My last work day!!

April 12th, 2012 Posted in Uncategorized | 3 Comments »

Happy Thursday all!! Well, today was my last day. So bittersweet!! We started this morning with our meeting, and then it was off to pediatric ward rounds. We had a very full ward today, so we were very busy. We have quite a few kiddos who seem to really be turning the corner, which is so awesome!! The hospital ran out of milk earlier this week, so we don’t have many options to supplement these kiddos nutrition right now. Usually the hospital staff makes a mild mixture that is fortified with vitamins and other nutrients and is very calorie dense to help these kids gain weight. But without milk, they aren’t able to make it, so all we have is either oral rehydration solution or plumpy nut (a sweet peanut butter mixture that is very calorie dense). The plumpy nut is a great alternative, but a lot of these kiddos are too sick to eat whole food and need everything via nasogastral tube. They are hoping to get more made up by this weekend as someone went to Lusaka today to buy milk. The kids that we were able to send home were all eating plumpy nut, so they did just fine. It really is nice to see the kiddos improving enough to go home, especially when you feel like you are fighting a losing battle with these kids a lot of the time. After rounds, I went to OPD, which was incredibly busy!! We saw a lot of patients all day, with a very wide range of illnesses. We unfortunately are starting to see more malaria. And some of them have already been treated not that long ago. So we are trying to determine if this is a resistance that is starting to develop or if it’s the same infection that just wasn’t cleared completely. It’s a difficult situation, as we really don’t want to call it resistance until we are completely sure. After work, I organized myself and packed as much as I could. I have to use a lot of the stuff in the morning, so that makes packing a bit tricky. I also called the bus driver so that he will come and pick me up at the house so I don’t have to haul all my stuff all the way to the market, which is wonderful!! I was able to get rid of a lot of the clothes I bought, which I thought would make my luggage so much lighter. Especially since I have eaten all my food and used most of my shampoo and stuff. But it seems to weigh about the same somehow!! But I haven’t packed my carry on, so I think that my carry on isn’t going to be nearly as full so there may be some shuffling of stuff. Tonight, my housemates and I are having some people from the hospital over to the house for a little going away get together. It will be nice to say good bye to people, but really difficult as well. After the get together at the house, we are inviting everyone up to Gidian’s (the bar/general store/dance hall/pool hall) for a last rendezvous through the bush!! I have to be up very early tomorrow, but I figure all I have to do is get on a couple of buses, so nothing very strenuous. I can be sleep deprived for one last night out!! I don’t believe that I will have any internet access until I am back in the states, although I may have some in Spain. I can’t believe that my time here is done. This was an experience of a lifetime!!! And I really wouldn’t give this up for anything. I am eternally grateful to all the people here who have taught me so much. From Dr. Spurrier and Dr. Thuma who gave me more medical knowledge and inspiration than I thought I could receive, to the medical licensates who were an absolute joy to work with, to the nurses and nursing students who always had a smile for me in the morning and even through tough days, to the house keeping staff who were always willing to help out, to my patients who taught me so much about not only medicine but also myself. I am truly honored to have had the opportunity to come here and work, and I am forever indebted to all who are here and everyone back home. You have all made my time so wonderful, with the constant love, support and prayers!! Such a bittersweet time to leave such a gift to go home, which is an indescribably gift in itself!!! Can not wait to be back in the states!! Sunday is the day!!! Love to all!!

Happy hump day!!

April 11th, 2012 Posted in Uncategorized | 2 Comments »

Counting down the days!! As anxious as I am, it’s very difficult to think that tomorrow is my last day here in the hospital. Today, at the morning meeting, I gave a presentation on the initiation of ARV treatment in HIV patients and a specific syndrome we need to be vigilant about watching for. It’s called IRIS (Immune Reconstitution Inflammatory Syndrome) and it can happen when a patient is first started on ARV treatment. It doesn’t always happen, but it can be pretty severe, and even life-threatening. We typically think of this happening in the first 12 weeks, but some of them can appear up to 4 years after initiating ARVs. At that point, we start to think that it’s treatment failure instead of IRIS, so I think this was a great topic to go over. We even discovered that some of our TB patients haven’t been started on their ARVs as quickly as they should be. We talked a lot about different things that we could institute here to meet some of the requirements to get patients started on ARVs given special situations. After the meeting, I went to pediatrics to check on the ward. We had a few new admissions already this morning, so we took care of those. Then it was off to ART clinic. We had a lot of patients today, so Dr. Thuma and I split them up. He saw the kiddos, and I would see the mothers. It was really nice to see my own patients in ART clinic and especially to have that vote of confidence from Dr. Thuma!! We saw a few very complicated and interesting cases, closed a few files because the babies were HIV negative, and of course had the routine and stable cases. It was fun to see patients with Dr. Thuma because we got to go through each kiddo’s history. A lot of the kiddos coming in had been on the ward at some point, most of them looking incredibly sick, and not expecting to recover at all. Those stories are always so rewarding and help you find the successes even when you feel like you are surrounded by difficulties. It was a pretty long day today, and challenging, but great!! We have a female patient that we were asked to see in the female ward. She is a nursing student here. Her story continues to change everyday, but she essentially has been sick for quite some time, years really. One of our staff has been seeing her for various medical problems for a few years and has been encouraging her to get HIV tested. Every time he would see her, she would say that she got tested, but could never produce the results. Now she has come in and is really very sick. We aren’t really sure what is going anymore, especially since her story continues to change. She has multiple organs affected, and most of them are heading to the point of failure. She is also a Jehovah’s Witness, so that just adds to the difficulty of treating her. And to add insult to injury, we know that her family is giving her some herbal treatments, even while she is in the hospital. The hospital did a study in which they took blood samples and had them analyzed for herbs and substances to try and pin point what these traditional healers are giving people. Even with all the advanced testing that was done, none of the samples were the same and there were multiple chemicals that they couldn’t identify. And of the ones that they could, a lot of them were very damaging to the liver and kidneys. Between the lack of consistency of the history, the herbs that her family is giving her, and her religious affiliation, we are really fighting an uphill battle with this girl. She continues to look worse every day, and we really aren’t sure what to do with her. We are all very afraid that we are going to lose her. In cases like this, our hands really are tied, and it’s so frustrating because it really could be a lot different. We will see how she is tomorrow, but things are not looking very good for her right now. Tomorrow will be my last day at the hospital. Very bittersweet. I almost don’t want to tell people so that I don’t have to say good bye. But I am very much hoping to come back!!! I also got my invoice for my room here. I owe almost 2.5 million. Kwacha that is!! :) It’s about k5000 to one dollar. But still fun to say that I have 2.5 million!! I hope everyone is having a wonderful week!! Happy hump day!! Love to all!!

