Congo Day 8 - Back alley abortions

Day 2 of working in the hospital, which I guess makes it Tuesday. I feel like I've lost complete track of time here, which is in part because we spent several days in Brazzaville, after losing a day on the plane, and losing 6 hours of time, but it probably also is partly because we have a LOT of time at night that makes time seem to drag on. Typical days here end around 4pm, and it gets dark around 6pm. Once it gets dark....everything shuts down. And it's not like I can pull up my favorite TV shows or Netflix to burn away the hours like I do at home. So, we read, and study, and play card games, and wait to see if anything happens in the hospital as far as an emergency. So, time is a bit different. It's really just the difference in cultures more than anything probably. I'm used to moving and running and doing for 24 hours a day, and if I sit down to relax and do nothing, I feel like I should be looking to do something. There's a definite peace and "ahhhhhhh" moment that comes with it. But, you lose track of exactly how much time has passed. I'm sure after a few weeks here and adapting to that environment, I'm not going to want to return to the craziness of American life.

We again started the day with Chapel at 7am, and Henri gave a quick study in French and we sang a few hymns. Morning report was a bit quicker as nothing really interesting seemed to happen overnight again. Then we headed off on rounds. We started in the emergency room/ICU, and ended up spending the better part of our day there with one little patient. He's a small child, I think they said 18months? (I'll check later), who had come in with some respiratory distress. Yesterday I think we had thought maybe he just had some bronchiolitis, and if I remember right he just sounded a little wheezy, but otherwise not too bad. Today he was breathing really fast, had intercostal retractions, and had spiked some fevers over night. His lungs sounds weren't super impressive, louder on the right than on the left. We grabbed the ultrasound and started looking around. In the left side of his lung cavity we thought maybe we saw some fluid, though we had a hard time getting a conclusive picture. So, Dr. Wegner stuck a 22 gauge needle in.....and out came.....PUS! Yep, that pus again. It's everywhere. So chest tube time it was. I've only put chest tubes into cadavers, so I was excited to put one into an actual person. Now this poor little guy had already been poked and prodded all day long as they had been trying to get an IV into him, and after 6-7 tries of arms, legs, head, neck....they still couldn't get it. So we switched and I put the chest tube in. Pretty immediately we got pus squirting out and drained about 150-160 cc's of good old nasty smelling pus. He's really too small to tell me what's going on, but I have to believe he felt a lot better after taking all that pus out. He continued to be a squirmy fella though and as we tried to put in an IV again, he pulled out the chest tube. So we grabbed Dr. Wegner again to come help and we replaced the chest tube and tried to place an IV with the ultrasound. We kept getting it, but the catheter wouldn't thread over the needle. It took us through the better part of the early afternoon to finally get it placed. Ah finally. Chest tube in, check. IV in, check. NOW PLEASE JUST HOLD HIM DOWN! We had to give mom some instructions to try to keep him still and make sure he doesn't go yanking everything out again.

The girls had done a 2 surgical cases during this time, I think a hydrocele/hernia repair and a cyst removal with appendectomy. Jason, Dr. Wegner and I took another kid who had a gigantic abscess (pus, yep) on his face/neck, and put him under with Ketamine and drained it. Wasn't nearly as satisfying, but we got it drained and packed. The last case of the day was going to be from complications related to a back alley abortion. I think I mentioned this in a prior post, but it seems to be fairly common where these women go and get these back alley abortions and end up having really severe complications as a result. From a public health standpoint, I would rather they had a safer, more accepted way to do them. Now before the pro-life crowd goes up in arms against me for saying that, let me explain. In public health we like to take a look at behavior, and we recognize that we cannot necessarily change behavior, but we can try to reduce the public health implications that might result from that behavior. So, for instance, we give drug addicts clean needles. We offer needle exchanges all over the city of Chicago where they can get not only needles, but tourniquets, filters, etc. whatever they need to help them do drugs safely. Why? Am I empowering them to do drugs? No, I don't think so. They are going to do drugs regardless of if I help them or not. But, I would rather they have a clean needle and not share, which means not sharing HIV or Hepatitis, which means them not dying sooner, which means maybe we can start to work on the behavioral changes and get them the help they need to no longer need drugs. But, if I just say that, well they shouldn't do drugs, and they get HIV and die sooner, I'm not giving myself any options to help them. Similarly when it comes to abortion, I think this is the problem that we see in America. The pro-life crowd wants abortion made illegal, and the pro-choice crowd wants it to stay legal.....the reasons behind this are varying clearly with some being religious, some being about rights, some being about whose life matters, etc. Now I'm not saying I'm pro abortion, and I'm not saying I'm against it - because the point of this post is not to start a discussion on that - the point of this post is to discuss public health related to abortion. In this case, abortions aren't available in a safe manner, so they go to back alleys and have them performed in an unsafe, dirty, contaminated way, and as a result these women are getting abdomens filled with infection (pus again), some of them dying. Now you can say that they shouldn't be having abortions, but some of them don't choose it. It may be the family, it may be the husband, I'm not quite sure. It may be that they have 9 children already and they are not able to care for more, so they have an abortion. I've mentioned before how contraceptive methods aren't really accepted either at this point. Anyway, in this case, the girl was 27 years old, had an abortion 1 week ago, still had retained fetal products in her uterus, had a ruptured uterus, ruptured vaginal wall, pus throughout.....and was lucky to be alive. The goal was at first to go in and remove all the pus and try to repair the uterus, but there was just no way. We converted to an open hysterectomy and took the ruptured uterus out. The anterior portion of her vaginal wall was also completely obliterated, with no way to re-stitch it together.....so we had to use the posterior wall of the bladder for the new anterior wall of the vagina. Pretty crazy, but it worked and now we just hope that her ureters didn't get damaged. Jason and I will check on her later tonight, and hopefully she starts peeing sometime in the near future so we know. I'm not sure how many kids this girl has, if any, but her failed abortion resulted in her never having kids again. Sounds like this is a fairly common thing that these women come in with, so from my public health mindset, you have to start asking the questions on what can be done. In this case, I would say that there needs to be a safe way for women to have abortions because if there isn't, they will have a method done that is so incredibly dangerous that we see cases like the ones today. I'm just not sure if that would ever take in a place like this. It's a tough one, and there isn't a good answer. An easier public health solution would be to just offer contraception and try to make that readily available, and it would be more accepted within the religion of the culture than abortions.....but I'm not sure. Something really should change though so that these women stop dying from these back alley abortions. If you've made it to this point, and haven't written me off (from either perspective), thank you. I'm trying to walk a thin line here and be sensitive to everyone reading who is both pro-life and choice. I ask that you put aside your personal beliefs for just a moment and think about it from the public health mindset as I am, and maybe that will help you. After that, you can filter it however you wish. But just realize that these are the difficulties we face in other countries like this. Sometimes you have to put aside your own personal belief system and try to find the best way to actually help someone, which is clearly not always black and white, and clearly not always feasible.....you know, the old clear as mud. This is really turning into an incoherent rant I think, and I don't feel like going back and rewriting it into something more coherent for you all. Again I figure if you're still reading to this point, you've accepted the fact that I don't have a good answer for it. This is why I both love and sometimes hate public health. It's really really really hard to influence change. It's nice in medicine when we can fix things, but when it's just putting a bandaid on the problem, it's even more frustrating for me.

At this point 6pm has hit, and after the last case ended around 5pm there isn't much else going on. Jason and I will plan to do our post-operative checks and see how our kiddo is doing around 8pm. Jason is off hanging with Noah Harvey back at the other compound. He took a bike and left a while ago, so when he gets back him and I can go round. Other than that, it's really just waiting to see if anything goes down as far as an emergency goes. I think I say that in about every post so far and nothing has happened yet. But.....it will I'm sure. Crazy things happen in Africa, and I'm sure we will get our fair share of craziness at some point in the middle of the night. I have two and a half weeks to go, so it won't escape me.

I suppose I can tell you about the geek squad that just arrived, as I don't think I've mentioned it yet. Joyce had mentioned to us that they were having a team come to fix the internet, and by fix I mean try to get from crawling turtle to jogging turtle speed probably. But also they are hoping to get the signal boosted so that it is around the complex more. So anyway, I hear this IT team is coming, which I affectionally name the geek squad, and then we found out it's a group of IT people from Hong Kong. Very stereotypical, so everyone here has had a good laugh, including them. They were like, yes, we are the asian geek squad....so we'll see what they can do over the next 12 days. Maybe I can get internet at the house instead of walking to the admin building every night. That would definitely spoil us.

