Good day today - no one died, had good fellowship and conversation, ate some good food, went to the market, and did some plastic surgery. Maybe I should say "plastic surgery" to not offend any plastic surgeons who may read this.....we'll get to that soon.
Today is a holiday in the Congo. The day after Easter....so somehow a holiday. I guess it's like how I say the day after SuperBowl Sunday (probably the biggest national holiday and the day 2/3 of all avocados are sold....which after living in the Congo and eating avocado every day, I think I'm definitely deciding that statement is false....anyway) should be a holiday so you can digest all the food and drink from the glorious day. But, they get the day off here so the hospital was a bit sparse with staff. We didn't have chapel or morning report, so we met up with Dr. Wegner at 8am to round on all the patients. Pretty good overall, all the patients were doing fairly well and as I said, no one died.....yet. There was a premature baby born who is like 1 kilo, so we have low hopes of him surviving. I think Dr. Wegner said the babies under 1200 have never survived (which is just cause the smallest baby that has survived here was 1200g). He's super tiny and was delivered last night, and the fact that he's holding on for the moment is impressive. We've got him on CPAP, so we shall see. Dr. Wegner mentioned tonight that if anyone was going to die tonight, that's whom we expect. Kind of depends how the generator holds up too with the power fluctuating at night. Anyway, back to rounds. We had one little guy who we thought might have meningitis, so Kara did a spinal tap on him, and did a great job too. She was excited because PAs typically don't get to do lumbar punctures unless they work in specific fields, so it was good for her to have that opportunity. Stephanie also did a pericentesis (drained fluid out of a belly) on a young woman (I think 27) who is super sick. She had tuberculosis that messed up her lungs super bad, which caused problems with her heart, which is backing up into her liver and causing her belly to fill up with fluid and overall just killing her. I don't think they really expect her to survive very long. She's the one we built the mud hut for last week, and I'm not sure when they plan to transfer her over there for more or less hospice care. They drain her belly pretty frequently and usually take out about 4-5 liters of fluid each time. Stephanie also did a great job with that. There's no lack of procedures and it's definitely made me realize for sure that I chose the right field in emergency medicine. There's so much bread and butter medicine you have to do, and so many procedural techniques that you need to feel comfortable doing, that just as a student of emergency medicine up to this point I feel pretty confident. I'm sure after 3 years of residency and however many years of practicing it independently, I know I'll be well equipped to work wherever.
The rest of the patients were pretty straightforward. We ultrasounded a few pregnant bellies, and discovered some were no longer pregnant (one patient popped a couple Chloramphenicol tablets to try to induce an abortion as she already had 9 children, others were spontaneous). Afterwards we had the Inaugural Resuscitation Training Committee Meeting, at least that's what we called it to feel special. Basically we are going to try to teach some CPR to the nursing staff here. They don't really understand what CPR is apparently, and when we do it they either wonder why we are pushing on the dead body, or they don't seem to realize that the person is already dead. They actually have 3 mannequins here, which is awesome. We were trying to figure out how to make a mannequin the other day. Someone recommended a bed sheet stretched across two chairs, I advised killing a chicken and using it's corpse, or using Jason (but he's leaving). But we have official training mannequins, so all is ok for the chickens of Impfondo (at least until we fry them and eat them again). Dr. Wegner, Amanda (nurse), Jason and I discussed what parts of BLS we wanted to train them, came up with some catchy Red Cross type slogans in French to teach them to remember the steps, and what song we wanted them to sing to get the rate of 100 per minute right. The big problem I guess is that they've had the nurses start CPR, but then just stop and leave to go get someone or do something else, and they don't realize what they're doing needs to continue without stopping. So that's step one, the importance of CPR and how maybe we actually save someone in the future with practice. I spent part of the afternoon searching through the medical container looking for ambu bags to ventilate, and found them after realizing I was just blind and missing them (first I looked in the wrong container and found the EBOLA protective equipment anyway, so I know where that is (there's no EBOLA here though, no worries). I also talked to Victor, one of the Hong Kong Team members, who is THE "IT" GUY, and he was able to download the Stayin Alive music video from 1977 from YouTube (don't ask me how), so we can show that. It's what we use in the states to remember the pace of 100 per minute. That or "Another one bites the dust," but "Stayin Alive" is a bit friendlier. They'll enjoy learning the American song I hear as well, and will find it funny when we translate for them, so they should remember it. And watching the video will probably be hilariously awesome. We are planning to do our modified BLS classes on Thursday and Saturday, and then test them the following week. So I'll lead one of the classes and likely Charles will help translate for me. Should be a lot of fun.