Another Tuesday starting with a cold bath . . .

April 10th, 2012 Posted in Uncategorized | 3 Comments »

Today was my last theatre day. A bittersweet ending for sure!! We had our morning meeting this morning, which was not the same without Dr. Spurrier. He left for a conference this morning and will be gone the rest of the week, so I won’t even get a chance to say good bye on my last day. After the meeting, I went and checked on the pediatric ward. We had another baby pass early this morning. We were expecting it really, not that it makes it any easier. Once these kiddos get to the point of being so malnourished, it is really hard to pull them back. There is so much damage to their intestinal tracks that just absorption of the fortified milk we give them is difficult. Most of the other patients are stable, so it was off to theatre. We had a lot of dressing changes today and a hernia repair in a kiddo right away, and I bounced back and forth between both of them. All went off without a hitch!! Then we had a circumcision of an adult male. There is a big push in Zambia for males to get circumcised to reduce the transmission of HIV. It won’t reduce the transmission to zero, but there are studies to show that there is a significant reduction in the transmission to the male if he is circumcised. I was very impressed with this young man taking responsibility into his own hands to protect himself as much as he can. And, I had never seen an adult circumcision before, so that was interesting. Especially the administration of the local anesthetic!!! Yikes!! After that, there were a few other minor procedures, and time for lunch. After lunch, I went to OPD and was met with a huge line up of patients to be seen. We had a few pretty complicated patients, but most were routine outpatient things. I had a lady come in today with a story sounding like she had contracted genital herpes. She said that she is only active with her husband, and when I asked her about her husband, she said, “Oh, you know how men can be. I just don’t ask anymore.” I was really shocked. That really is not a mind set that I can ever imagine having to adopt. Thank goodness I don’t!! She also told me that she and her husband got syphilis in 2005 (although I have a feeling it was more that the husband gave it to her). I had to remind myself of the importance of not showing anger here to understand her almost passiveness with the situation, and being polite so that I didn’t offend her. Such a very different culture and so fascinating to learn about and immerse myself in. We got out of OPD pretty late, and then I had to go and see my little girl that had the cleft lip repair. She developed an infection and now there are some areas that have pulled apart. I had the surgeon look at it, but we aren’t quite sure what to do with it. She is on an antibiotic, so hopefully it will clear up and heal. It won’t be as pretty as it could have been, but still better than she had. Tonight I worked on another presentation that I will be giving tomorrow morning at the meeting. It took me a lot longer than I expected, mainly because I wasn’t exactly sure what direction I was going to go with it, but I think it turned out quite well. It was definitely a good learning tool for me to review some very important things, so that in and of itself made it worth the time. I am definitely getting anxious to pack my bags and jump on the bus, to the next bus, to the cab, to the hostel, to the cab, to the airport, on my plane, to another plane, to the hotel, back to the plane and finally to that wonderful place called O’Hare International Airport!!! Not to mention all the hot showers I have waiting for me!! These cold baths are getting harder to take with the mornings being so much cooler now. Great for sleeping, but not good for cold baths!! Every morning, I wake up and tell myself how many cold baths I have left to take. It’s down to 3!!! I hope everyone is enjoying their Tuesdays!! And your hot showers!! Love to all!!

New work week starts!!

April 9th, 2012 Posted in Uncategorized | 2 Comments »