It'll be pretty weird when Jason leaves, which is fast approaching in like 6 days. Since the flights are limited out of Impfondo, I'm guessing he'll fly out on Monday to make sure that he can make his flight on Wednesday. Potentially there could be a flight on Tuesday, but those flights have been getting cancelled, and we wouldn't want him to miss his flight.....well, I'd be okay with it, but I'm guessing his wife wants him home on time. Either way, it'll be pretty weird to lose my housemate. Dr. Kiong is still here, and the geek squad is right next door, so it won't be completely empty obviously. But it's nice having a traveling companion, and Jason and I get along really easily.....so it'll be a bit strange. The girls will be here for one week longer than Jason, and I see them throughout the day. They live back by the Harvey compound, so I don't really see them in the evenings. I think they leave on the 13th then, and I'll be here in Impfondo until the 18th I'd guess. I'll take my flight back to Brazzaville and wait until Monday to fly back to the states. I guess I didn't really plan my flights out super well, cause flying out on a Monday means I'll have the whole weekend to chill in Brazzaville alone. I did want to walk around and grab some souvenir stuff from there, so that will at least allow me the time to do that. The Harvey's had some cool stuff from the Acca people (spelling....I think that's right), which is hand carved of different woods, and they have it for sale at their house. So I'll try to snag some of that too before I go. Anyway, It's nice that we stay busy during the day at the hospital, we may have to think of some group activities to do in the evening or something.

This post was kind of rambling, so I apologize for that. Wanted you to get an idea of what I'm thinking with everything going on around me, and I suppose I haven't quite made sense of it all yet.....so it's coming out as a ramble. I'll do my best to make this into more coherent thoughts as we move forward through the week. Thanks again for reading, and feel free to post any comments below. Especially if you have any thoughts related to the public health dilemmas we face. I won't really get to see your posts until I return because the internet is too slow to load them, but I would love to hear your thoughts as well. So please feel free to share.

Prayer requests: I'm getting over being sick still, and I'm not coughing quite as much, so that's good. Just hoping and praying that I keep recovering and that I haven't shot my immune system down too much to where I catch anything else. Pray for all these patient's we are treating. A lot of them are really very sick. We pray for each of them during rounds and before and after surgical procedures. We have such limited resources that really we have to pray as there's only so much that we can do. Pray a blessing over all these people who have been serving here long term too. It's quite amazing that they are raising their families here and many of them have been living in this country for multiple years, serving the Congolese. I really want to make overseas mission work part of my life, and I have always envisioned doing multiple mid-length trips during the year, while I continue to work in America as an emergency medicine doctor. Not yet sure if I'll ever settle in one place permanently. Regardless, it's great to see the people here who have been here for extended periods of times and all the struggles and joys that they have to face. It's eye opening to say the least, and is helping me to think through all the ways that I could best use my talents overseas.

Thanks so much. If you stuck through the long post, you're a trooper and I appreciate all your support. If anything you're reading is inspiring you, please send it on to your friends and family as well. Also, consider helping to support us on our future trips as well. I have a trip planned to Honduras in the first week of June as well, and any financial support to make that trip happen, and others like it, we would greatly appreciate. If you would like to support us financially, check out our website at www.makeachangeinternational.org

UPDATE:
Well around 10pm we got a call that there was an emergency so Dr. Kiong and I ran over. Nothing too serious really, but there was a motorcycle accident and one of the guards was involved I think. He had a broken right ring finger and some small lacerations on two fingers that needed stitching. I did a nerve block on the finger, set the bone as best I could and made a splint. The other guy involved just had some abrasions and nothing serious. We then quickly rounded on our post-op patients, and everyone is doing quite well. I'm pretty tired tonight, so hopefully I get well rested and there isn't too much excitement tonight.

Congo Day 7 - You can never have enough pus

Today is the first official day we are working in the L'hospital Evangelique a Impfondo. The weekend was fairly light, so other than that surgery I mentioned, Jason and I didn't do any other surgical cases. There were a couple cases that came in, but they weren't urgent enough for that day. We headed over to the Chapel at 7am, where they start their day with singing a few hymns and doing short devotional (in Lingala). Dr. Harvey and Wegner introduced and welcomed us to serve in the hospital. From there we headed to the administration building for the morning report, which is exactly what it sounds like....a report in the morning of all that happened/is going on. There were some updates regarding the maternity ward and a few of the pediatric cases of malaria. Malaria here is a pretty big deal, and really common.....and really bad. Hemoglobins drop lower and seizures are common occurrences (and could be from fever, hypoglycemia, or cerebral malaria).

So anyway, after morning report we headed to do a hospital orientation with Dr. Wegner, who showed us around everything and gave a run through on how things work and the expectations for us while we are here. Basically, have fun, learn a lot, help as much as you can, and try not to get (too) sick. We then headed over to meet with Anna Wegner, who gave us a rundown on the cultural things to know about the Congolese, which was great. From there we headed over to catch up on rounds on all the patients. We followed Dr. Keon, who has been on call and is most familiar with most of the cases that have come in. We saw post-operative patients who had gotten hernia repairs, eye surgery, and incision and drainage (I&D) of lots and lots of pus. If there's one thing the Congolese seem to have an abundance of, it's pus. And it's the good kind of pus. You know, the kind that runs, spills, smells, sticks, gets everywhere.....and kills you if you don't get it out. So we drain it. We drain lots of pus. Pus in the belly. Pus in the leg. Pus in the face. You name it, pus will go there and we will drain it. So we checked on a few post-drain-pus-patients and decided if we had to re-drain, discharge home, watch for another day, etc. We also saw our intussusception guy from Friday, who's healing quite well.....we are just going to watch him another day and see how his bowels start working.

One big problem they have here in the Congo is related to abortions. Abortion is not something that really seems to be accepted as okay, so men will pay for their wives to have them done in mud huts for example, and then come to the doctor afterwards when there has been a nasty infection (hey, pus again) that develops, and then lie about what happened. We can tell though. The docs here then have to do a D&C and clean out the uterus of all the infection. Sometimes the abortions are spontaneous and end up being septic and.....yep, you bet.....pus.  So there's a lot of gyne type pus surgeries going on is the point. I think you've heard enough about pus for a moment.

We then headed over to the pediatric units, which has a bunch of the kids being treated for malaria. One of them we weren't quite sure, but his neck was stiff so we did a spinal tap there and will start on antibiotics. They have one incubator and they had a very small 36 week preterm baby boy in there. 1 week old and I think at about 1500g. So they do have some medical equipment for stuff like that, but other things they have are just broken and it makes it difficult. There seems to be a lot of babies being born and most women are on their like 8th child that we've seen....so the birthing process is super quick for the most part. From what I hear, they moan a bit but if they scream, then their mothers (baby's grandmothers) usually yell at them and tell them to hush. I'm sure we'll see a couple babies born here. There was a one woman who came in this morning who we were going to induce....she was at 42 weeks. Not sure if she had the baby yet.....but I'd guess yes.

We rounded for a couple hours and went through the medicine areas, surgical patients, ER/ICU patients, and pediatrics. Then I headed over with Dr. Keon to get started on a surgery. The guy was young, probably late 20s early 30s, and he had gone to a local witch/voodoo doctor who had basically stabbed him in the foot to "drain out evil spirits." Not sure why he was trying to get rid of evil spirits, but they are really into some of that stuff here. I guess if the witch doctor tells you that you have cancer because of your uncle, then they might go try to kill the uncle, for instance. Or, stab your foot to drain out evil spirits. So, this guy was stabbed in the top of the foot and as a result developed infection, cellulitis and.....yeah we are back to pus again. Basically on the lateral side of his right ankle was a whole bunch of necrotic tissue, and on the medical side was some more with deep pockets of pus. So we took him into surgery to debride it all. We cut out all the dead skin, which was a lot, and scraped the underlying tissue to make sure it bled and was viable. He'll need a skin graft at the end of the week....we took off more than the size of my palm....and it's about a centimeter or two deep. On the medial side we took out about half the size but made deep incisions to find the abscesses, which tracked up behind his calf muscle. Truly disgusting but fairly satisfying to drain and cut away. This is a great example though of the difficulties that we run into when modern medicine clashes with their "medicine." Please don't take my cynicism for cultural insensitivity, as I don't mean to be. However, when something like this causes so much unneeded harm to someone, it's really just sad. These people are so trapped into believing that these "doctors" are trying to help them, but now this guy is going to be in the hospital recovering for quite a while, undergoing surgeries and skin grafts trying to save his leg, which is at the moment filled with pus and dying. Throughout medical school we have looked at situations like this and discussed the "right" ways to approach them, and I don't think there is a right way, we just do the best we can.

