preparation for the great unknown ahead. We are getting close to the point that the org will have some scholarship/grants set up for global health trips, and I am working with some others on developing a database of opportunities. This will allow the org to keep running and being effective in supporting global health in a variety of ways. We also have a great fundraiser coming up in February that I hope and pray will be successful and raise a lot of money to support all that is happening. As unknown as the future all is, I have faith that things will work out in a way that is better than I could have planned. Every step of my journey thus far has been different than I thought it would be, and I know that he continues to guide my steps. Thank you to each of you for the support that you provide to the work we are doing, and all the different ways you support us and me especially. As always, we really continue to need great financial support, as that is often a limiting factor. But I cannot place a value on how necessary your prayers are, as well as just knowing that you support what we are doing.....it means a lot to me. I know that great things are going to happen around the world because of all the small things I am taking part in now. In the words of Mother Teresa, "I alone cannot change the world, but I can cast a stone across the waters to create many ripples." It's my hope that everything I am doing now will start a domino effect and inspire others to do similar things. I know that my vision is too big for just me, and I hope that I can just be a small pebble that ripples along. Each of you, with all your support, adds to that ripple. May he richly bless you. Until next time.....
Tuesday, December 16, 2014
Dominican Republic December 13, 2014
Our final day in Peralta working in the hospital. Sad to see it go by so fast. It was a quick trip, yet at the same time, it feels like it's been months since we first arrived. It's easy to lose yourself here. The people are amazing, the area is beautiful, and the work that we do is fulfilling. It's the little things too, like the coffee. I wish I could explain how much I love the coffee. They grow it here in the mountains, and the place we get it from (a guy named Chino) is an all organic farm that is some of the most expensive in the area. When they ship it out to the rest of the country and the world they import the coffee from all over the area and mix it together. So by the time we get coffee, even if you were to go buy organic Dominican coffee in the states, you would be getting a mixture of all different qualities. Here, it's pure, one of a kind, perfection. It's the smoothest most delicious coffee you've ever tasted. They also bring us this "hot chocolate" every morning, which is not like hot chocolate you are thinking of at the moment. It's basically liquified chocolate mixed with milk -- best way I can describe it. It's pretty much just amazing, and really hard to describe without tasting it. So we get that every morning too, and if you mix it with the coffee you kind of can get like a mocha. All throughout the day then they bring us coffee, so we were able to keep caffeinated and plow through all the surgeries. Since I'm on the topic, I'll describe the food a bit. Breakfast is usually some bread, peanut butter, processed meat and cheese. Simple. And coffee! Ok, moving on from coffee (I think you get the point). Lunch is usually rice and beans, some type of chicken, and some yucca, okra, mashed plantain, or some other banana creation that is fried or something. Dinner is pretty similar as well. They do quite a bit with banana, plantains, and yucca. The meals are all prepared by the pastor's family that the group that runs our logistics is partnered with. The logistics connection is called Del Camino Connection, or DCC, and that's where Henry and Alfredo work. So they handle all the lodging, travel (gas is like $5 a gallon here, was $7 a few months ago), food, water, etc. Anyway, so on our last day we had 5 surgeries. We did 3 adenoidectomies, 1 cleft lip revision (looks great now), and 1 bilateral ear keloid removal. We were supposed to have these two kids come in with bilateral cleft lip and palate disease, but we never found out what happened to them. I guess they talked to Wendy (one of our people in the DR) who had set it up and they were traveling from afar, but we lost contact. Hopefully in the future we can connect and help them. The day went really well though, again with no complications. Peter is an absolutely amazing surgeon, and really really humble about it. He continues to be a great teacher too, always looking for little tips to give me for my future as an ER doctor as well. I'll definitely be posting some pictures of the lip revisions that we did and you'll be able to see his artistic surgical skills as well. It's great to not only be able to provide surgical care that is helpful to these people, but also to provide top notch surgical repair. Like, he's the guy you would want to go to if you needed a facial plastic surgeon to repair something. That's what I love about working with Dr. Wang and the other's from Rush. We aren't providing sub-par care that is free, we are providing the best, most high quality health care available -- and otherwise, as mentioned before, these people would never receive any of it. It's really crazy how the system works because you can get a lot of health care here....if you have money. In the evening we drove back to Santo Domingo, which is a couple hours away, to spend the night and make the drive to the airport in the morning a little bit easier. We stopped at a local grocery store in Peralta first to buy some coffee, then once we hit Santo Domingo, Henry, Oscar, Peter, Stephanie and I all grabbed dinner at this chicken place. Chicken here is really quite amazing. Probably because it was clucking a few minutes before. Afterwards Henry dropped the three of us off at this little hotel, and we sat on the rooftop relaxing and talking about the trip. It was nice to relax and get to know each other a little more as well, talking about our travels and our future goals in global health and medicine. It's really awesome to work with like minded people who have great experience in this field, and both Stephanie and Peter have traveled extensively and have a lot of helpful input. I look forward to a future that involves working with both of them.
