Day 16. Definitely the longest I've worked in another country, and I still think I'm just going to start to feel like I'm getting the hang of things when I'm going to have to leave. A week and a half left, which really doesn't seem like much. Considering more than half the trip is over already, it's a bit strange. Starting to reflect on what I've done already, and thinking about what I'm hoping to do during the remainder of the trip. Dr. Wegner has been a great teacher and I've really started to get a grasp of the way they practice medicine here in the Congo, which will translate well into many other countries considering the tropical medicine style is pretty similar. I have a trip planned to Honduras in the first week of June, which I will be doing with Dr. Pilch (my ER mentor in the states) and Global Brigades. We'll have a group of pre-med students, and it will be my first official trip as a medical doctor, and I think they are working on getting me licensed to practice independently while in Honduras -- though I'll still have Dr. Pilch to consult with. So this trip is going to be great for moving forward and the things I'll see in places like Honduras. Procedurally it's been great, and even things that I will do in my residency in Detroit I'm starting to do here a bit. The surgical stuff not so much, as I'm not a surgical resident, but I still love the exposure and learning to do that stuff as I hope to incorporate into what I do overseas in the future. But chest tubes, lumbar punctures, laceration repairs - typical stuff you might do in an ER - as well as just diagnosing various conditions, stabilizing really sick patients, and trying to resuscitate those without a pulse - which there is no short supply of people (mostly children if you've been reading) without a pulse who we try to bring back with CPR (and drugs).
Hard to say really what the next week and a half will bring, though I am working to set up to go with Sarah Spear on some home visits to check on the leprosy patients and whatever other conditions she treats. I need to figure out the best day to do that, preferably one where it's a bit slower here at the hospital. That'll be cool to see though and it's again more of a public health type thing for me. Even seeing where and how the Aca people live in the forest areas, great public health experience. I'm trying to get a good grasp on the basic way of life of the Congolese and assess what types of ways public health could influence their long term medical health. Considering malaria is pretty preventable, and we have been watching children die frequently due to malaria, there is definitely something that needs to be done. I know a girl who was setting up a study with introducing some kind of spider that just eats mosquitos into a village and seeing how that helped.....maybe that'll be the answer. Maybe they don't use mosquito nets at home, which is super easy to change -- at least I think it should be, considering they use them when in the hospital, so there isn't an obvious objection to sleeping under a mosquito net. Maybe there's a way to get them on long term prophylaxis, but that's expensive, so a bit tougher. I think the hardest thing to change is that they prevent so late to the hospital for most of their conditions. Many will try the traditional healers first, which don't typically help and often cause worse problems, and then they come to the PCH hospital pretty much beyond the point where we can help them. Then they get worse or die, and then the American hospital is blamed because Western medicine is what killed them. That's then trying to change an entire cultural perception of medicine and trying to change an entire cultural perception of what their traditional "healer's" value is, which may not be doable. Again, I don't like trying to change cultures, unless it's harmful, but in this case, I think there are some cultural things that are actually harming and killing people, and I would like to figure out a way to influence change.
Today we rounded with Dr. Kiong as Wednesdays are Dr. Wegner's day off. Pretty quick rounding day overall. Most of our patients are doing pretty well, though that premature baby didn't look so good this morning. His belly is getting distended, he is jaundiced, and he was vomiting up a couple times, which worried me for him aspirating. Dr. Wegner was going to go take a look at him still since he is the pediatrician, so I'll have to check in, but it's looking like he isn't going to live very long. We had a new patient come in with fever and shortness of breath, and they started treating her for pneumonia. I took the ultrasound later and looked at her right lung, which sounded diminished, and there was a lot of fluid. We stuck a needle in and......PUS! Yay, good ol' pus again. So we had Stephanie the PA student do the chest tube and we drained out about 2700ml of pus. We drain it into a urine bag, which was apparently open when Jason attached it and we didn't realize it, so for a bit there we had a lot of pus going out the chest, through the tube, into the bag, out the bag, and onto the floor. Yay pus everywhere! I like pus to be in bags or tubes typically, not on the floor. But hey, I was glad I didn't mess up my ultrasound and read it wrong, though with that much pus, it would be hard to screw it up.