After the surgery I headed over to catch up with the rest of the group and Dr. Wegner. We hung out in his office and saw patients for the remainder of the afternoon. He's really an amazing guy and a great teacher as well. Today he wanted to teach us a bit about ultrasound, and they do have a portable machine that they use to diagnose.....well everything. I think they sometimes have an X-ray, but other than that, anything we might use a CT, MRI, Xray for....let's try an ultrasound and see what we see. He gave us a basic review and the next several patient's we saw he had each of us do a full abdominal/chest ultrasound on them for practice. Make me excited to get started in my residency and start learning a lot more about utilizing ultrasound, and becoming an expert in time. Dr. Wegner believes that it will be the new stethoscope in medicine......I'm inclined to agree with him.....or maybe it's just that I really hope that it happens. I want to creat an iPad app that has a bluetooth attachment....even more portable. I'm not technologically smart enough though and I'm sure it's being created.

After we finished up with all the patients I headed over to the Chapel to help with the worship practice. After last night, playing the piano for those hymns during their "Sunday Night Live" (forgot to tell you that's what they call it), Joyce really wants me to play with them while I'm here now. Which, I'm happy to do....any excuse to play the piano works for me. Dr. Wegner came over to play the acoustic guitar, a medical student from France played the flute, Joyce's daughter (Cherissa) played the violin, and Henri pounded the drum. They have a bit of a problem staying in a rhythm, but their hearts are in the right place, so it's enjoyable. I gave them some pointers on starting songs and how to try to play more together along with the drums. They've got some work to do, but like I said, their hearts are in the right place. I would try to lead them more but they sing a lot of the songs in French, and I pretty much just can't sing in French at all. Hopefully the rest of the time I'm here I can sit in on their practices and try to help give some pointers for improvement. Joyce also asked if I could give her some piano lessons, which I'll definitely make time to do.

That's about it for events of the day. I went back to Albany (house I'm staying in) and made some dinner. We got a phone now so they can call us if anything goes down during the night. Thanks again for reading!

Congo Day 6 - In Congo, death is common...

Today is church day, so one culturally consistent thing between Africa and America (and pretty much everywhere). We went to both services this morning, to see what they were like. The first service, from 9am to 11am was all French and Lingala. They sing hymns in Lingala and preach in French. Henri, the eye surgeon, preached this morning. It was a lot of fun to be a part of for sure. They're singing especially, with a boy banging a drum in the background, was a cultural treat. The second service is the English and French service, and Joyce preached for that one, telling her story of how they ended up in Africa and talking about how one will never be "ready" to go be a missionary, you just have to go. They sang songs that you would commonly hear in a contemporary church service, and went back and forth between French and English on verses and choruses. I think I will be helping out with that next week, as long as my voice is better. I still can't sing and am coughing consistently throughout the night, making it difficult to sleep, so hopefully I recover by next week.

We went to the Wegner's house for lunch afterwards, and we met Amanda as well, who is a nurse here for a 1 year stint. We talked a bit about how Make A Change International started and what our goals are, and I welcomed any suggestions for us as we develop our organization. I look forward to partnering with this community as we move forward, and I know this will be a wonderful connection to maintain. Soon after we finished we were alerted that a boy had collapsed and was unresponsive. He was in the pediatric ward being treated for a respiratory infection. We ran over and Dr. Keong was already starting chest compressions. We put in an IV and I drew up  some epinephrine. Zach and another hospital worker continued to bag for ventilation. We pushed the epinephrine, and continued compressions. Nothing. I took over compressions and we pushed another round of epinephrine. They don't have a lot of crash cart meds here, and so they do what they can. Aspiration is common and the boy had puke all over him. We could technically intubate, but have to way to really ventilate, so they don't do it. We had to call it at this point as there was nothing we could do. Dr. Wegner noted that we usually lose one pediatric patient a week, and sometimes more adults. By the time they're on the ground and you're doing compressions, he said, it's unlikely we can get them back. The hardest part of any third world country is when your hands are tied by limited resources, and this is yet another case. We do the best we can, and practice the best medicine possible in the circumstances. We will see a lot of death over the next couple of weeks, and the one glimmer of hope I see through that is at least each of these patient's is placed into an environment surrounded by Christian doctors who at least present them with an option for some hope. Many of the patient's families were at the church service this morning, and I'm sure it's of some comfort. Death is more expected in a place like this than in America. If you brought your child to the hospital for a respiratory infection you would unlikely be assuming they would die.....but in the Congo, death is common....

We spent the evening at the Harvey's house, where they do a bible study and worship of sorts each Sunday night. Being Palm Sunday, they had Palm branches for all the kids and they read through related scripture. They asked if I would play In Christ Alone and How Deep the Father's Love for us on the piano, and they had the chord charts so that was no biggie. Later they asked if I'd play a song that I didn't know, so I told them to start singing and I followed along and made it work. They asked if the next couple weeks I could keep doing the worship, which I'm more than happy to do. Next week being Easter, I'm going to meet with Becky (Dr. Harvey's wife) to discuss songs that they want to do and all for the holiday. I brought some stuff too, so maybe I can teach them some of my favorite worship songs as well. Jason and I each shared a bit about our testimony and how we ended up in Africa, and they prayed for us and our success while we are here.

Tomorrow is day 1 of typical hospital work, and we have chapel at 7am, morning report after, and then rounds. From there we shall see what the day holds. They have worship practice at 4pm, so depending I may be able to help them with that as well. Tonight when I got back to my room I turned the key and it got stuck. So, I took the door apart and found that the tumbler had crumbled into a bunch of pieces....so I need to find a way to fix the door too. I'll let Henri know as I think he's their "handyman," so maybe he'll have extra door parts? Lots of firsts here. Anyway, a more solemn day with everything, but I assume that over the next few weeks there will be lots of sadness experienced, but I will try to keep the blogs more light and lively and filled with the excitement of things going on as well. Everyone has a fantastic attitude here and it's definitely not as maybe depressing as I've made this post seem. I hope you had a great Palm Sunday, and stay tuned for all that will happen in this coming work week.

Congo Day 5 - Part 2 - L'Hospital Evangelique a Impfondo

Decided to write a part 2 for day 5 to give you a bit more about L'Hospital Evangelique a Impfondo or "HELP" - Hospital Evangelique Le Pionier. First off, fun trivia fact for you (according to Jason), the two closest capitals of separate countries are DRC and Congo.....Brazzaville, Congo is just across the river from Kinshasha, DRC. Now that's in the more southern part of the Congo. Impfondo, where I'm working at the hospital, is more north, but right on the border of the DRC and Congo still. The city sits right on the Oubangi river (spelling, sorry, couldn't remember), which eventually runs into the Congo River, which at this point is further East in the DRC.....which then turns into the rivers that I mentioned we walked to see. Pull up a map on google and take a look. To answer the burning question you may have, there are no wild gorillas here. They are in the preserves, which are further west, not close enough for me to walk. We do have big spiders here though! Yay. I just killed one because it was brown and colored striped and looked like the type that would purposefully eat me. There's a big black one on the wall across from me, but he's probably been there for a while, and I see them around. I accidentally left my suitcase open for a bit, so just doused it in 99% deet, and hopefully there's no friends waiting for me when I put on a clean shirt. I guess I will shake well. Now I have to worry about bot flies and spiders in my clothes.....welcome to the Congo. I'm sure in 2-3 weeks I won't even notice them. I sleep under a mosquito net, which is really a generalized bug net considering it is tucked into the side of the mattress. Though I keep thinking I have mosquitos on me, but that's just the beads of sweat rolling down my back as I sit here in my room and type. It's the wonderful weather where it's just muggy, and you're wet, no matter what. I don't have a fan here....maybe I should go sleep on the Samatou's couch, as they have fans.....but then a spider could eat me, so pick your poison I guess. ANYway, back to the hospital.