Happy Monday!! Today was another holiday here . . . Monday after Easter. It was suppose to be a half a day, but there were a lot of patients in OPD today, so we wound up working for quite a while. We didn’t have our morning meeting today because of the holiday, so it was right to pediatric ward for me!! We unfortunately lost 2 kiddos last night. They both were very sick, and just really weren’t responding to any of the treatments we were giving them. It’s very interesting being the pediatric area. There are so many cultural things that you have to learn to understand why things are the way they are. It is a whole other dynamic to my growing practice of medicine. We have this 2 ½ year old kiddo, who is severely malnourished. He also has HIV. From the records, the mother has only taken the baby to the “under 5” clinic (clinic specializing in peds) once and has not taken him to the ART clinic. We have been writing orders for her to take the baby to the ART clinic for over a week, but here it is up to the patients themselves to go. And with the kiddos, if the parents don’t take them, they don’t go. This mom is so quiet and almost detached, there has to be something going on. Dr. Thuma and I were just thinking of the possibilities, maybe she is ashamed, maybe the baby isn’t her husband’s, maybe she just doesn’t understand what we are asking her to do or how severe this is. It’s frustrating, because the only way this child is going to get better is if he is started on ARVs, and that will only happen if the mother takes the child to the ART clinic. Back home, this would definitely be a case for Child Protective Services, but that doesn’t really happen here. This is a difficult time of year for the malnourished areas in the peds ward. It’s the end of the rainy season, which means that the crops are starting to be harvested. You would think that because they are beginning to harvest the crops, there should be more food. But what happens is they sell a lot of it and what they keep at the end of the harvest needs to be enough to last the family until this time next year. You can see this pattern even in the adults. Everyone tends to drop quite a bit of weight during this time because of shortage of food and extra work in the fields. And then they all tend to gain the weight back around June and July when the work is done and everyone has an abundance of food again. The kiddos just don’t have much reserve, so a decrease in their intake is a much harder hit to them than an adult. Dr. Thuma and I were talking about what we can do for these kiddos when they go home. He has made some very interesting observations and has a intriguing view point on this. If you look at the adults, none of them are malnourished. In fact, many of them appear very well nourished. So you can conclude that the food is there, just the education of the mothers as to what they kiddos need in their diets, ie not just porridge but you have to add crushed peanuts for the essential amino acids, is a bit lacking. Dr. Thuma talked about this book that is written by a Zambian woman, who is very educated, about how aid actually kills countries. It’s a very interesting concept. It doesn’t apply to countries where there is global malnutrition or poverty, but more so to countries who are borderline like Zambia. Her theory is is that if you give a country all kinds of aid, they develop a mind-set of “We are poor and will always need help.” She quotes a lot of different examples of countries in which their national GDP actually decreases in relation to the amount of aid they get from other countries. She gives Zambia as a prime example. Zambia is the largest producer of copper in Africa and they have plenty of farm and agriculture land. They have the resources to not be a poor country. But anytime there is an increase in the amount of funding they are getting, they productivity decreases. I think it’s a very interesting dynamic to think about. You would like to think that giving money to countries who are in need is a good thing, but I also understand the authors reasoning for it actually working against them. Just one of the many interesting and thought provoking conversations that Dr. Thuma and I had today. After rounds, I went to OPD to see some patients. There were a lot to be seen today, but we made it through them and were done a couple hours early. After work, I came home and read. The power went out a couple of times, but I am hoping it’s on now for the rest of the evening. I am very anxious about coming home. I have my hostel booked in Lusaka and the hotel in Madrid booked. I am so looking forward to hot showers in both places!!! It’s hard to not start packing, although I know this would be pretty pointless since I still have 3 work days left. Hope everyone is having a wonderful Monday!!! Love to all!!

Happy Easter!!!

April 8th, 2012 Posted in Uncategorized | 3 Comments »

Happy Easter!! It’s definitely not the same here, but it has been a nice weekend. Yesterday, I had rounds in the pediatric ward with Dr. Thuma. We are starting to see more and more malaria cases, which is concerning since they have pretty much eradicated malaria not that long ago. We were talking about the drugs that we use to treat it here and why we aren’t seeing kids get better. Usually, you see the fever disappear within about 24 hours of starting the drug. When these drugs were first used, everyone thought they were a complete miracle drug. Now, we are seeing the kiddos take a lot longer for get over the illness and their fever is sticking around for a few days. He was telling me that there have been many reports of drugs coming from southeast China that don’t actually contain any of the active medication that they are suppose to. I was completely shocked that this can occur. These companies sell these “drugs” at a much cheaper rate and then make boat loads of money because they aren’t really spending any money on the chemical that is suppose to be in them. Dr. Thuma and I were both getting furious thinking about this. These people are killing people because they aren’t getting the drugs they need, all to make money!!! It’s really infuriating!! These companies from China even make holograms to put on the bottles so that they look authentic. The lengths that they are going to, and then people die because of it. So frustrating. And the Chinese government refuses to go after these companies. So we are kind of struggling with these kiddos. Dr. Thuma has the lot number of some of our drugs and is going to contact the pharmaceutical company that supposedly manufacture the drug and see if it’s a lot number they use. After our rounds, which took quite a while because our census is pretty full, we went to see this premie that was brought in on Friday. The baby was 6 days old on Friday and was born at home. But he hasn’t passed any stool yet. He weighs less than 3 pounds!!! So so tiny. And we aren’t exactly sure what, if anything, we can do for him. We are afraid that he may have an atresia somewhere in his intestines (the intestines don’t form properly and there is a section missing, usually requiring surgery). He is too sick to transfer him to Lusaka, so we are still trying different things with him. We also have another boy in male ward that we were asked to see. He is 17, and had been sent to secondary school to continue his education. While he was there, the headmaster of the school had given him a math tool set (compass, protractor, etc) I assume because he needed one but maybe his family couldn’t afford it. While he was there, the boy suffered a psychotic break. He began talking to himself, hallucinating and ruminating on certain phrases or things or activities. They brought him in and he was agitated so they gave him some sedatives. We were asked to see him because now he has in the past 2 days developed dry gangrene of both legs, meaning the blood flow in his arteries has been stopped. Both of his legs are cool to the touch, he has no peripheral pulses and very weak femoral pulses. We really aren’t sure what to do or why this is happening, but the most interesting thing is talking with the family. They believe that because this headmaster gave this boy a math tool set, with no real reason to, he is practicing Satanism and witchcraft and has put a spell on the boy with the math tool set. Dr. Thuma explained to me that Zambians tend to be very suspicious of perks or charity out of the blue. For example, if you gave a child some candy, just to be nice, and that child got sick, you would be accused of witchcraft. And now this headmaster is at risk of losing his job. Very interesting. Dr. Thuma and I also spoke a lot about the different ethics and morals in this society. I had asked him about the mothers in pediatrics because many of them almost seem aloof and it seems like they don’t really understand the severity of these kiddos health. He was explaining to me, that the 2 most important things in this society are being polite and not showing anger. A lot of things start making sense after understanding that. Also, there was a study done here, not that long ago, with over 100 different villages and they showed that the survival rate of children up to 14 was 50%!! So these mothers are almost expecting that half of their children will die before they are 14 years old. Definitely not a mind set that I am used to. In addition to that, there is a huge belief in fate. Dr. Thuma’s father, who actually started Macha Hospital, used to say that the theme song here should be “Que sera, sera.” Dr. Thuma told me a story about a child that was here for malnutrition and really wasn’t getting better despite everything they were giving him. After a few days, they discovered that the grandmother was actually drinking the milk, saying that the child’s fate was already decided so why should the milk go to waste in a child who was going to die anyway. Such a dichotic society in ways. It’s really fascinating to learn all of these things!! After work, I went to the house of one of the nurses in the theatre to have lunch with her and her family. It was wonderful!! So peaceful and her family is so nice!! I got to play with her grandson, who is very ticklish!! He is 3, and such a boy!! Hilarious!! At one point, he started dripping drool from his mouth to make designs in the sand. I was laughing the whole time with him!! Last night, I had a chance to chat with mom for a long time. It was nice to catch up and I am so incredibly thankful for Skype!!! This morning, we had a sunrise gathering at a dam. It was beautiful and so peaceful. There were just a few of us, but we sang some and read some scripture and just enjoyed the quiet beauty that God had given us in nature. After the service, we walked back to Marlys and Chris’s place and had breakfast things. Everyone brought things to share and everything was delicious!! I came home for a bit and then headed to church at 10. There really weren’t very many people at mass, and no choir today, because they were all at the other church for the Holy Week services. The rest of the day is going to be relaxing day with some reading and a little bit of organizing myself for the trip home. I can not believe how quickly my time has gone!! When I first came, I was not sure if I would make it. I am so thankful for all the love and support that I had and continue to have to help me through this. If it were for technology to keep communications, I don’t know that I would have. I hope everyone has a very blessed and wonderful Easter!! Wishing I was home, but happy and grateful that I will be there soon!!! Love to all!!

