And now, back to our story...
Live in Yuka is one of severe isolation. They struggle to get people to work here for that reason alone. The doctor here is on bond with the government, and had no choice but to come. On the other hand, he grew up in western Zambia, so it's not so bad for him. The other doctor, an Argintinian, is on medical leave having a hernia repaired. He gave it to himself after lifting an engine without asking for assistance.
Futher complicating things is payment of salaries. See, there is no bank here. In fact there's no bank in Kalabo either. The nearest bank is back in Mongu, and that's going to take 1/2 a months salary to pay for gas to ride to the bank. So, if you choose to do this, you lose 1/2 your salary just taking your salary to the bank! "Why not just get a safe at the hospital?" I asked. Becuase no one trusts any ONE person to be in charge of keeping the safe, well, SAFE. Petty theft is nearly the norm out here, even among some of the hospital workers. It's largely, in my opinion, why places like this can't grow or flourish. The solution for now is that the accountant takes everone's money on ONE boat ride at the end of the month and puts all of it into the bank, returning with records for each person who made a deposit.
I spent one afternoon trying to clean out their O2 concentrator. It was about 2000 hours overdue for maintenance, and I didn't have any replacement filters for this thing (made in Colorado, USA, c.a. 1980). We did actually get to do surgery on that guy I mentioned in the previous post... the volvulous (torsion of the bowel). Here's how it went down.
After the doctor's meeting finished, we went over to the Kalabo district hospital, and went into the OR. I found a state of the art, new, Japanese anesthesia machine (with O2, CO2, and anesthesia agent analyzer), 2 new portable vital sign monitors, and an oxygen concentrator! Too bad there was no compressed air, oxygen or halothane that's required to actually USE such a system. In fact, there is no anesthetist at this hospital. And no muscle relaxants to use on this guy's massively swollen, bigger than 40 weeks pregnant abdomen. Sheeze. This was going to be fun.
So, I used what I had. I gave him the African triumverate of: 5 mg of diazepam (Valium), 600 micrograms of atropine (to counter the drooling-like-a-dog side effect of the...) ketamine! No intubation, LMA or mask, no inhaled anesthesia, no local anesthesia, no morphine. Just a nasal canula, an IV and the aforementioned drugs. I used what I had, and I had to use it well.
The bowel lunged out of the incision and looked to be about the size of my upper thigh. 4 hours and 2 GRAMS of ketamine later, we rolled him out to the medical ward minus most of his large bowel (there is no such things as a post anesthesia care unit here). I hoped they would check vitals on this guy, though he'd done quite well for me during surgery. (We heard that the next day he was doing well.)
So after a total of 3 days in Yuka, we awoke at 0530 to go to the dock and take the boat to Mongu, and catch the 9 AM bus to Lusaka. Of course, since we weren't the only ones going from the hospital to Mongu, we had to wait on them to arrive on African time (meaning anywhere from 45-90 minutes late). We loaded onto the little boat as it began to rain and pushed off into the river.
The boat wouldn't start. After a dozen or so attempts, it did fire up. Which kinda surprised me, since this wasn't the nice boat we came on. It was the hospital's boat, which had the gearbox drop out of the bottom of it a month or so ago and had been under repairs. Repairs had been delayed since the fishermen who retrieved the hunk of metal from the bottom of the river held it for ransom to the tune of 3 million Kwatcha. This had recently been negotiated down to a more reasonable price, and then the boat "fixed." Yeah, fixed. Fixed like a cat taken to the vet.
So we're idling up to speed, leaving 45 minutes behine schedule, and the pilot announces that we have too much weight on board. We go back and spend 15 more minutes to the dock and put 2 people and their luggage off (which was smart since we didn't have enough life vests for all of us anyway), and restarting the engine... again, and again, and again.
We arrived at Mongu 30 minutes after the bus was to leave. In reality, this is usually enough time to get on the bus before it leaves. However, we had to wait for a taxi to drive by, flag it down and get to the bus station. And, that took time. After getting to the bus station at 9:45 , we saw a lovely, huge, yellow bus idling and pointing in the direction of Lusaka. You can imagine the combination of comic disdain I felt when they told us that yes, that was the bus to Lusaka, and it would be leaving at 2200 hours. Lovely.