This complex was built as a communist camp originally, so it's not really a hospital at all. Not sure if the camp was ever used, but its intended use was to indoctrinate children into communism. So, there isn't even like one building, it's a collection of a bunch of small buildings. So there's the admin building, which has internet and the offices and such. There's a chapel. There's a lab with an attached pharmacy, and I believe that's where the ER sits as well. The OR is what actually was the cafeteria. It is air conditioned (thank God) and has 220 and 110 electricity if I remember seeing that right. Just the one OR that I saw, with one bed, though I think there's a separate OR area for OB/Gyne stuff. There's two buildings for baby birthing stuff, one for before and one for after the baby arrives. There's a men's ward, women's ward, and pediatric ward. There's the eye clinic that Henri runs (mentioned previously). There's a small library, a radio station (not sure where it goes or what it plays), a nursing and public health school that I'm not sure if are in use, and there's the well. There's a big tent set up too that I hear is for EBOLA should one arise. I might be forgetting a building or two, but you get the idea. Then there's the houses that we all live in. There's a big field where they play soccer, and a playground that I believe Mercy Ships built at some point.....though that's all metal....."Hey, let's slide down the big metal slide of death in 90 Congo weather!" "Hey, let's not." I guess it's the rainy season, so maybe in a cloudy downpour.....but then if there's lightning you're gonna be sitting in a perfect conductor....so just sounds like a death trap, but hey the kids say they use it. So anyway, the complex was built for the communists, but when Dr. Harvey came to the Congo I think 20 something years ago, it was being unused and they go permission to convert it over to a hospital. The place we stayed in Brazzaville, Hotel Bravo, used to be owned and operated by MSF/Doctors without borders. But when they pulled out (as they do when disasters "end"), the government took over their hospital in the west and the Harvey's team took over Hotel Bravo.

So yeah, I think I talked about this earlier, but how it works is that all the services here are paid for by the patient, and nothing is free. If you cannot pay up front, they have the right to hold you at the hospital until you can come up with the money (say there was an emergency procedure performed). I guess the government gave them the okay to do that, and like I believe I mentioned before, they do something similar at the university hospital. I haven't seen a normal week of the hospital in action yet, so I'll know more about that side of things pretty soon, and until then I can only tell you what I know.

I need to go walk around the area more, which we will either do tomorrow or wait till Monday when I think the market might be open again. There's a lot of little shops and stuff that sell snacks/drinks and such, but I think to get good meat or fruit you have to go to the market. Need to find that out. Did I mention the pineapple yet? Holy cow. The papaya too. Oh, and the honey? And the yogurt....this is pretty sweet. The family next to us is leaving us some of the yogurt culture. So we just add some water and powdered milk, put it in a pot and leave it outside in the sun all day, put it in fridge overnight to get cold, and you have amazing amazing yogurt. Sun-made yogurt....can't beat it. Add some of that honey to it and you might as well stop reading and fly over here and try it, it's that good.

I don't really know much about Impfondo as a city, other than I think it's around 50,000 people. There's a Catholic church and an Evangelical church, and I'm not quite sure which way the population lies as far as more of which one. The group here is evangelical, non-denominational, and like I said they have their own services on Sunday. Jason and I plan to attend them tomorrow and see what they're like. I think both of them, even though the first is completely in French and Lingala. I'm just hoping this cough goes away, otherwise I might wait till next week so I'm not coughing a fit the whole service. I'll post more about the town as I find it out, but this gives you kind of an intro to everything about this area that I know so far anyway. Hope you found all this helpful. Enjoy the cold back in Chicago....Until tomorrow.

Congo Day 5 - Mudding

Woke up around 7am today and checked in with Dr. Keong, who's on call. They rotate call on the weekends, and they don't round the same way as they do in the week. He said nothing really interesting was going on, and we should get acclimated and check in with Sarah to see if any community work was going on. Enter the mudding. But first I'll mention that Olivia, a girl from the other family here, made some pancakes this morning for us, so that was a good start to the day. Then Kara and Stephanie came by and asked if we wanted to go mud houses with them and Sarah. Ummmm yes? Sounds awesome. I miss good hard labor actually, does the body some good.

They warned me I would get muddy, but I was pretty prepared. I brought some nice hiking boots down with me and also some gaiters, so I was prepped and ready for the mud. We had to fill 75L worth of containers with water and I pushed the wheelbarrow a ways to a giant pit of mud, where we dumped it and started making some good ol' wet mud. Then we scooped it up with our hands and started basically forming bricks on the walls of the stick house. They had started the house and were mostly done, but we had a good 4-5 hours of work that we did. It was fun because all the village kids came out and started helping us and wanted to take pictures with us, and they started a mud fight with Jason and Noah. Definitely hot, messy work -- but It's what they do to live so it's a great public health experience as well for me to start getting a grip on what I'm dealing with in these communities. It's definitely why all these people are so fit. Their daily lives involve hard labor as just the normal. I was like, yes a workout for the day! And they're like, this is why we don't need to workout! Really glad I got this Olympus Tough camera before I left (thanks mom and dad) because it's indestructible, mud proof, and water proof. So I didn't have to worry about pulling it out and taking pictures even though it was wet and muddy by the end. I got some good videos too of how it works, so I'll be excited to share those with you in the future too.

We got back and took much needed showers. Those boots and gaiters worked super well because I was clean underneath at all (though drenched from sweat, so clean is a relative term here). We then headed to the Samatou's for lunch. Joyce and Henri - she's a family practice doc from Hong Kong and he's a surgeon from Gabon, and together they run an eye surgery clinic. They have 3 totally awesome little kids (I am going to butcher spelling here, sorry), Cherissa (9), Ezra (6 I think), and Karis (4 I believe). They're actually looking for a teacher for a year to come down and live and teach, and are offering a stipend, so if you know of anyone looking to do some international volunteering who has teaching skills, you should let me know. These kids are awesome.....and they have sweet accents (they lived in England too for a while). Joyce made us chocolate chip pancakes and french toast, and we had fresh pineapple (OMG, I'm never going to want to eat other fruit in the states). We started to get to know everybody and Joyce and I talked a bit about the plans for the church. They really want me to help train the musicians for the worship service, mostly with some basics like starting in on the song together, playing the same thing, etc. Also with stuff like improving off of just chord sheets, and teaching them some new songs as well. Not sure quite yet what the hospital work will look like starting on Monday, but as much free time as I have, the idea of teaching music stuff is right up my alley and better than sitting around. Sounds like we will be busy with the hospital because one of the doctors is leaving on Monday and another one was recently airlifted out because his wife went into preterm labor. So, there's a definite need for Jason and I here.

We gave the girls a tour of the hospital complex after lunch and Ezra and Cherissa came with us to help show us around. We borrowed a laptop from Joyce to try to get access to some of the girls e-mails, but it was actually infested with ants and spiders......yep, inside the computer. They poured out of the headphone jack by the thousands. Welcome to the Congo I guess.

Nothing medical today. Doesn't sound like there were any emergencies or much going on with the patients, which isn't a bad thing. Tomorrow they have the church service, and we'll see if anything comes up. Monday we do rounds and the regular hospital work, and I know we'll be quite busy. Looking forward to doing as much as we can while we are here. So far already in the couple days I'm in Africa, I really really love it. The whole atmosphere here is just amazing, the people are wonderful, and the community the Harvey's have built is just tremendous. It's really great to see the kids who have grown up here, like Noah Harvey, and the amazing things they get to grow up doing without all the US distractions. The other Harvey kids are all back in the states now in College or beyond. Noah is fluent in Lingala and I think French too, which is also a definite plus. Speaking of which, Lingala is hard. That's all. I'm gonna try, but so far I've got Mbote = hello, malamu = good, azali malamu = I'm good, combo neyi nani (I think) = what is your name. None of that is probably spelled right either, but I'm working on it.

Anyway, aside from the mudding, a pretty uneventful day for me to share with you. The mudding really did take a long time, and the pictures will be fun for you to see once I'm back. Oh, I did just find the guitar, so I got it tuned and started playing around with it. It needs a bit of work that I can't do, and the action is a little rough, but it'll be enough to show them some worship songs, so I'm not complaining. They have a keyboard in the church it sounds like too. We'll see what the service is like tomorrow and I think they do some type of worship at night as well.