Happy Good Friday

April 6th, 2012 Posted in Uncategorized | 3 Comments »

Happy Good Friday!!! I’m not sure that happy is the right phrase, but it works. Today, I went to the HIV outreach clinic. We went to a village called Moobola. There were quite a few patients, and we wound up having a pretty great day!! We saw a lot of patients, most of them were very stable, which is always nice to see. There were a lot of little kids running around, but this wasn’t nearly as lively as Mapanza that I went to 2 weeks ago. The clinic is a little more isolated from the rest of the village, so the people that were around tended to be just the patients. This village tends to be the busiest out of all the outreach clinics, but I think there were less patients today because of the holiday. The church here isn’t doing any services other than on Sunday. As a congregation, they hold all the holy week services at one church, and it rotates churches every year. This year, it is at a church that is about a 30 minute drive, so much too far for me to walk to. The people that travel from here will stay there overnight, either at relatives houses or just sleeping outside near the church. I am continually impressed with the level of dedication that the people here have. I don’t think that many people back home would be at mass if they had to camp out for 3 days just to attend mass. On Sunday morning, there is an outdoor sunrise service, which I am very excited about. Not so much the getting up that early, but I think it will be gorgeous and peaceful!! After I got home from outreach, I came home to relax and read for a bit. After about 20 minutes, one of my housemates told me that the girl from Holland was here and asked if I wanted to accompany him to pick her up from the market. Of course I did!!! We went to meet her to help her carry stuff (she brought some groceries), but she didn’t want to wait for us so we met her about half way. She is such a goof ball!! It’s really nice to have her here, even if I have to share her with Jonathon. I opened my bag of Cadbury mini eggs after we got back and shared some with the 2 of them for Easter. Mom had bought me a bag, since they are my favorite Easter candy and I am here for Easter, and I have been saving them. I figured that it is Easter weekend, so it’s close enough. And I have been staring at them for 5 weeks now, so it was time. They were more delicious than I remember!! It was difficult to stop, but I figured I had better since my stomach isn’t used to chocolate anymore. Tonight, we are just hanging out chatting. Lidewij (the girl from Holland) and I were chatting tonight about patients, specifically maternity. I was saying something about “advanced maternal age” patients and then referred to them as AMA. She looked at me funny and asked what that meant. When I said “advanced maternal age,” she said they don’t have that in Holland. Then we both laughed because we realized it was only because they use Dutch phrasing and it doesn’t translate to AMA. She cracks me up sometimes. When she is really tired, she will start speaking to me in Dutch and then become very confused as to why I am not answering her question. We are planning on going to the sunrise service Sunday morning, so no bar hopping to Choma (and running out of gas) for us this weekend!! I hope everyone is having a very blessed Good Friday!! Wishing I was home for the Easter celebrations, but I will only be a week late!! Love to all!!

Happy Thursday!!

April 6th, 2012 Posted in Uncategorized | 1 Comment »