We had to take a mini-bus (16 passengers) that was scheduled to leave at 11 AM and headed TOWARDS Lusaka. We'd transfer at some other place to take another bus that was SUPPOSED to be crossing paths with us SOMETIME between 1400 and 1500 hours. It was the best we could get, and Jim and I HAD to be in Lusaka that night to catch the 6 AM bus to Chipata the next morning, so we could then leave the day after that for lake Malawi. So, I layed down on the concrete porch and rested my head on my backpack, pulled my hat over my eyes and chilled until the minibus showed up.
We loaded up around 10:45. I saw an albino load up, and tried not to stare. It had been years since I'd seen an African albino... the white skin, almost yellow hair... pink eyes. Then there was another passenger... a boy, about 5 years old climbed in too. It didn't seem as though he was with anyone. His face appeared as though it had been melted in fire, the sink now hardened like previously dripping candlewax, about a quarter inch lower than youd expect the facial features to be. He had no read ability to express emotion anymore. He sat behind me, as we faced the front. I wondered if he looked at me, like I looked at him.
Of course, we left late again, and we ended up driving around town to find fuel. We found some, but not legally. See, there is no gas out here. Or at least none left. What I saw the driver siphoning out, by mout from a used 10 gallon corn oil jug, and flow out a cut garden hose and through a rag/filter before filling the fuel tank, was actually Namibian gas brought over the boarder and sold on the black market. Without this fuel, Mongu has no transportation system.
We FINALLY got off TOWARDS Lusaka. With 21 people in a 16 person mini-van. What I wouldn't have paid for a small privat plane at that moment. Dude, these poeple smelled like phys-ed left over from last month!
About 3 hours later the driver pointed out the front window and said, "There's your bus." It was aobut 1/3 of a mile ahead of us, driving on the same road, belching diesel fumes out the tail pipe, looking all the world like the one I had seen on MacGyver 25 years ago that he had to repair before escaping from Mexico. Well, I thought, at least a bus in that bad of shape shouldn't be too hard to catch up with.
We did catch it, and after paying the extra 1.50$US bribe to have my bags underneith the bus instead of carry-on, we settled in for another 7 hours to Lusaka. I couldn't complain. I had an isle seat, and had brought enough kwatcha this time for a packaged snack (shipped over from China probably 6-12 months ago), fresh water, and some left over to pay for a couple first class pee-breaks (worth every penny when compared with the cleanliness of the free versions).
Total costs for the day were about 15$US per person.
I slept face d0wn again that night, my butt was so sore.
Sunday, March 30, 2008
Wednesday, March 26, 2008
From Blantyre, With Love
And now, back to our story.
OK, so... Yuka mission is right near Kalabo (8 Km), if you can find that on a map. We arrived there after traveling 8 hrs. by bus from Lusaka, after leaving there 45 min late. Now, I have figured out the reason they leave late (this is the 3rd time I've taken what they call a "timed" bus, and they didn't leave on time). They charge you extra for taking luggage along that has to be loaded underneith. The guy who takes your money charges you more than the bus company actually expects from him at the end of the day. So, at the beginning of the day, he and his buddies divy up the extra cash amongst their theiving little selves before turning in the cash and receipts for the bus that is leaving right then. Bingo. Free money for them.
We rode through a big game park about 4 hours into the ride. I saw a lone, large male elephant, a cluster of zebra butts sticking out of the bush, a lot of impala, 2 grey monkey, and some large birds. Sorry, no picts (we were driving kind of fast).