More than anything I'm just really glad to be getting to know everyone here. All of the doctors are so well versed in different things and practice outside of their residency training to fill the voids that exist. Like I said, Dr. Wegner is an ER/peds doc who is the main surgeon now. Dr. Harvey is a family med doc who also does surgeries. They've had training I think in the DRC from a surgeon, but still it's pretty cool and inspiring because I can see myself learning and doing similar. Sounds like they are going to teach me a lot too while I'm here and I'll get some great experience practicing some procedural stuff that I need to amp up (like spinals). We are just chillin' now for the rest of the night unless an emergency case comes in, otherwise I'll look forward to updating you tomorrow with the church stuff.

I'll just close with the bot fly. They are these flies that lay eggs in your clothes if you leave them out to dry at night, and then they burrow under your skin and grow inside of your skin. They look like an abscess or a boil.....until a bot fly hatches out of your skin. So basically, the moral of the story is don't leave wet clothes out at night, or you'll be hatching a visitor. I prefer to have things hatch outside of my skin, so I'll be grabbing clothes quickly :)

Thanks again for reading. The exciting things will start to happen again on Monday, but hopefully the cultural stuff is of interest to you and maybe if you are public health minded like me, it spins some wheels in your head.

Oh, and in case you're wondering, in general yes it's quite hot! Rainy, muggy, hot with mosquitos.

Congo Day 4 - Impfondo

Today is the day we set off for Impfondo.....finally. I guess the original plan was to fly up there on Wednesday, but after the craziness with that German flight, a lot of flights with Air France were cancelled. If you didn't hear, I guess a German operated flight crashed the other day killing over 130 people. I guess the co-pilot had just been fired and so when the captain went to use the bathroom, the co-pilot locked him out and crashed the plane. Something like that. Anyway, airlines in this part of the world are a little more cautious now. I guess you're only as safe as your craziest copilot.

Anyway, Reol made breakfast for us at 6am and we headed off shortly after. Adolphe, the travel agent, met us again at the airport and magically walked us through a line of people and got us right up to security. Not sure how we would have done it without him, so our $5 fee seemed no big deal. We made it through baggage check and security with no problems and soon were setting off on a small plane to Impfondo. And when I say small, I mean small and......old, like really old plane. Flight was only an hour though so not so bad. It reminded me a bit of the plane from Jurassic park, the one that crashes in the third one....and flying over the jungle made it seem more like that. And Kara (PA student) was reading a book from the 90s that talked about finding dinosaurs in the Congo....so it really felt like we might be flying into Jurassic Park. Sadly though, no dinosaurs yet.

I have to take a moment now to tell you about the baggage claim in Impfondo, as it is quite the experience. The airport is pretty much just a room to begin with, and you exit the plane onto the runway and walk into the room, but not before handing your passport to an armed guard (and you're hoping you get it back). Then, we watched as one guy took a handcart back and forth unloading the luggage. It was a good trek for each trip, so at first we thought this was going to take forever. Then another guy dragged a bigger cart and that increased the luggage amounts. They have a carousel, but it doesn't work, they just unload it from the outside to the first part of the carousel and then EVERYONE mad rushes it looking for their bag. Now, everyone who shipped luggage to Impfondo doesn't actually have "luggage," they have cardboard boxes, TV boxes, plastic bags, and coolers that are all packed with stuff.....and they all look the same. So it's chaotic to say the least. We had the only real luggage so everyone knew to pass the bags to the white people, so that helped, but our stuff was close to last. It took quite a while, at least an hour and a half, for the two guys to unload everything. I wanted to recommend that we just all get off the plane and grab our bag....but I don't speak French and they've been doing it this way for a while I hear, so unlikely to change on my opinion.

Sarah picked us up from the airport and drove us to the hospital. She's an older, gray-haired nurse who has been here for quite a long time from what I hear. They call her "mama Sarah." She works a lot with the leprosy population (home visits) and the pygmy groups. She's really quite awesome. Kara and Stephanie are staying at the compound with the Harvey's and Jason and I are staying on the hospital grounds in a guest house. Both places are quite nice. Ours has two rooms, one that I'm using and one that Dr. Keong is using, and Jason has a makeshift area with a cot (he's here for a shorter time so I got the room). There is a shared common area and kitchen and another similar set up on the other side of the house. We have our own bathroom and there is running water with a shower. They have a well and the water is technically safe to drink, but we filter it all for taste so it's not well water tasting (and I'd be nervous still anyway). The electricity is fairly reliable, and if we lose it during the day the generator kicks on around 6pm. The internet is only in one location, at the admin building, so I just have to walk over there and plop on the steps to upload all this to you all back home. It's slow, but hey it's WiFi in the Congo.

I'll be posting more and more about the hospital as we go, and today I don't have as much time to write because we ended up going into a surgery late in the evening. The patient had an intussusception (I advise google for an image, look for the target sign on ultrasound), which is basically when the intestines roll over onto themselves (think of a telescope closing, one part inside the other). Usually happens in young kids, but it's pretty rare in adults. There has to be something that the intestine catches on to cause it, and adults that usually means tumor. So this guy they identified it with ultrasound and we decided to do an ex lap, or exploratory laparotomy, to confirm and see how we could fix it. Basically means we cut his belly open and took a look. We found it and Dr. Wegner (ER-peds doctor who is the primary surgeon now.....you'll hear more from me about him in the coming days I'm sure) and did a resection of the large intestine at the level of the cecum and an end to side anastomosis, or basically cut out the bad stuff and reconnected the gut together so he can still poop. It's pretty cool, we pray before surgery in French with the patient, and prayed afterwards that God would bless the work. Similar to the DR, spinals are used for anesthesia. The case was a success as far as we could tell, and that about wraps up the day. Not sure what tomorrow holds yet, but I'm gonna hit the sack.

Congo Day 3 - "There is no try."

Last day hanging out in Brazzaville, so we definitely made the best of it. I got up around 6am and read a bit from a tropical medicine textbook, and Reol prepped breakfast for when the rest of the gang woke up. Kara and Stephanie, the two physician assistant students from Indianapolis, arrived last night, so we ate breakfast with them and then helped worked with Mr. Mbossa to get their money changed over. Much much easier today with the smaller amounts being changed. But yet again, the "ambulatory bank" showed up to give us the cash. I guess the reason is that the US dollar is pretty much worthless in the Republic of Congo, but over in the Democratic Republic of Congo they actually want the dollar (here they like the Euro). So, they go over to the DRC and get it changed over. So the guy once again started pulling money out of his sock and exchanging it....and he still had ours from yesterday, so we were shocked that he's just walking around with a couple grand in USD still. Must have a mean right hook. We also realized Jason speaks more French than he gives himself credit. Considering we speak none, and he was able to translate the majority of what was being said, we aren't letting him pretend any longer.

Once we finished with the money exchange we set off to explore Brazzaville. Thankfully Jason, Kara, and Stephanie were cool with just setting off with no real plan. I've been with groups before who are worried about wandering around a place like this and saying it's dangerous.....which I suppose it could be, but I'm usually not too worried. Anyway, we knew that if set off and took a right outside the compound, and took a left at the gas station, and then headed straight....we should hit more of the city. As Jason put it, it actually kind of looked a lot like Florida. Today was much cooler than yesterday, and there was a slight occasional drizzle that felt amazing. We decided to head towards the river, which when we found a spot to go through it was basically a construction site with a lot of garbage everywhere, so we didn't exactly get to show the girls the same awesomeness we saw yesterday. Not exactly the best place to hang out so we continued on. We wanted to get some food, and were hoping for some local "street meat," so we trekked on looking for that. We grabbed a couple of bottles of water from a small store and then found a woman hacking away at some "chicken" on a grill. We bought the chicken and some bread for a few bucks and Jason said we should look for a park bench to sit and eat. I replied that there was no way we would find a park bench in the Congo, let alone a park, that we could eat. So we kept walking with Jason insisting....and sure enough, a park. An actual park, with park benches. I stand corrected. We had a good chuckle and settled down to eat our street meat and bread. Talk about well seasoned chicken. I was tempted to go back and get the recipe, if I could speak French I guess. I suppose we shall see by tomorrow morning if we're all sick on the plane, but it was well cooked and tasted delicious, so regardless it was worth it. After that we started to head back to Hotel Bravo, as Aucolz was supposed to meet us in the afternoon....and we did find our way back, without too much difficulty really, so that was good. We got the hang of the street crossings too, which basically involves just walking across the street and putting your hand out to signal to the cars that they need to stop....and they do, oddly enough. I'm still alive, so I guess it works.