What an absolutely fantastic day!!! I really needed one of these days!! I have been feeling kind of in a funk recently, so this was a much welcomed, wonderful day!! Today we started with our morning meeting and talked about the schedule for today. There was a plastic surgeon flying in from Lusaka to operate on some patients for the day. The schedule was going to be very busy, so the meeting was short and we all went to work on the wards. Today was pediatric general rounds, and I was working with Dr. Thuma, who is a very patient man and wonderful teacher. About 30 min into rounds, Dr. Spurrier called over and asked me to come over and assist the surgeon. I was so excited!! I have never seen any plastic surgery, and I knew there were some very cool cases on for the day. When I got over there, Dr. Spurrier said that I would actually be scrubbing in and assisting the surgeon. I had an awesome time!! Dr. Goram (the surgeon) was so nice and encouraging; he and Dr. Spurrier were teaching me the whole time!! The first case we did was to separate the fingers of a child with syndactoly, meaning the ring and little finger of her left hand were fused together. This was so fascinating. We separated the fingers, and then had to skin graft some of the areas that no longer had skin coverage. It was so impressive to just watch Dr. Goram; he just knew where to make his cuts. The most impressive thing that I saw him do all day was taking the skin grafts. Not because of the technique, but because just about every time he drew out the area he was going to remove, I thought to myself that it was far too much skin. But every time, it wound up being almost the exact amount. It was amazing. The second case was a girl with a contracture of the hand. She had been burned on her palm, and the scar tissue had fused her fingers to her palm so she wasn’t able to open her fingers at all. We cut the skin that was between her fingers and palm, stretched the fingers open, made cuts along her fingers to relieve the tension on the skin and put K wires into her fingers. The K wires go through the bones and keep the fingers straight. They will be removed in 3 weeks, but keep her fingers straight to help with the healing of the skin grafts. After the K wires were in, we skin grafted the palmer surface of the hands. Our third case was a cleft lip and cleft palate. This was such an impressive surgery!! We only fixed the cleft lip and the child will have to go to Lusaka to have the palate fixed. But the before and after pictures are amazing!! As Dr. Goram was making his cuts and sewing things together, I just couldn’t believe how the anatomy just came back together the way God intended. It was truly amazing to watch everything just be pieced back together, and to see it happen up close was priceless. Our next case was a little girl who had been bitten by a snake on her wrist, and had been skin grafted before. She had developed a contracture on the back of her wrist, so she wasn’t able to flex her wrist at all. Dr. Goram released the contracture, put some K wires in, skin grafted the area and then casted her wrist to keep it in a neutral position. The next case was a very difficult case, at least for anesthesia, which I was now doing with Dr. Spurrier. The lady had been burned on her right arm and was skin grafted in 2009. When I was helping get the patient ready, I had asked Dr. Spurrier when she was grafted. He said he didn’t know and didn’t even think it was at Macha. I said that it was too bad because it was a really nice graft and I was going to give him the credit. After a while, we asked the patient what had happened, and she gave us the story, saying she had it done in 2009 and Dr. Spurrier had done it. Dr. Spurrier and I laughed about this for a while. As a result of the graft, she had developed a contracture of her elbow and had minimal range of motion at that joint. Dr. Goram was attempting to do the same kind of procedure, but the patient just wouldn’t fall asleep. Dr. Spurrier continued to give her ketamine, but after a while, every time he would give it to her, she would drop her oxygen saturation. We had quite the time with this patient. She took more ketamine than any other patient I have ever seen!! More than I have seen 3 patients take!! And to top it off, she also received 3 doses of Valium!! It was impressive. And even after all that ketamine, we don’t think she really ever was that deep asleep. The next case I was back to assisting. It was a little girl who had an injury to her left hand, we aren’t really sure what, but also had some very severe contractures of her fingers to her palm. Her fingers were also a little deformed, so it was a little bit more challenging of a case. We did the same procedure, separate the fingers from the palm, place the K wires, and skin graft the area that were missing skin. The exciting, or challenging, part of this case was that the power was shut off for “load shedding” in the middle of the case. The overhead spot light in the theatre is backed up by a battery, so that we had some light, but that only lasts about 15 minutes and Dr. Spurrier was concerned that the generator wouldn’t be on in time. He wasn’t even sure who was on call for maintenance, but as he was going to call the head of maintenance, we heard the generator be started up. It was almost like he knew it was going to happen. Our last case was a very intense case; save the best for last. We skin grafted the girl with epilepsy who fell into the fire and burned almost the entire of her upper body. I haven’t seen her wounds for about 2 weeks, and I was amazed at how good she looks. She came it my second day here, and I remember writing that no one thought she would survive. But she has, and her wounds really looked good. We harvested skin from almost her entire right leg, and most of the upper left leg. Dr. Goram thought it would be enough, but unfortunately it wasn’t enough to cover all of her burns. We were able to cover the entire chest and stomach, but we didn’t have enough for the arms. Dr. Goram thought about taking more, but he said that you have to weigh the risks and benefits. If we took more skin, then yes, we could cover all the burned area. However, then you are also exposing even more of the underlying layers and risking more infection. So, we left the arms alone and Dr. Spurrier will skin graft those later when the other harvested areas heal a bit. She still has a long way to go, but she has beaten all odds thus far!! We finally left the theatre at 1030 last night. I was exhausted, but absolutely rejuvenated!! I hope everyone else is having as wonderful of a Thursday as I have had!!! Happy Holy Week!! Love to all!!!

Yeah for Wednesday!!

April 4th, 2012 Posted in Uncategorized | 2 Comments »