Speaking of driving... I've been trying to learn the rules here. You know, they use the wrong side and everything, and honk all the time. Actually, they don't always drive on the left side of the road because there are SO MANY pot holes, that if the ride would be smoother, you always swerve and weave and curve to get the cleanest path possible. This is one reason why being a driver is actually a career here. I'm not kidding. It takes skill, man. All this while dodging farm animals being hearded over the road (goats, cows), small children left unattended (or more likely, orphaned by HIV) on the side of the road, a soccer match gone astray, bicycles and pedestrians going in both directions, merchants looking to sell their wares (who knows how) to cars speeding past, and the generally unattentive bystander. To effectively dodge these continual annoyances, one must use the car's horn. There is a code I've elucidate that goes a little something like this:
1 short toot = I see you, and see that you see me coming. Get out of the way, I'm coming.
2 short toots = I see you, and see that you DON'T see me coming. Get out of the way, I'm coming.
3 short toots = I see all of you, and see that some of you can see me coming, but some can't or don't seem to care. Get out of the way, I'm coming through where all of you are.
1 long toot = I see you didn't respond to my last toot/toots. You annoy me, now get out of my way! I'm coming through.
1 long toot, 1-3 short toots, followed by 1 more long toot = I see you see me, I don't think you're deaf, and your being rebellious. Now, get the hell out of my way! I'm coming through anyway, and I'm not slowing down for you (though if there are big pot holes, I may have to slow down inspite of your pig-headedness).
At least, that's what I think it all means. I asked if you had to get an international drivers license to drive here and was told "no." I thought it might be hard to learn all the rules of the road, but in retrospect it's quite easy here, compared to the US. Here, all you have to know or do is... honk all the time, and don't hit anything or anybody. Then, it's all good.
Well, we got to Mongu after about 8 hours and took a taxi to the "harbor." Actually, we took 2. See, we'd come with 13 boxes of medicines and supplies (the government hadn't supplied Yuka with any meds for about 2 months), so it took a bit of extra car space. At the harbor, I made my one monitary splurge for the whole trip: round trip speed boat for the 3 of us and our stuff... 600$ US. Why, you may ask? Here's why...
The rainy season leaves only one road open to Yuka from Mongu/Lusaka. It is about 350 Km and takes over one day to drive. There is also 2 other boat options... the slow boat (aka the banana boat), which might as well be to China. It's travel time varies from 8-24 hours, depending on the weather and skill of the pilot (one person told me they got lost in the rain, at night, and had to sleep until morning and then find their way after it was light). So, this is how it went in Mongu... Taxi from the bus station to the harbor: 10$. Cookies and water from the local "market:" 2$. Price for riding on a 80 hp Mercury outboard powered "speedboat:" 600$. Not having to sit on my but for another 8-24 hours while swatting mosquitoes, trying to stay dry, and not letting my hands fall into the water with the crockodiles (no kidding, really): PRICELESS!
Yuka translates to "Someplace to rest." No kidding. And did I ever need it!
When we got to the "harbor" in Kalabo in the twilight and transfered ourselves and 13 boxes into to 2 ORVs. I grabbed Dr. Suingini's 12 fish, hanging on a stringer, and climbed into the back of a barely running jeep/ambulance that was donated from Mwami (probably because it didn't work). I had to hold the back door shut with the hand not holding the fish by pulling on a rope. Fortunately, someone thought "Hmmmm... that doesn't look to safe, even if it is only for 8 Km." Frankly, I didn't care at that point. Anyway, I climbed back out, went to the other car, and they tied the door shut behind me after I got out.
We arrived to no electricity (BTW, I've yet to spend one day in Africa where I didn't have electricity for some part of the day, or something didn't work), lit some candles, and ate supper with the Valenciano family (She's a physician, he's the maintenence chief). Then, Ed and I went to our half of the duplex that serves as the guest house.
Elmita is in the other half, she's the 4th year Argentinian med student who's been here 7 months in a row (one more to go). She's seen 2 amputations following snake bites and said that they killed 5 cobras the first month or so she was there, and she met one on the path to the TB ward a few days ago. It was raised up on it's tail to a hight of about 3 feet, hood spread out, and about a yard in front of her. A photo I saw of one Mr. Valenciano had clubbed and held out at arms length above his head gave me my only glimpse of a snake during my 3 days at Yuka. It was about 7 feet long, and as big around as my forearm! They later noticed the snake wasn't actually dead (it's easy to laugh when you weren't the one holding on to it at the time!) The cobras like eggs, and when rainy season comes, they flee up out of the flood plain to higher ground. If you happen to raise chickens, they know, and they come to your place to eat. It's simple actually. Very predictable (and enough to make me vegetarian).