When we got back to Hotel Bravo we played some card games for a while, and Reol prepared some food for us. I've definitely eaten more here than I normally do. They mentioned we would likely lose weight, but I think I might gain some with all this food they keep feeding us. It's all delicious too. I'm going to be quite spoiled by the time I get back to the states. Soon after, Aucolz arrived (he's the resident from yesterday that showed us the hopsital). The guy is really a lot of fun, and quite a joy to be around. He hung out with us for a couple hours and we just chatted about this and that, he asked us questions about our hobbies and such.....it was great. It's awesome to meet people like him and build relationships around the world. During this time we found out that Ivonne, one of the girls who has been helping out around the Hotel, actually speak great English and is taking a college entrance test tomorrow to try to go to the US for school. She's really shy and has been acting like she didn't understand us, so once we found out we pulled her over to sit with us and we got her to start talking. They all at least speak much better English than we do French or Lingala (local dialect). This is where today's title comes into play. Aucolz asked me if I planned to learn Lingala and French during my month here, to which I replied, "I'll try." He responded, "There is no try, only do." I started laughing and asked him if he's ever seen star wars. He said yes, but didn't understand my reference. I told him that's what Yoda <(-_-)> says, so I told him "you are wise like star wars." So our slogan for our trip I think will be that there is no try.

Tomorrow we leave for Impfondo! We'll eat breakfast at 6am and head out around 6:45 for the airport. I think it's only like an hour long flight, so it shouldn't be too bad. But they are crazy strict on the kilos for the baggage, and they charge us per kilo over. Considering we planned for 50lbs each, and they want 44lbs, it'll be interesting. I'm going to try to load up on how much I can wear without dying of heat exhaustion. I don't think they weigh us, so we'll see. But really I think it's like only a dollar per kilo extra, so it's not the end of the world. We can try showing them the invite to the hospital and ask if they will let us slide by, but I hear they don't usually. Guess we'll see.

I talked with Dr. Harvey a bit today about the plans for the week for Jason and me. Dr. Wegner is an emergency medicine physician who also is the primary surgeon (so freakin' cool), so I'll work mainly with him. He'll be able to teach me a lot about emergency medicine in an international place as well as how he acquired the skills to do surgery so well. I'll also get to assist him with surgeries it sounds like. Awesome considering it's the best of both worlds for what I want to do in the future. I nearly did surgery for my residency, but decided the lifestyle and training requirements weren't suited for me accomplishing my goals internationally, and emergency medicine was definitely a better fit. Between my procedures that we do in the ER and getting the opportunities to do surgery in places like the Dominican Republic with the Rush group (check out my prior blog posts from our trips back in November/December....we did general surgery, orthopedic, and ENT/cleft lip and palate repairs), this is a great chance to see an ER doc who has been able to become well versed in surgical techniques as well. Jason will then work predominantly with Dr. Harvey, who is a family med doctor who also does a lot of surgical cases. He's the primary surgeon when no other doctors are around, and when Dr. Wegner is there, he handles mostly the cesarean sections. Jason is going into surgery, so any surgical cases will be of interest to him, but he's also expressed an interest in learning other techniques, like cesarean, so that he's able to handle anything he encounters overseas. Sounds like it's going to be a great couple of weeks and I'll learn a ton. Now just to hoping that the flight to Impfondo doesn't get cancelled for any reason.

That's about all I have for todays events. Just a lot of exploring and I think I've got some good pictures reflecting it. We are planning to set up a dropbox to share photos later since some of us got photos from different times, so I'll for sure be posting everything once I'm back. I think I'll have a day or two back in Brazzaville before I leave, so I hope to buy some sort of a souvenir to show everyone back home, I just didn't find many local shops during our trek....so I'll see what I can find. Might be able to find some cool stuff in Impfondo though. Until tomorrow......just remember, there is no try, only do.

Congo Day 2 - Brazzaville

Day 2 has come and gone, but not without its share of exciting events. Despite going to bed early to try to kick this cold, I was able to sleep through the night (well, I woke up every hour, but there was this epic storm....and I love storms) so I felt rather refreshed. Jason and I both got up around 6am. We chatted and read for a while and Reol made us omelets with sides of fresh avocado (it's avocado season here....enough said), bananas (also amazing) and bread with freshly made peanut butter (yep). Over the next couple of hours Jason and I chatted some more with Nastasia about all that's been going on in the Congo, more about her desires to do global medical service work, and exchanged ideas. It's been absolutely tremendous having her here with us.....not only is she great company, but she is extremely knowledgeable about everything in this area and has really been able to educate us quite a bit. And, she speaks French and some Lingala. She's Haitian, so she speaks the French rather well. Considering all of our hosts here don't speak much English, it's been a lifesaver. This morning we had our money exchanged as well.....which would have been an utter disaster if she wasn't there. In addition to the money Jason and I exchanged, and some money that was wired to us for one of the nurses here, we had over 4 million Francs.....so I can say I've seen 4 million money bills anyway :). They quoted us at a pretty good exchange rate and said they use the "bank of so and so," some guy on the street who can somehow get a better exchange rate. Honestly, if you're ever lost in the Congo, find this guy. He comes walking in to Hotel Bravo and starts pulling huge wads of cash out of his right pocket, then his left....a few minutes later, pulls another stack out of his sock. He was a bout a million short, so he's like "hold on, I'll be right back." He disappears and in 5-8 minutes comes back with more stacks of cash. It was pretty awesome. I wanted to follow him and see where he had his can buried! But at least I know, he's the guy with connections for sure. Counting all that money took quite a while, and it was great to have Nastasia there to help translate all their questions and confirming we got the right amount of money.

A couple hours later we went off with Honore and Nastasia to see the Cataracts, which is where three different rivers all form into the big river that separates the Republic of Congo from the Democratic Republic of Congo. I can't remember the names at the moment, but I have a video where Nastasia explains it, so I'll post that when I'm back with the river names. Pictures are going to be worth a thousand words here, so I'll do my best to explain the journey until I get back to the states and can show you them. We will have some WiFi once we hit Impfondo, but all my pictures are on my camera and I don't think it's fast enough to upload all of them anyway. So Honore drove us there, which was great because he knew exactly the best place to go, and we found a lady who said we could park on her lawn for 1000 Francs (560 per dollar, so little less than 2 bucks). There is a great beach area and a bunch of really rocky areas all around. During the rainy season, everything in the area is covered with water and blends the rivers even more. The rainy season starts right about now, so it was pretty perfect timing for us to be there in order to see it. We could kind of see the main river from a distance, and then Honore came up and said he found a guy who would take us across the river closest to us in a "boat" for 5000F. It was like a small canoe, with the 3 of us in the middle and 2 of them on either end (standing) and paddling. Pretty fun, and I have some videos and pictures to post later as well. Once we were across the river, we started our trek. The guy asked if we wanted him to be a guide for us, and at first we were like oh no, we'll be ok (thinking he would want more money). But as soon as we started walking the wrong way, he just signaled to follow and so we did. We followed a "path" through the sand....which just looked like regular old sand to me at first, but after a while you could start to realize it was kind of a path. Then we approached the giant rocks. More like big boulders that damned the rivers from each other during the dry season. They said something about wanting to remove them all.....but you would need some crazy heavy machinery, so I don't see that happening. There were white arrows at this point along the rocks that guide you through so you know which ones are stable. This guide dude was like a spider monkey, just gliding through the boulders in his flip flops like it was nothing. Jason and I both had hiking boots on, so it was pretty easy. Nastasia had flip flops on as well because they told her prior to leaving, flip flops would be totally fine......I don't think they realized she didn't have spider monkey in her blood. We helped her along and trekked on for a good probably 1/2 mile to mile through the rocks. And wow, what a view. Across the river you could see Kinshasha, DRC (which is where we had our really short layover), which is pretty built up and a nice area for the rich. Being upriver, they don't have any problems with flooding like they do in the Congo during the rainy season. It was a crazy awesome looking rapids, and I asked if anyone went rafting down it.....and the guy was like, um no? There was a giant ship wrecked right in the middle actually, so I guess if a ship couldn't make it, probably a raft was a bad idea, but had to ask. All in all it was a great, once in a lifetime experience for sure. On the way back we talked a bit about how it's really untapped potential, like most of the resources in countries like this. In the same way that they don't export really any of their amazing fruits/veggies, all along the boulder path you noticed garbage and lost items, and they really didn't utilize the power of the river or the potential for tourist attractions for such a great spot. I'll come back to this a bit later, because it did inspire some ideas.