Dominican Republic December 12, 2014
Third day in the DR was a busy one. We had 7 surgeries scheduled, and with only one ENT surgeon, with myself to assist and Dr. Wang doing everything else, we knew it would be a little crazy. Today was Tonsil and Adenoid day, and one nasal polyp biopsy/removal. Most of these kids have huge chronically infected tonsils and adenoids, and many of them were symptomatic (trouble breathing/eating/fevers/etc). Taking them out may seem like a minor thing, and maybe even routine in some regard, but here it is difficult to get surgery. One of the moms was explaining how she had placed her child on a waiting list for six months to have the tonsils removed. When the day of surgery came, they drove a few hours to the hospital and waited....and the surgeon did not show up to do the surgery. The next available slot was a year later. You hear stories like that and it makes our small trips feel much larger. Sure there are 60ish kids waiting for these surgeries in this region, and we will do a total of of 15ish this week, abd again with one surgeon and a total of 3 people from Rush here working.....enough said. The most amazing thing is that this really isn't a "short term service trip" by any means. Because Dr. Wang and the Rush group travel here so frequently, we can tell people that we will be back and we can schedule them for another trip. Many of the surgeries we would like to do, we simply do not have the supplies needed. But now knowing what we need, we can try to acquire those supplies before the next trip and maybe we can do some more of those complicated cases. Either way, this short trip is going to have some amazing results. This evening after we finished all the surgical cases, we drove back down to Azua (the main region that we are staying in). There is a hospital there owned by the Taiwanese (long story) and a general surgeon and his wife, who is an anesthesiologist, invited us to join them for dinner. They are both truly incredible people. He works in the area and does some cases at the hospital that we work in. When we do trips here, he comes and volunteers his time to do some surgical cases as well. I guess he says that if we can come from America to do free surgeries, he can come help his own community alongside us. His wife works in anesthesia in the Taiwan hospital and was a big asset when the orthopedic surgeons were here with us a few weeks ago (they worked in that hospital as they have more ORs and more ortho equipment). Anyway, we met them at a building they work in, which had a rooftop party thing going on. They ordered pizza (which was quite delicious really, and had the most meat I've ever seen on a pizza) and we got to relax and chat with them and a few of the other Dominicans we have been working with. When we got back I decided to take a hike up the mountain to the dam/waterfall I had gone to a few weeks ago. I like night time hikes, and with it being11pm and pitch black, the stars are absolutely amazing. It's about an hour walk there and back, so it was a nice quiet hike and a chance to reflect on things that happened the last few days. I'm looking forward to tomorrow and finishing the rest of our cases. We were supposed to have two more cleft lip/palate kids come in, but we haven't heard.....maybe they'll just show up. But we have 4 cases otherwise scheduled for tomorrow. Thankfully we haven't had any surgical complications or post-op infections. Actually, Dr. Wang said that over the years they've done over 800 surgeries and never had a really severe post-op infection. Considering the conditions in which we do surgery, and the limited resources.....it's amazing. I can describe in detail to you in person sometime kind of how different things are, but it would be difficult in a short post to really give you a good picture of it. Maybe if you see some pictures from the trip on the website you'll get an idea for how different things are. I think that God has his hand on this place though and he is watching out for everyone that comes on these trips, whether they believe in him or not. He definitely has not forgotten about these people. Continue to pray for our success here, and pray for the people of the DR, especially the community here in Peralta.