We ate lunch at the Wegners today with Dr. Kiong, and we had a special treat: MANGO. Mango season is just starting, and even though the mangos on the tree aren't quite ready, Anna did find some at the market. The Wegner children were all calling us mango thieves, and they didn't seem terribly thrilled we were sharing in the feast of their mangos. But there was enough :) It wasn't even completely ripe but was still better than mango you get in the states. Pair that up with some fresh pineapple (which is far better than any in the states) and you could have stopped there for lunch. But we had some rice and pork stew as well, which was equally delicious.
Some of the staff here are still feeling sick, and I've had a migraine for the past couple days, but everyone pushes through without saying much about it. Hard to complain when you have patient's dying of malaria and aspiration. The migraines suck, and the heat doesn't help, but I've been functional enough with the migraine meds, but if you feel like praying for me to keep pushing through it would be appreciated. Continue to pray for the rest of the staff here too that aren't feeling so hot (well, we all are feeling hot, but you catch my drift).
This afternoon at about 4pm we had our second team meeting. Well, my second team meeting, they do them every week. Just sharing updates about the travel changes, how things are going with everyone, health status of different people, etc, The Hong Kong Team gave some updates regarding the internet and the power as well. Seems they've been able to do quite a bit in their short time here and the internet should really be working much much better moving forward. The main issue now has been with the power, generators, and batteries, so we'll see how that all works out. But they've set up a good system with it storing some info in a cache so they aren't reloading the same information constantly, and have been able to relay the WiFi to different buildings that needed it. Good to have people come down with great IT experience who can do the things that seem impossible when you don't know what you're doing.
After the meeting we found out that our premature baby died about an hour before. The generator was having some issues and shut down for a bit, and because he didn't have oxygen, he died. We knew it was going to happen sooner or later, just a bummer that it happened because of lack of oxygen secondary to generator failure.
I've been thinking a lot about the long term sustainable aspect of what we are doing. Right now it's a little depressing as it doesn't feel like we are making much of a difference. It's hard when you come for such a short period of time, and even with a month, it's still not anything close to long term or sustainable-inducing. I was just talking with Dr. Kiong and Jason about this and saying how I have to think in more of my public health mindset when it comes to this and realize that it's a bunch of small steps leading to a long term goal of sustainable health. In this case, each trip we do, each experience, each connection builds a bridge to a more sustainable system for Make A Change International as an organization and for me in what I want to do in global health. I think as long as I focus on the big picture and keep moving towards that goal, I can hang on. As I've said before, being in a place like this, seeing what I do know and what I've learned, but also realizing the gaping holes in my knowledge and skill sets, I am excited for residency where I can hone those skills. Today was tough as I was sitting there listening at the team meeting and just thought about how I wish I could just stay here and keep helping, finding ways to increase what they are doing, gathering funds to help support the medical work here and maybe stop death from happening because of lack of supplies. But then I thought about how this is just one place. It's one town. It's one country. It's one continent. Our goal is to make a change across the globe, and I have to keep thinking big. Yes, I want tangible goals, and this is a great place to stay connected with to make something tangible happen. But, it's scary when you start to think about how this is still just one place, and even if we set up the most amazing sustainable health care system here, there's still the next town over, or the other African countries where people die because of lack of supplies. It's overwhelming. I'm not quite sure how to deal with it right now, except for focus on the bigger picture, and try to be that rock in the water causing a ripple. "I alone cannot change the world, but I can cast a stone across the waters to create many ripples." - Mother Teresa. That's what I have to focus on. It's not easy, in fact, it's really really hard. I'd appreciate your thoughts if you have them. Feel free to comment below or shoot me an e-mail. I'm sure I'll touch on this again soon, but it's a start to the pondering. As always, thanks again for reading.
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