By the time we made it back, we were realizing the full extent of just how hot it was, and we were quite thirsty. Glad I wore long sleeves though and my Tilley hat, because I didn't get burned. We stopped at a Pharmacy after that so I could by a Z-pack. At this point my chest has been burning so bad, I've been coughing like crazy, my throat is raw, and my chest has been so tight it's hard to breathe.....so Nastasia was like, we should get a Z-pack now. The pharmacy sells antibiotics over the counter actually, and even though it was 3 times the amount of money it would have been in Impfondo, it was worth it. Hopefully it knocks this out and by the time I get to Impfondo I'm ready to hit the ground running. We grabbed some water from a next door shop and headed off to the University Hospital in Brazzaville. Dr. Harvey set up this great experience for us and connected us with a resident named Aucolz. He's a 2nd year general surgery resident. Really quick I'll explain their education system, since it's a bit different than ours. In the states you do 4 years of college, 4 years of medical school (in my case throw a masters for 1.5 years between), and then a residency. General surgery is 5 years, and emergency medicine is 3 years. In a lot of foreign countries, it's a bit different. So here, out of high school they go into an 8 year medical school program. During the 7th year they are considered interns (which is our first year of residency), and then their 8th year they do a research project and present kind of like a dissertation almost. Then they jump into residency from there. In Aucolz's case, he had just graduated last November and started his 2nd year of residency (because they do the intern year in medical school year 7). Hope that made sense. Anyway, he met us out front and he speaks pretty good English, though we still had Nastasia to translate quite a bit for us, when needed, so that was awesome. Aucolz brought us into the conference room where the surgery attendings, residents, and interns were having an educational discussion. He introduced us and introduced each of them, and they seemd quite happy to meet us. As they went through their educational session, Nastasia translated the gist of the teaching point, which was largely centered around hernia repairs, open vs. laprascopic, mesh vs. no mesh, strangulated vs. not. The interns were lost on what a strangulated hernia was and it seemed like the head surgeon was chewing them out a bit....so glad nothing changes in different countries haha. After the session finished, Aucolz took us on a tour of the hospital, which was pretty amazing overall. It's very open, with all the connecting hallways being exposed to the outside (couldn't really do that in Chicago, there would be snow everywhere sadly). It had a great feel to it. In the ICU, outside on all the doors they had fresh flowers hanging. Since we weren't in scrubs we couldn't go into any of the operating rooms to see them, but we got a pretty good idea of what things were like. Things work a bit different at the hospital, namely in that usually if you cannot pay you cannot receive treatment. There are a few exceptions. The absolute exception to the rule is a C-section. They realized too many pregnant mothers were dying and so they made an adjustment, and now if you come in emergently and need a C-section, you absolutely get it no matter what. Other emergency type situations, say like appendicitis, or head trauma, that requires surgery, they will do the surgery but you are required to come up with the money before you leave the hospital. This is similar to the way that Dr. Harvey does it in Impfondo. There, if you don't have the money, they will still do things if it's urgent, but they can actually hold you in the hospital until you pay them. Overall, things are relatively cheap. An MRI only costs $300 USD, and a daily stay in the surgical suite costs $12 USD per. If you've ever gotten an MRI or stayed in a hospital you know what I mean. But for a lot of people it's astronomical still. If it's not an emergency situation, and you can't pay, then they for sure won't do anything.

As we were getting ready to leave the hospital, we passed by one of the peds/neonatal areas, and this guy had just lost his baby/young child. He was walking up and down the hall screaming in despair. It was a rather sad moment. To perhaps make it worse, we watched as he had to carry his dead child out of the hospital and got into a taxi. It was the same when I was in Haiti -- if a family member dies in the hospital, you take the body with you and make arrangements. Pretty different from the US. I can imagine losing a child is heart breaking, but I can't imagine it helps to carry the dead body out with you into a taxi. With that, we said our goodbyes to Aucolz, who informed us that he would stop by Hotel Bravo tomorrow to visit with us. He's a cool dude, so I'm looking forward to it.

We got back to Hotel Bravo and Jason and I grabbed our stuff and were going to head out to look for some dinner. Reol said that they made some extra and we could just eat there, so we figured why not. A couple minutes later a huge storm hit and rain just poured down.....so we were happy. We would have been drenched with not much guarantee of finding food at that point. After dinner I had to go turn in and rest. Really trying to kick this illness now, and on top of that had a bit of a migraine today. Started the Z-pack and hoping that it helps to knock it out. At least I remembered cough drops this time....provides at least a bit of relief for the raw throat.

Before I close out for the day, I wanted to touch on something briefly that we discussed with Nastasia, which is in regards to farming, or really the lack thereof. I guess in the Congo, it is really considered an unlofty thing to be a farmer. Everybody wants to get an office job of some sort, because they think that's what westerners would consider important. What's sad, is that their land is prime for growing all sorts of fruits (papaya, pineapple, bananas) and avocados, etc. If they could see the potential for growing/farming and starting to export, they could really turn the wealth of the country around. Now, I'm not sure how much politics plays into this either, but even locally, they will line up on the river and buy stuff from the people of the DRC rather than grow it themselves. It's really a shame. What we were discussing this morning was ways to implement sustainable health care, and one of those being to find a way to increase the economics of the area and help fund a clinic. I suggested giving a couple money to help them start a farm, tell them we would take a percentage of it which would go to fund a clinic, and as it started to grow and they saw the financial potential, maybe it would even inspire others around. Nastasia said it might work, if you gave the money to a woman in the area. The men are very against farming and it is a lowly position in their mind, but a woman might be willing to give it a try. Just thinking of ideas for the future, but if in a region like this you could find a few that would be willing to at least try it, it could just work. Again, I suppose it would depend on the politics, but I think part of any type of long term medical care in a country is getting in with the political officers and making it beneficial for them as well. It's all a work in progress, and feel free to add some comments at the bottom if you have any suggestions. I really want to implement sustainable health care, and influencing the public health is key (clean water, building the economy, etc).....and I'm more than open to input. So please utilize that comment box!

Thanks again for reading!

Congo Day 1 - Travel

It's finally arrived. It's kind of crazy how fast time has flow by since I planned this trip, and it almost doesn't feel real....though I'm sure when we land in Ethiopia it'll hit me that I'm actually, finally IN AFRICA! I've really dreamed about this moment since I was a kid and we sent those shoeboxes to the boys in Malawi and Sierra Leone. It's a surreal experience knowing that I'm finally getting to go and work with the people of such a tremendous place. To update you on some general things, I just matched into Emergency Medicine at Henry Ford Hospital in Detroit. To know that when I get back, I graduate from medical school and can begin my training as an ER doc....pretty cool. I'm going to learn a lot and be able to make that much more of a difference in my future. This trip is going to really lay some foundations I think for both becoming an ER physician and a global health adventurer. I don't know about you, but I love being in a new environment, unfamiliar culture, surrounded by people of different colors, who speak languages that are not my own (and that I do not understand). For one, it helps me to understand my patients a little bit better -- doctors consistently speak in a language that is unfamiliar to their patients. "Your WBC is 14,000," or "Your MRI shows an infarct in the left MCA region".....some are better at interpreting that for patients, and some are not. Anyway, this is kind of a tangent, but that's one of the reasons I love it. The other is that the world is such a vast, amazing place filled with variety and unknown -- and most people never experience it! Right before I left I was talking with a friend and I brought up an experience in the Dominican Republic where I was working with an otolaryngologist, and she said something about wishing she had cool stories about her world travels to tell people. I'm fortunate that I've been provided with the experiences via the support that all of you who are reading have given us. And, more importantly, we can extend those experiences to other health care professionals now and really start to make a difference in the world. This spring alone MACI is supporting 10 other medical students on trips to India, Dominican Republic, Congo, Philippines, Korea, and Peru -- that's insane to me. The quote that I've based my organization around is by Mother Teresa, "I alone cannot change the world, but I can cast a stone across the waters to create many ripples." Well my friends, thank you so so much for the support because we've dropped a boulder into the global health pond this spring. Now, many of you may argue that we are wasting our time....you know, because we are only going for "short term mission trips," and we are getting more out of it than the people we are helping. Two responses for you in utter disagreement, and maybe I can help change your mind. 