Happy hump day!! Since I had Monday off, I am all confused about what day it actually is. Especially since I am on another ward and the schedule is a little shifted compared to what I am used to doing. The morning meeting was cancelled this morning, which was a nice surprise. So we went and checked on the pediatric ward. One of the babies there, who is in the hospital for malnutrition, was wanting to take her child home. The child is far from ready; however, every time we go in to see the child, the mother has taken him and usually doesn’t return until late in the evening. She essentially just sleeps at the hospital with the child and is now wanting to leave. We explained that she will have to sign a paper stating that she is leaving against medical advice, but there really aren’t any consequences of this happening, other than the child won’t get the treatment, which he isn’t now anyway since they are never there. It was a very frustrating situation because we want the child to stay, but he isn’t there anyway, and we can’t force her to keep the child around. At one point, we literally asked her why she even brought the baby in to the hospital. It was almost as if she thought that just by being inside the building, the child would get better. We tried to explain that these children with malnourishment need special formulas to help them gain weight and they also need to be getting this multiple times a day, which this child isn’t. This conversation took quite a while, but in the end she and the baby left. Our guess is that the child will be returning soon or later, and unfortunately in worse condition. After the wards, it was pediatric day in the ART clinic. There are adults too, and we do see kids on other days, but we try to keep the more complicated kiddos on Wednesday if possible. We had some pretty complicated cases to try and sort out. There were a few cases of possible treatment failure, and then a few cases in which we had to try and present the cases just right in order to justify starting anti-retroviral treatment. Dr. Thuma and I had a very interesting conversation about this today. So right now, there are certain guidelines for starting a child or adult on ARVs. In short, they really don’t allow you start the medications until the patient presents with a very depressed immune system or a stage 3 or 4 illness. Dr. Thuma’s theory is that this will be one of the things that when we look back in 20 years at how we used to treat things, this is will one that people will say, “What were they thinking??” The original rationale was that because the drugs were so expensive and limited, it was a better idea to wait until they really needed them to start treatment. But with the drugs being relatively cheap now, there really isn’t a whole ton of reason to justify withholding the medication that long. So, with a few of our patients today, they were falling on the cusps of most of the criteria. So with a little tracking back and looking at long term patterns, we were able to show certain things, like stunting of their growth, that would classify them as eligible to start. We also had one kiddo that we were able to close his file today, meaning that he is no longer breastfeeding, so his exposure is gone, and all of his tests have been negative!! So very exciting and the mom was so happy. That was her 5th child that has been negative!! It’s so encouraging that the drugs work for preventing the transmission from mother to child, because here, if you can’t have children, your identity as a woman is gone and the likelihood is that your husband will leave you. It’s really wonderful to be able to give these women the gift of child bearing even though they have this disease. After work, I had to do laundry. Well, as you can guess, there isn’t a washing machine, so it was washing everything by hand in a bucket. Let me tell you, I have never worked so hard to clean clothes!! I will never again complain about having to do laundry back home!! It took me a good hour and a half to wash everything, and now it’s hanging up to dry. It’s no wonder women don’t typically work here. There isn’t enough time in a day to work, cook, clean and do the laundry. And I only had to do mine, not the whole family!! But my housemates did offer to “let me” do their laundry as well. I said there wasn’t enough money in the whole of Zambia!! My hands were literally rubbed to the bone!!! I am exhausted and can’t wait to lie down and read my book!! I hope that things are well there!!! Brewers opening day is coming up!!! Love to all!!

First day back!!

April 3rd, 2012 Posted in Uncategorized | 1 Comment »

Well, today was my first day back to work after such an awesome time away. I think it’s always hard to go back to work after a vacation, especially one in which you had so many new and exciting experiences. I just keep looking at all my pictures from the trip. I can’t wait to relive all the memories with family!! :) This morning I woke up to shower, definitely missing my hot showers, and the water shut off in the middle of washing my hair!! I had to jump in and out of the tub to grab water from the big tub of water to rinse all the shampoo out of my hair :( Welcome back to the village!! But it was back to work today. I switched to the pediatric ward for my last 2 weeks here, so that is a nice change as well. I did check on my 2 little boys, and both are doing well. :) The boy with the amputation had a revision yesterday and hopefully will not need any more and should just heal. The boy with the snake bite is doing well also. He is still needed some cleaning of the wound, but it’s much less and he will be getting ready for skin grafting soon hopefully. This morning we had our morning meeting and then I tagged along to check on the pediatric ward. Not too much was going on, but it is very full right now, so we will have our work cut out for us during full rounding days!! It was also a theatre day and full of firsts again!! We had a tubal ligation to start, which is pretty routine and not very exciting. But then we had a prostatectomy (removal of the prostate). I have never seen this procedure done before, so this was great to watch!! :) It went pretty well, no complications, which is always nice. Then we did a revision of an amputation of a woman who was involved in a car accident a few weeks ago. When she came in from the accident, her foot was almost completely detached from her leg, and so it was amputated that night. Since then, we have been battling infections, but today we did a semi-final revision of her leg. It was very interesting to learn all that you have to plan for when doing a final revision. Whenever there is an amputation, the skin will always retract after a few days. You must plan for this, otherwise the bone will wind up poking out the end and causing many more problems. That case took us right through lunch, and we still had a couple more to go. We wound up pushing back at least one of the cases until tomorrow because of time. After the amputation revision, I removed a growth off this woman’s lower eye lid. I’m not a big fan of the eye, and it was kind of creepy working so closely to the eye. :/ So funny how different things creep different people out. I didn’t leave the theatre until almost 4pm!! Very long day. But I headed over to ART clinic to help out over there. The first case that I saw was a woman who might be failing on her treatment, but we aren’t 100% sure. And if she is, we definitely aren’t sure why because we don’t know what medications she was given in the beginning of her treatment and why she was switched or how she was switched. If there was something wrong then, she probably developed a resistance to the drugs, which is crucial to know which mutations the virus now has. And I think that the most difficult thing about it all is that there really isn’t a way for us to figure it out. Ideally, we would get a genotype on the virus and map out exactly what mutations it now has. That testing is really not available here, except in Lusaka. This specific patient has a history of not coming to her appointments at our hospital, so the likelihood is that she won’t travel all the way to Lusaka every month for her treatment. The rest of the cases that I saw were straight forward for the most part. It’s always nice to see patients who are doing well on their medications. Dr. Spurrier and I were chatting about what the emphasis should be with respect to lowering the spread and transmission. We both agreed that it needed to be the mother to child transmission. The cost for treating one patient with HIV here is $600 per year (insanely less than in the states!!) When we worked out the numbers, estimating a 40 year life span of these children, that is saving $24000 for every baby that we prevent from getting the virus from the mother!! So much money can be saved, but so many of these woman aren’t getting tested to even know if they should be on treatment for their babies health. It’s estimated that only about 40% of Zambians get tested, but about 1 in 4 Zambians are infected with the virus. It’s truly amazing how strong the stigma still is here. Even with all the public advertising. They have billboards all over the country promoting using condoms, getting tested and knowing your status, and even for men to “Be smart. Get circumsized.” :) They are really putting forth a huge effort to make it an approachable subject so that people do get tested, but I think the education is where the emphasis really needs to be, which is by the much more difficult part. It all gets so complicated so quickly, and the disease is just so fascinating from a scientific perspective. Tomorrow I am in the ART clinic again for the day, so I am really looking forward to that. I feel like there is just so much to learn, the more time I spend in there, the more I understand and the more I understand I need to learn about. Congrats to Kentucky!!! Definitely wasn’t what I thought was going to happen in the brackets, but it was fun to follow it with some of the other Americans here and talk about it in the hospital. Made it feel a little bit more like home. Hope everyone is well back there!!! Love to all!!