Back in my half of the duplex, I did have a mosquito net already hanging over the bed I was to sleep on. Which was fortunate, because the silicone glue I had brought with me to install the hooks on the ceiling for hanging my own jumbo-sized, safari-grade, ultra fine mesh net... solidified in the tube (I also could've used it to seal the leak in the vaporizor back at Mwami. Rats.)
I went to the bathroom to wash up. The toilet seat was cracked, and pinched when you sat on it (I shouldn't complain... at least this one HAD a seat). The tub had no shower curtain, and no shower head. The sink had one out of two spiggots working (YES!!!!). It did leak onto the floor a bit (a least I hoped that's where the water came from. The other option was the toilet).
Spiders crawled on the walls. I small frog jumped on my head while I dozed on the sofa one time. A cought an unrecognizable insect crawling up and over my right shoulder, and on another occation (on the boat ride back), one crawled off my lifevest onto my face when I turned to look back up river.
I woke up with a few mosquito bites. Which means the net wasn't treated with Permethrine. The mosquitos will bit you through the net if you lie to close and touch it during the night.
Seet dreams and sleep tight, America.
OK, so... Yuka mission is right near Kalabo (8 Km), if you can find that on a map. We arrived there after traveling 8 hrs. by bus from Lusaka, after leaving there 45 min late. Now, I have figured out the reason they leave late (this is the 3rd time I've taken what they call a "timed" bus, and they didn't leave on time). They charge you extra for taking luggage along that has to be loaded underneith. The guy who takes your money charges you more than the bus company actually expects from him at the end of the day. So, at the beginning of the day, he and his buddies divy up the extra cash amongst their theiving little selves before turning in the cash and receipts for the bus that is leaving right then. Bingo. Free money for them.
We rode through a big game park about 4 hours into the ride. I saw a lone, large male elephant, a cluster of zebra butts sticking out of the bush, a lot of impala, 2 grey monkey, and some large birds. Sorry, no picts (we were driving kind of fast).
Speaking of driving... I've been trying to learn the rules here. You know, they use the wrong side and everything, and honk all the time. Actually, they don't always drive on the left side of the road because there are SO MANY pot holes, that if the ride would be smoother, you always swerve and weave and curve to get the cleanest path possible. This is one reason why being a driver is actually a career here. I'm not kidding. It takes skill, man. All this while dodging farm animals being hearded over the road (goats, cows), small children left unattended (or more likely, orphaned by HIV) on the side of the road, a soccer match gone astray, bicycles and pedestrians going in both directions, merchants looking to sell their wares (who knows how) to cars speeding past, and the generally unattentive bystander. To effectively dodge these continual annoyances, one must use the car's horn. There is a code I've elucidate that goes a little something like this:
1 short toot = I see you, and see that you see me coming. Get out of the way, I'm coming.
2 short toots = I see you, and see that you DON'T see me coming. Get out of the way, I'm coming.
3 short toots = I see all of you, and see that some of you can see me coming, but some can't or don't seem to care. Get out of the way, I'm coming through where all of you are.
1 long toot = I see you didn't respond to my last toot/toots. You annoy me, now get out of my way! I'm coming through.
1 long toot, 1-3 short toots, followed by 1 more long toot = I see you see me, I don't think you're deaf, and your being rebellious. Now, get the hell out of my way! I'm coming through anyway, and I'm not slowing down for you (though if there are big pot holes, I may have to slow down inspite of your pig-headedness).
At least, that's what I think it all means. I asked if you had to get an international drivers license to drive here and was told "no." I thought it might be hard to learn all the rules of the road, but in retrospect it's quite easy here, compared to the US. Here, all you have to know or do is... honk all the time, and don't hit anything or anybody. Then, it's all good.