1) We are laying a foundation with the health care workers that we are sponsoring and giving them a knowledge and experience base from which they can continue their global health work in the future. Every single one of the people I have worked with overseas has come back changed, and most importantly, wanting to go back and find a way to make it part of their future practice. Maybe they don't want to go back....but they'll support it because they see the value in it. So, maybe that first trip they don't change the entire country, but ripples my friends, ripples. 

2) Have you ever done the smallest of deeds and seen an impact beyond your wildest dreams? You know, like when you bring someone coffee in the morning and it somehow changes everything for their day? If not, try it. If you have, then you're on the same page and keep following me. I'll be in the Congo for a month, some people will be on their trips for a week, two weeks, or longer -- either way, yes you can argue these are all short term trips. However, I have no idea how many lives I might impact during this short one month. Maybe it's only one....maybe I do something for one person and it alters their life.....WORTH IT. I hope you think so too. I've seen that on prior trips, or with the patient that I still e-mail from 2 years ago. Ultimately why this matters is because I believe in sustainability. It's what separates MACI from other organizations in general I think. We want sustainable health care in countries that don't have it. I want to develop a model of how to do that and start implementing it around the world. Well, to do that I have to experience what's lacking. Maybe it's the public health side of my mind more than the medical, but I don't walk into a country expecting to change things in a moment, I see a big picture....maybe years down the road. I do believe that the experiences, connections, and partnerships that come from these trips are....yep, you guessed it, ripples :)

Okkkk, I'll get off the soapbox and back to my current trip! So Jason and I left this morning at 3:30am for O'hare (thanks to my dad for driving us...he's taken me to every trip and most of them are at the crack of dawn, so he rocks) and we took our flight to Washington. Of course it wasn't quite that smooth.....they did revoke Jason's ticket because they said they didn't get the fax confirming his credit card, and they couldn't find my reservation....but we eventually got it straightened out-ish and flew to Washington. We had to exit and grab his bags because they couldn't check them straight through. By the time we got finally checked in by the no-rush Ethiopian airlines, we were well past our boarding time.....luckily, they don't board on time either. I will say that once boarding the airline, I'm extremely impressed with Ethiopian airlines. Super nice actually. Jason and I got put in the same row, with no one sitting between us, and they served us 3 meals during the course of our 11 hours. Pretty good too - some chicken/mashed potato meal, chicken sandwich, and an omelet. Airline is quite spacious and open feeling, so it was an overall pretty comfortable flight. The pillow, blanket, toothbrush and.....socks that they gave us were perks too. Don't really get the socks thing....they're bright yellow, and....socks. I was hoping not everyone was changing their socks on the plane, though maybe the ventilation is good. 

We arrived in Ethiopia and had about an hour and a half to chill as we waited for our flight to the DRC. You depart the plane on the tarmac in Ethiopia, and then they drive you to the airport. We all boarded the bus....and they drove about 20 feet and let us off. Everyone had a good chuckle as it took longer to load and load everyone than to drive. You had to leave security to go look at any of the airport shops, so I left Jason with the bags and went perusing. My nephew, Isaac, is adopted from Ethiopia, so even though I would only be there for an hour and a half, I wanted to snag him a gift....and something for my living room too. Good thing I left the bags with Jason because they were a bit more strict coming back through security and prolly wouldn't have let me take what I had with me as far as a carry on and a small bag (some of these airline restrictions are strangely annoying). The flight to the DRC was about 4ish hours, and after the 12-13 hour flight from Washington to Ethiopia, I was starting to feel the blood clots form in my legs (sarcasm) so the walk around the airport felt good for the ol' circulation. We were in Kinshasha in the DRC for about an hour sitting on the plane and then took the 7 minute flight to the Republic of Congo, Maya Maya International airport in Brazzaville. I didn't hear them announce it was 7 minutes so when we took off and then started to land I thought maybe the plane broke....but everyone applauded as usual when we landed (at least they do that overseas from my experience) so I figured we must have been somewhat ok. 

The first stop was the EBOLA screen. A nurse just scans your forehead to see if you have a fever. Now, right as we began our journey I started to come down with something, and by this point I had a deep burning sensation in my chest and was hacking up nasty green phlegm and had a headache....so I was mildly worried I'd have a fever and they would detain me, but I made it through. Then you fill out your documentation and proceed to the other medical check where they make sure you have a yellow fever vaccination card. The next stop was with the police dudes, and I was really expecting this to take a loooooonnnnnngggggg time.....but actually ended up being a few minutes and they passed us on our way. The letter that Dr. Harvey sent us, which invited us to work at L'Hospital Evangelique a Impfondo definitely helped.....it looked super professional and I'm guessing they've seen it before because they took the letter and didn't ask us a single question. 

At this point, Adolphe was waiting for us right outside the police stop, and he directed us to the baggage claim and helped us gather the luggage.....and score! We got everything. We had 4 bags in addition to carryons filled with supplies for the hospital, and considering we had to check them in at different hospitals due to the ticket revoking, I was pretty surprised. The next step though was the most terrifying.....running the luggage through the customs scanner. One of the things we were bringing down was a coagulation testing kit, which was a bunch of boxes of lab equipment in a giant styrofoam container with an ice pack on it....looked sketchy if you ask me. And a transformer (not the like Optimus sadly), and some other big scary lab stuff. I really expected them to detain us and ask us questions and see what we had, etc. But nope, walked right through. Maybe they knew Adolphe or something.....

There was a van waiting for us and we headed out to Hotel Bravo, which was a couple kilometers away. Dr. Harvey called us as soon as we arrived and let us know that he was setting up some opportunities for us the following day to see the university hospital, as well as a patient who was being transferred out for open heart surgery. Should be great. As I've harped on how much I want to impact the sustainability of health care in these countries, I need to see what the health care options are to start. Nastacia is a med/peds resident from OSF/St. Francis in Peoria who was at Hotel Bravo when we arrived -- and she spoke English, yay! Pretty much the whole afternoon she just gave us loads of information about the Congo, DRC, Rwanda, and the cultures/people within. Awesome to hear about these people and start to get an understanding for what we will be dealing with over the next month. Sounds like a couple of the doctors had to leave for personal medical reasons, so there might actually be more of a need for us to be here now. From what I can tell, the typical things we are dealing with is really malnourished children (kwashiorkor vs. marasmus), worms, cholera (or other nasty things from lack of clean water), malaria that is realllly bad (like kids seizing bad), leprosy in the pygmy population (one of the nurses does home leprosy visits, so that should be cool to see), and your typical other tropical type diseases....but sounds like everything is pretty far progressed. One really interesting thing for a public health minded brain, and maybe otherwise, is that the government reported HIV rate in Congo is 2%. However, with the number of pre-testing they do for blood transfusions (if the malaria is so bad that the hemoglobin is 2-3, they transfuse, and then 2-3 family members have to come and replenish the supply) they have identified that the number is more 5-7%. I feel a paper coming on.....maybe if I had more time/had more know-how into writing a paper, but I think this is interesting for several reasons. First, is this actually known and it's underreported for some political reason, or is it not known except by those identifying it. Second, it drastically affects sooooo many different aspects of their care and the real question is how do we stop it before it happens (birth control/condoms isn't really much of a thing in the country). Thirdly, this points to the fact I think that there are opportunities for scholarly work in third world countries that might influence even our health care....again, I'm pretty terrible at this point when it comes to scholarly work, but sounds like there are possibilities here to me....maybe in the future I'll learn more on how to contribute in that way. 

I felt pretty terrible after we ate dinner (which was amazing by the way....some Senegal style food that Reol cooked for us), and I went to lay down. This cough and migraine now is getting annoying, so I'm popping pills and hoping for the best. Jason headed off to find a phone card and check in with his wife, so I'll hear about that tomorrow. They are supposed to cook breakfast for us and then I'll see what the plan for the day is. I really want to explore Brazzaville a bit....taxi ride is $2 only, so no excuses. We have a couple days as our flight to Impfondo isn't till Friday, based on scheduling, and we are meeting with 2 PA students from Indiana as well, so the following days should be fun. As always, thanks for reading, I hope you enjoyed :)

Aaron Tabor, MPH

Founder and President

Make A Change International, Inc

aaron@makeachangeinternational.org

info@makeachangeinternational.org

www.makeachangeinternational.org 

708.580.MACI (6224)