Dominican Republic December 11, 2014
Today was the day we began the adventure of ear nose and throat surgery in the Dominican Republic. We started our day at the hospital in Perralta about 8:30am, and thankfully having Oscar as our anesthesiologist, who knows the lay of the land, we started pretty quickly. We kicked things off with a full palate repair. You've heard of kids with cleft lips and palate? This little guy had already had the first procedure, which was initial repair of the lip, and we were the first ones to start fixing his palate. It's a fairly complex procedure, separating the muscle and mucosal layers, and crossing them over in a z-like pattern to close the gap and create the palate that you and I are so very accustomed to, that allows us to do things like swallow, talk, and eat without food coming out of our nose. It took a couple hours, but the result was definitely a successful one, and we can only hope that all the post-op instructions are followed and no fistulas form. Fistulas, or small holes, can happen in the palate between the hard and soft palate, and apparently studies have shown that it is more common in countries like this than in America. Maybe because of some misunderstanding for how to care for the kids after surgery....but we aren't sure. In addition to the palatal reconstruction, we had two palate revisions today, which was fixing these fistulas that had formed over time.....again, not sure why, but it happens. Peter is a great surgeon, and a wonderful teacher. He has walked me through every step of the surgery, and it has been amazing to see how this works. Even more amazing to see the final outcome with these kids. We also repaired another cleft lip, which had already had an initial repair, but over the years as the child grew, he needed another surgery. I can't wait to post the before and after picture for you, because it is tremendous. We also did a revision on a lip for one of the palate kids too. So, overall we did 4 surgeries today, 1 palate reconstruction, 1 stand alone lip revision, 1 stand alone lip revision, and 1 lip revision and palate revision. The kids afterwards were doing great, and we will keep them at least overnight to make sure everything goes well. It's a cool surgery to take part in because there is definitely immediate gratification. Seeing these kids with gaping holes in the top of their mouth, affecting their daily ability to communicate and eat, and the deformed lips, which I'm sure affects how others treat them in some way.....it's just cool to be part of fixing that and giving them a new way of living. Overall we did surgery from about 8:30am until 7ish-pm, so it was a good long day. Tomorrow we have several tonsillectomies and adenoidectomies, which is going to be a little bit quicker each surgery but a long day nonetheless. I'm really glad I came on the trip, especially as there is only one ENT surgeon and no one else to assist.....Dr. Wang has her hands full with everything else going on, and though I'm sure she could handle it with pre-op and assisting in the surgeries, I think it's helping to take a load off and make things flow more smoothly. Peter has had me assist on some of the operations as well, and I've been doing a lot of just the nuts and bolts of getting things set up, moving along, and "scrub nursing" for the operations (making sure he has everything, passing the instruments and all that, etc.). It's nice to get to play all the roles in medicine, especially when you have to set things up from scratch that are normally just "done" in the hospital setting. It teaches you quite a bit outside the normal. Anyway, time to turn in for bed as we have a long day ahead of us tomorrow. I'm trying to take some more pictures on this trip and have some to show you when I return. It's hard to get some with me in them, but I have some of the patients and the surgeries we are doing, which is more important I think. Thanks for reading.