I ate lunch at the Wegners afterwards. I stopped by looking for Jason and Anna invited me to stay and eat with her, Stephen, and Amanda. Fried ham, avocado salad, bread, cucumber/tomato salad, and fruit. Also delicious. Anything with meat and avocado makes me happy, and I hadn't eaten a good amount of meat in a day or so. It was a great time of getting to know them better. I actually stopped by later to look at a textbook for a procedure, and Anna asked if I wanted to eat leftovers for dinner too as I waited for the patient to get prepped, so I ate dinner with Anna and Stephen, and got to know them better too. I told them since Jason is leaving I will probably be crashing their house more to hang out cause I'll be bored and lonely. Dr. Wegner said "anytime.....well, within reason obviously." I asked if we could start up the 6:00 morning runs that Jason mentioned. Ok, story time I guess, since I can't remember if I mentioned this. A couple days ago Jason asked Dr. Wegner what time rounds were the next morning. Dr. Wegner for whatever reason thought he asked him if they could go running tomorrow morning, to which he responded with, "um, sure yeah we could go for a run tomorrow morning." We were all like, huh? Once we realized the confusion we had a good laugh, but mostly because he was even agreeable to going running with Jason in the morning (they didn't go for a run by the way, we all thought that sounded like too much work, especially in this heat). So I made a joke about it tonight and he laughed and said sure. Though again, I'll forego the running in this weather. Although it didn't storm pretty good here tonight, like the curtains were blowing like crazy and the doorway flooded.....I love storms and these are pretty epic.
Anyway, the patient we were waiting for was my "plastic surgery" case. Apparently the woman is 1/4 of this guy's wives, and their family unit had a dispute and one of the kids of another wife hit her or threw something at her, splitting her nose and lip open. It was a good gash. Left nostril, split open through the cartilage. The lip was cut right through the vermillion border. So good approximation of the edges was key so that she looked relatively normal afterwards. Normally the nursing staff here stitches things up, and they charge about 5000F, but if they have to call in one of the doctors because it's a more difficult repair, it's 15,000F (like 30 bucks-ish). So we were waiting for them to figure out the money and agree to pay it before we fixed her. I joked that we flew in a plastic surgeon all the way from Chicago to fix her face (again, no offense to the plastic surgeons out there, you guys rock), and I started to fix her. It actually went together quite nicely and both Dr. Wegner and I were really pleased with how the repair went. Sadly because of the rain I had left my bag at home and didn't have a camera with me to take a picture or the before and after because it was pretty gnarly to start. We had to figure out how to numb her and ended up trying to numb branches of the 5th cranial nerve, which I'm not sure worked entirely well since she said "ow" the whole time I stitched, but I tried.
Jason and I also went to the market today again to look for some fabric to make scrub caps. We thought that would be a cool thing to have as a souvenir. He's going into general surgery so more for him than me, but I do surgical stuff when I go overseas, so it's cool to have. We found some of the smaller pieces of fabric and some cool patterns and bought some to make the scrub caps, and maybe a bag or two. Jason had to take back his making fun of us the other day for spending so long looking at fabrics at the markets when he realized just how many there were, and how cool so many of them were. We bought three different patterns that were pretty sweet, and there were others even that we thought were cool too, so we had to narrow down and pick. We also went back to one of the stores to buy a coke, and they tried to charge us 800 for one coke. We asked how much the 12 pack was and they said 4000F, which is like 333F each, or about 60 cents. So much cheaper. So we bought the 12 pack and even though Jason is leaving, I'll have coke to drink now for super cheap (here anyway).
After I finished up the evening playing plastic surgeon I stopped at the Wegners to borrow a head lamp, and Sarah was there and offered to give me a ride since it was raining pretty good still. Also, someone had just baked some cookie thing, and it was still warm, so they gave me a whole pan to bring back to our house.....I ate them all on the way over in the car. Actually not, but I thought about it. And they were delicious. It's some kind of oatmeal chocolate cooking thing, hard to describe, but it's tasty and sweet. That's about it for the events of the day. Jason leaves tomorrow morning around 9:30, so that'll be lame, but he's got family to get back to so I can't fault him. I said I was going to try to find a way to cancel his flight so he could stay two more weeks (Sorry, Jess). At least I get the bike that works now. When we rode to the market I borrowed Henri's bike, and as soon as I started riding it the back tire went flat. I was like oh great, I had it for 3 minutes and got a flat tire. So I took it back and asked for a pump and he was like, oh yeah that tire leaks, I forgot to refill it. So phew, not me. Anyway, the other bike Jason and I fixed up a bit is pretty good, and has brakes, so I'll keep using that. Sarah uses it sometimes too, so I just have to find it if she takes it, but it usually hangs around the house where I'm staying.
Thanks again for reading!
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