Livingstone adventures!!! And back to Macha

April 2nd, 2012 Posted in Uncategorized | 4 Comments »

Oh my goodness!! That is about all I can say about my weekend in Livingstone!! Phenomenal!! Highlight of my trip . . . HOT SHOWERS!!! I took at least one a day, most days 2!! I did have tons of other great times also. So, Friday night I met up with the student from Holland and one of her friends from Livingstone. We had drinks at the hostel and then went for dinner at this very authentic place (heavy sarcasm there); pretty much identical to KFC with fried chicken and biskets. I was pretty happy to have some “American” food though. When I got back to the hostel, I took my first hot shower in over 4 weeks and thoroughly enjoyed every minute!! Saturday morning, I woke up at 530, just out of habit, and read for a few hours. So relaxing!! Reminded me of being up north at the cabin and having lazy mornings with nothing to do but read and enjoy just being. The hostel has a free shuttle going to Victoria Falls every day at 10am, so I hopped on that and toured the falls. They are incredible!!! You could hear the rush of the water as you entered the park, even over the running engine of the bus!!! Since it’s the rainy season, there is a ton of water, which makes the falls incredibly impressive!! But it’s kind of a catch 22; you want there to be a ton of water so you can see the absolute majesty of the falls, but when there is so much water, the spray is really thick and it’s hard to see the whole thing. They rent ponchos for $1, which was a very smart investment. You still get very wet, but my back pack stayed dry, which was the crucial part. There is a bridge that crosses over, and it was very difficult to maneuver across because of all the water running down and spraying across, but I managed. After seeing the falls straight on, I wandered down to the past where the falls end and water pools, an area called the boiling pot. The vegetation was awesome!! It was a rainforest!! Just beautiful!! I also saw the bridge that they bungee jump off of, but as promised, I did not partake. I did see a few people jumping when I was sitting by the boiling pot, and happy to say they all bounced back up!! After I had explored the Zambian side of the falls (there is also a Zimbawe side that is suppose to be more impressive and not as wet, but you had to buy another visa back into Zambia and that was not in my budget), I grabbed a cab back to the hostel and got ready for my next excursion!! I was picked up at 3pm and taken to a resort. I met the rest of my group, total of 14 of us, and we were led to the start of our elephant ride. We paired up and had a guide on the elephant with us and went for an hour ride through the bush on the back of an elephant!! It took a while to get used to the lumbering, but once I adjust, it was very fun. My elephant’s name was Mary and she is 22 years old. My guide taught me a lot about the elephants and their habits and needs. About half way through the journey, someone ahead of us had dropped their hotel key card on the path. My guide spotted it, and when we got close, he said “Mary stop,” and she stopped right before the key card. Then he said, “Mary, pick up.” And Mary, as if she just knew that a key card didn’t belong in the bush and he didn’t mean the sticks that were on the ground, picked up the key card with her trunk and handed it to our guide. She then received a huge hand full of pellets for reward – positive reinforcement at it’s finest!!! A little while later, she did the same thing when someone had knocked their sunglasses off their head. It was very impressive!! Once our ride was done, we dismounted under a boabab tree that is estimated to 6000 years old (yes, that’s 3 zeros behind that 6!!). Then the elephants all lined up and were instructed how to feed the elephants. You could either say “Mouth open” and they would flip their trunk up so you could put the pellets in their mouth, or you could say “Trunk down” and they would use their trunk to suck the pellet up and put them in their mouths themselves. I did both ways!! It was pretty funny to watch all these adults grabbing for more pellets and acting like little kids!! We commented on how “us adults” were grabbing for more pellets than any of the kids who had come on the ride. Since there were 14 people on the elephant ride, I assumed everyone else was going on the lion walk and cheetah experience. But, it turned out that I was the only one!!! This was AMAZING!!! My guide met me after the elephant walk and left to go back into the bush while everyone else got into jeeps and drove back. On the way to meet the lions, the guide instructed me on how to behave with the lions and what to expect and about the reintroduction project they are doing. Then I met them!!!! 2 lions: Luva, 13 months, and Nelly, 18 months. Let me tell you, for toddlers, these girls were huge!!! And so beautiful!!! I had such a great time. There were also 3 other guides with me, so a total of 4 to talk with and ask questions. One of the guides was the designated camera guy, and because I was the only camera he had, I was on a safari photo shoot!! I think that I later deleted probably half of the pictures because they were blurry or pretty much duplicates, and I still have about 100 between the lions and cheetahs!! I spent an hour walking them through the bush and playing with them. They mostly played with each other, but they would lie by me while I sat and rest for a while. The walk took about an hour and I wish it would have gone at least another hour!! They were so much fun!! When they are walking, they like their tails to be carried. At one point, the guides and I started joking around and really having a great time being in the African bush with the King of the Beasts, and they told me to use Nelly’s tail as a microphone to sing into it. So I did!! I started to sing Hakuna Mata (from Disney’s The Lion King – felt appropriate) and they all thought that was awesome and joined in!! When we got back to the resort where the elephant walk started, the lions knew they were home and started to play pretty rough, so we really had to be careful. But they tired out after less than 2 minutes and went back to their cages for the night. I hated to leave them, but it was onto the cheetahs!!! They brought out all three cheetahs for me to play with. Lily, 16 months, McGeyser, 17 months, and Susie, 18 months. These cats were probably my favorite!! I was able to pet them just like a house cat, head and ears and all!!! And they purr like crazy!!! You could see the side of their neck vibrating with the purring!!! And they love to like your hand in appreciation!! McGeyser licked my whole arm. Apparently he thought I needed a bath. After I hung out and pet them for a while, we took them for