Well, we got to Mongu after about 8 hours and took a taxi to the "harbor." Actually, we took 2. See, we'd come with 13 boxes of medicines and supplies (the government hadn't supplied Yuka with any meds for about 2 months), so it took a bit of extra car space. At the harbor, I made my one monitary splurge for the whole trip: round trip speed boat for the 3 of us and our stuff... 600$ US. Why, you may ask? Here's why...
The rainy season leaves only one road open to Yuka from Mongu/Lusaka. It is about 350 Km and takes over one day to drive. There is also 2 other boat options... the slow boat (aka the banana boat), which might as well be to China. It's travel time varies from 8-24 hours, depending on the weather and skill of the pilot (one person told me they got lost in the rain, at night, and had to sleep until morning and then find their way after it was light). So, this is how it went in Mongu... Taxi from the bus station to the harbor: 10$. Cookies and water from the local "market:" 2$. Price for riding on a 80 hp Mercury outboard powered "speedboat:" 600$. Not having to sit on my but for another 8-24 hours while swatting mosquitoes, trying to stay dry, and not letting my hands fall into the water with the crockodiles (no kidding, really): PRICELESS!
Yuka translates to "Someplace to rest." No kidding. And did I ever need it!
When we got to the "harbor" in Kalabo in the twilight and transfered ourselves and 13 boxes into to 2 ORVs. I grabbed Dr. Suingini's 12 fish, hanging on a stringer, and climbed into the back of a barely running jeep/ambulance that was donated from Mwami (probably because it didn't work). I had to hold the back door shut with the hand not holding the fish by pulling on a rope. Fortunately, someone thought "Hmmmm... that doesn't look to safe, even if it is only for 8 Km." Frankly, I didn't care at that point. Anyway, I climbed back out, went to the other car, and they tied the door shut behind me after I got out.
We arrived to no electricity (BTW, I've yet to spend one day in Africa where I didn't have electricity for some part of the day, or something didn't work), lit some candles, and ate supper with the Valenciano family (She's a physician, he's the maintenence chief). Then, Ed and I went to our half of the duplex that serves as the guest house.
Elmita is in the other half, she's the 4th year Argentinian med student who's been here 7 months in a row (one more to go). She's seen 2 amputations following snake bites and said that they killed 5 cobras the first month or so she was there, and she met one on the path to the TB ward a few days ago. It was raised up on it's tail to a hight of about 3 feet, hood spread out, and about a yard in front of her. A photo I saw of one Mr. Valenciano had clubbed and held out at arms length above his head gave me my only glimpse of a snake during my 3 days at Yuka. It was about 7 feet long, and as big around as my forearm! They later noticed the snake wasn't actually dead (it's easy to laugh when you weren't the one holding on to it at the time!) The cobras like eggs, and when rainy season comes, they flee up out of the flood plain to higher ground. If you happen to raise chickens, they know, and they come to your place to eat. It's simple actually. Very predictable (and enough to make me vegetarian).
Back in my half of the duplex, I did have a mosquito net already hanging over the bed I was to sleep on. Which was fortunate, because the silicone glue I had brought with me to install the hooks on the ceiling for hanging my own jumbo-sized, safari-grade, ultra fine mesh net... solidified in the tube (I also could've used it to seal the leak in the vaporizor back at Mwami. Rats.)
I went to the bathroom to wash up. The toilet seat was cracked, and pinched when you sat on it (I shouldn't complain... at least this one HAD a seat). The tub had no shower curtain, and no shower head. The sink had one out of two spiggots working (YES!!!!). It did leak onto the floor a bit (a least I hoped that's where the water came from. The other option was the toilet).
Spiders crawled on the walls. I small frog jumped on my head while I dozed on the sofa one time. A cought an unrecognizable insect crawling up and over my right shoulder, and on another occation (on the boat ride back), one crawled off my lifevest onto my face when I turned to look back up river.
I woke up with a few mosquito bites. Which means the net wasn't treated with Permethrine. The mosquitos will bit you through the net if you lie to close and touch it during the night.
