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.
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