Dominican Republic December 10, 2014
Today we flew back to the Dominican Republic. Small group this time, just Dr. Wang, an ENT/plastics doc named Peter, and myself. We will meet up with Alfredo and Henry in Santo Domingo, and Oscar will again be joining us to do anesthesia. Our journey down had a few mishaps, as I suppose I expect on any trip now. We arrived at O'hare at 3am for our flight, only to have that flight cancelled, resulting in us missing our connecting flight in Miami. Thankfully, we were rebooked on the next flight and still made it down to Santo Domingo. The only downside being that we arrived 3-4 hours later, and there were patients waiting to be screened for their surgeries the next day. Alfredo picked us up and we drove the few hour trip from Santo Domingo to Perralta in Azua, south west of the city. I've only been here once before, on my trip a few weeks ago, but it strangely feels like I'm driving back home. I see familiar sights of landscape and the houses and mini-stores set up along the way. It's nice to be back. When we arrived at the clinic, I started seeing patients with Peter, setting up surgeries for the next couple days. Thursday will be several cleft lips and palates, Friday looks like Tonsillectomy and Adenoidectomy day, and Saturday we got a mix of things. Sadly, we again have to turn away a lot of the people that have traveled and waited all day for us. But, we'll see how many we can get through, and with just the one surgeon, it'll be an impressive amount regardless. As we learn very little ear nose and throat type stuff in medical school, save my dissections of cadavers, it's already been a fascinating and educational experience. I'm looking forward to the surgeries and continuing to enhance my hands on skills. Even the "basics" like placing IVs and all that pre-operation stuff, that very few med students and even doctors do, I'm looking forward to doing and increasing my experience. The next few days are going to be very busy.....like I'm sure next to the insane level. Even today we didn't finish with our patient screenings until 11pm, which considering I didn't sleep the night prior and only napped on the plane for a few hours, it's a little tiring. But knowing that you're providing a service for these people that they could not otherwise obtain, is as always, just the most incredible feeling. Surgical trips are always more instantly rewarding as I'll be able to see the effects of our work immediately -- and will be able to share that with you in some regard through some pictures. Anyway, I'm just going to jot down some thoughts each night and a little recap of the day, and I'll upload all of these to the blog when I return, so you'll be able to read the whole trip at once. I didn't get to do this much on the last trip given some time constraints, but I'll make sure it happens each night, even if it's just for a short while. I know you all are praying for us back home, and I thank you for the support you offered in that way during this time.
November 8-16 Dominican Republic Trip
Finally, I get a chance to sit down and reflect on the trip that took place and share our experiences with you all. We flew out of O'Hare on Saturday morning, and the trip started out with great success as I was able to talk to the manager at the JetBlue check in counter and get all of our second bags packed with medical supplies checked onto the airport for free -- saved us about $600-700. We connected in San Juan and arrived in the DR that evening. The medical team from the prior week was on their last day, and we were able to meet up with them for lunch and discuss a bit about what they did and the patients they saw. Sunday morning we left Santo Domingo and drove about 3 hours to Peralta, where we spent a bit of time sorting through our supplies and started pre-screening patients for the surgeries in the coming week. The general surgeons will be doing things like hernia repairs, mass removals, hysterectomies, tubal ligations, etc. and the orthopedic guys will be working in a hospital in Azua. Sadly, we didn't have a great deal of supplies as far as orthopedic stuff goes, so we had to turn away some people that could easily be fixed in the states. Things like plates and screws are not cheap, and they are hard to come by in the DR. Motor vehicle accidents are common around here, especially motor bikes vs cars/vans/trucks, so lots of broken bones. We saw one guy right off the bat Sunday morning who had previously shattered his femur and had some plates put in, but reinjured somehow and came to us with metal hardware sticking out of his knee -- basically have to amputate here because otherwise we would need 5-6 surgeries with a total process of about a year -- impossible here. He never showed up for surgery, I guess he was keen on the idea of keeping his leg, though the infection that he has will kill him at some point.
That afternoon we worked in a clinic in the main part of Peralta, and I lost count on how many patients we saw, but I think we scheduled about 40 surgeries, and declined quite a few cases or deemed them non-surgical candidates for one reason or another. The masses were gathered outside and we sadly had to turn away another 50+ people that we just could not possibly see. At some point you realize that we can't fix everyone....though that doesn't make it any easier. Having to walk through the crowds and apologize that we had no more space....words don't quite describe it. Some of these people travelled several hours, and waited all day long to see us....and we couldn't help them. Again, you have to realize that there is no way that we could see everyone, and there will always be more to patients to treat. But, that's the benefit of working with a group like this that returns to the same area over and over, year after year.