a walk to an area that we would run them. They all had on harnesses with leashes, and for a while I had all three, walking them like dogs. The guides told me that they are the large cat with the most dog-like characteristics. And they really were!! When we got to the running area, I got to run with a soccer ball attached to a stick that they would chase. A little intimidating trying to run in front of land’s fastest animal!! But they are cats, and overall are pretty lazy. After my hour with the cheetahs, it was back to the hostel with all my pictures!! The guide took so many pictures that the camera ran out of battery power!! On Saturday night, the student from Holland met me at the hostel for a couple of beers and to hear about my adventures. When it was time for her to leave, she was going to grab a taxi, but it was a 4 block walk. We asked the guards at the front gate if it was safe for her to walk, and since their were 2 of them they offered to escort us there and me back. We thought this was really nice, but it wasn’t just a regular escort. The guard grabbed a night stick to walk with us!! I wasn’t sure if I should feel incredibly safe or really nervous that there was so much crime that he needed a night stick!! Nothing happened, but because there are so many tourists, white people automatically get associated with money and consequently get attacked. After learning that, we were very happy to have the protection. Sunday morning I had to be up early for the Safari in Chobe National Park in Botswana. They picked us up at 7am, and I of course took another hot shower in the morning – glorious!!! We drove to the Zambezi river, crossed in a boat, crossed the border into Botswana, went through immigration and jumped into safari jeeps. It was a 45 minute ride to the safari lodge where we had muffins with coffee or tea, which I passed on of course, but the muffins were delicious!! After the morning snacks, we started our safari with a trip down the Chobe River, which boarders Botswana and Namibia. We saw a lot of hippos hanging out in the water at first. Then some elephants came down to drink and play in the mud near the riverbank. They are beautiful creatures and so peaceful to watch in their environment. The second part of the trip on the river was pretty quiet; not many animals but so wonderful to be cruising on the water on a boat!! Ahhhh, summer on the water is coming!! After our river ride, we had lunch at this beautiful resort right on the Chobe River. Someday, it would be a beautiful place to stay and watch the sunset over the river!! Lunch was delicious!! I had a few different things, but I think the most unique thing was Impala Lasagna. Impala is kind of a gamey meat, but not bad. And it wasn’t any kind of lasagna I make, but it was good. There was also dessert and a huge bowl of fresh fruit!!! During lunch, I started talking to a couple and it turned out that the guy is an interventional cardiologist and is doing percutaneous valve replacements!!! There are only a handful of people doing these now, so this was absolutely incredible to meet him!! I was almost too intimidated to talk to him. But we did chat, and he gave me some great advice about how to start to get ball rolling on trying to start up a training program specifically geared toward the valve replacements if that’s what I am interested in doing. He had some really great ideas and was really excited to help me pioneer a brand new training program. He was very impressed that I was going to be training at Iowa and recommended a few things that I should definitely do during my residency to get the ball rolling on developing the training program and getting all the skills that I would need. Amazing how God just puts the right people in your life sometimes!! After lunch, we started our driving tour. We drove along a different part of the Chobe River, more of a wet land area and came upon a herd of about 60 elephants!!! They were on our side of the river, wading through the water and on the island just hanging out and playing in the mud. At one point when the jeep was stopped, we heard rustling in the bush next to our jeep. The bushes then started to visibly move, and we were all just waiting to see what was going to pop out. I felt like I was in Jurassic Park, just waiting for the T rex to appear and eat me!! A few seconds later, a huge elephant burst out of the bush about 10 feet from the jeep!! I think it was as scared as we were!! It stopped dead in its tracks and then turned and went back to the bush to eat. When we drove away, the elephant made its way into the water to cool off. I think I could have watched those elephants for hours, but he had to travel on. But as we started leaving, we saw 2 males start fighting!! The one male won, and the other one was exiled from the herd. Well, at least the part with the female that the winning male wanted. We drove on and saw many more impala and puku (similar to an impala, but only found in Botswana – honestly, they look the same to me). There were also wart hogs and water buffalo, but no lions were spotted. They said they were out earlier in the morning, but who knows. I wasn’t nearly as disappointed as some of the other people in our group, especially since I not only saw but played with them the day before!! But I didn’t tell anyone else that!! At the very end, we did see 2 giraffes, but the camera was out of battery again!!! Apparently I saw some amazing things to take pictures of!! I did have my iphone, so that came in handy!! The pictures are quite as good, but at least I have them. After the safari, it was back across the border to Zambia, new visa in hand, and back to the hostel. I was exhausted from the past few day and wound up falling asleep at 9pm!!! I left the hostel at 8am to catch my bus to Choma, which left at 930. Then I caught the bus back to Macha and arrived around 5pm. Full day of travel when you are at the mercy of the bus system!! It’s Marlys’s birthday tomorrow, and she invited me to join her and Chris (her husband) for dinner with some of the other doctors at the restaurant tonight. Now I am home and getting ready for work tomorrow morning. I will be starting on pediatrics, so a new ward to start after my time off. It’s always hard to come back to work after vacation, but this is really hard because all I want to do is come home and show all my pictures!! But soon enough!! Less than 2 weeks!! I apologize for the long post, but I had so much to tell and will have even more when I have pictures to help tell the stories!! I hope everyone had a wonderful weekend!!! And I am glad to be back in my settled area with internet and a room that I can lock!! But I am already missing the hot showers. Have a great week!! Love to all!!

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