We scheduled about 6-7 general surgery cases a day, and a gen surgeon who does OB/GYN stuff who is from the DR came in to volunteer and do hysterectomies and tubal ligations, and he has a good number of those scheduled each day.
Monday morning we started our surgical cases. I started out helping in the pre-op area, getting IVs placed and all that. Then I started to circulate the OR with our two gen surgeons, scrubbing in on a few cases throughout the day to help assist or close the patients. Surprisingly, things ran fairly smoothly for being the first day. We did 6-7 gen surg cases, 2 hysterectomies, and 6-7 tubal ligations. Every surgery went well. We had one patient several hours later who spontaneously went into respiratory distress and was found cyanotic and not breathing. She ended up doing ok - though we monitored her throughout the night and made sure she continued to breathe. She ended up having some strange narcolepsy disease, but it had been going on a long time. So, as soon as she was ok to go home, we discharged her.
The group I'm here with is absolutely amazing - gen surgeons, ortho, nurses, PA student, CRNA, and our fearless leader Dr. Stephanie Wang, who started this whole process at Rush and makes all this possible. She's an incredible inspiration to me, and proves to anyone and everyone that it's possible to do global health in a way that really partners with communities and empowers them. I'm privileged to learn from her and honored that I get to be part of this experience. it will be invaluable for my training as a doctor and in global health. The entire group is just a joy to be around though and in the evenings, after the work is done, we have a good time. The bonds that form between people while doing medical service work is like none other -- and maybe it's the "I haven't showered in a while and I'm standing in surgical gear super close to you sweating like crazy and changing people's lives".....but everyone pretty instantly connected and the celebrations at night make all the hard work of the day that much easier.
In the past I've sent these posts out to you nightly and asked for prayer requests and such at the end, sadly as I am posting these all at once at the end of the trip I cannot do that. However, for all of you who had been praying for our success during the whole trip, thank you so so much. Knowing that you all are back home in support of this is wonderful, and helps me to keep going. I ended up not getting to write down each night as much as I had hoped during this trip, but now that I am sitting back home I will recap a little more for you.
The entire week was an amazing success. We ended up doing 92 cases in total, with about 80 of those being major surgeries. This included the general surgeries, orthopedic surgeries in Azua, and the assistance of the Dominican surgeon. It was really amazing how much we got done in just 5 days. Every day we worked hard, long hours. But everyone kept such an amazing attitude and worked so hard, it was inspiring. I spent one of the days in Azua with the ortho guys, and I have to say, I saw some of the most bizarre things in my life. People that had been in accidents years before, with horrible fractures healed wrong, walking on legs that looked they had two knees.....just crazy. We were fortunate in that the hospital there ended up having some hardware that the ortho guys were able to use, and we were able to do some tibial and fibular nails to repair broken bones. Normally you would do these with constant x-ray, but not in the DR as they just don't have it. So we did a lot of it blind, and I prayed. It was amazing that every surgery went smoothly and there were no complications. I just returned from my second trip as well (read the later blog postings) and everyone is doing just amazing. No post-op complications, even in the conditions we were in. There was one point where this fly was buzzing around the OR, and even during the surgery landed in the open surgical site......one of the nurses squirted some antibiotics in there and we moved on. It reminded me of that episode of breaking bad where the guy is hunting down the fly for the whole 45 minutes.....yeah, that was us. I think I scrubbed out at one point and tried to find that fly. No such luck. But, he didn't infect our patient, so thank God for that.
I will be posting some pictures on the website, so please check them out. Also, on the next trip I went on I was able to blog each night, and all those are now posted as well, so please read. I was able to type more about the area and such too. Thanks for reading, and thanks as always, for your support!
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