Seet dreams and sleep tight, America.
Monday, March 17, 2008
Quick Update from Kalabo, Zambia
Hi all,
This has to be quick, and I´ll try to do a more complete update later this week...
Arrived yesterday at Yuka Mission Hospital near Kalabo, in the western provice. From Lusaka, it was a 8 hour bus trip, followed by 2 hours in boat on a tributary of the Zambezi river. For most of the past week I was at the Lusaka Adventist Eye Hospital, where they actually do more than just eyeballs, turns out. They´re pretty well off there so I didn´t do much work there, just a financial analysis to see if we ought to upgrade their equipment, and how long it would take for it to be worth their while financially for having done so.
Here in Yuka, it´s an entirely different story. They have an anesthesia machine, a Boyle´s model, with serial number 1605. The thing was in a closet, and no one knew how to use it. There is no circuit, and no anesthesia gases. I might not have even recognize the vaporizers, except they were labeled with big letters... ETHER and HALOTHANE. They were like nothing I´ve ever seen. They belong in a museum! In fact, I may try to bring them home just to have as my own personal peices, come to think of it.
Well, at the moment, I´m using a wireless connection at the Liuwa Plain National Park Headquarters (legally, I might add). I and a doctor from Yuka, along with a 4th year med. student from Rio Plata, Argentina, are waiting to hear from the medical director of Yuka who had told us to meet him here in town at the district hospital for an emergent operation for a patient who came in a few hours ago to Yuka. The patient, as best I can tell, is septic (38.7 ºC), and has a belly tighter than a drum head due to abdominal perferation (they didn´t take X-rays, and they had to retrive the one, manual, mercury, BP kit from the nurses station so I could measure vitals myself). I checked and was glad to see that at least he had an IV in place. Too bad it was only a 20 g, and was dripping quite slowly. I opened it up wide and asked if it was his first bag of saline, then realized as I spoke the words he should be happy he´s getting any fluids at all. Back at Mwami, they don´t give IV fluids to any but the hypotensive or C-section patients. It´s just not available, and very expensive.
The OR there at Yuka is under repairs, since it started raining in after the roof collapsed a few days ago. The bats love to fly in under the roof of the hospital buildings, pee and poop all night long for years and years until the ceiling rots and caves in. Such is life, eh?
Outside, no snake citings yet :) I did, however (mom, you´ll love this story), meet the red fire ants they have here last night. Fortunately for me, and my scarred for life psyche, there were only 2. But, they both bit me at once, just like the old days, on my legs after I inadvertantly walked too slowly past them. I´ll try to get a pict of these beggers... they travel in hords here, HUGE groups of them. I saw them this morning, traveling about 10 to 12 ants wide, both going and coming in a trail that flatened out the sand. You CANNOT stop and look at them long. They DO notice you, and the DO come after you. I´m having flash-backs just writing about it.
*Dream-like sequence here*
I was about 4 years old, playing in the front yard in Savannah, GA. I didn´t know it, but I was standing on a fire-ant hill, and suddenly, after climbing both of my legs up to my crotch, one of them gave the signal to bite, and so they did... all at once. After that, all I can remember is excruciating pain and being stripped naked faster than a trauma in the ER so I could be washed off.
*End PTSD recollection here*
Back in the present, we´ve been notified that the doctor who asked us to come for surgery here in Kalabo is in a meeting. I asked if the Kalabo hospital could deal with the surgery without us... I mean, they have a hospital with a functional OR, doctors, maybe even a nurse of two on duty, what the big deal? They said the Kalabo doctors are in the same meeting! Trouble is, the power in this region goes out every day at 7 PM until 9 AM the next morning. So, if you want to operate WITH electricity, they´ve only got 1 more hour to go. I also learned that while Kalabo District Hospital does have a new anesthesia machine, there is no one there who actually knows how to use it. :) How convenient.
My guess is this guy isn´t going to get a surgery until tomorrow. And that´s if he lives.
This has to be quick, and I´ll try to do a more complete update later this week...
Arrived yesterday at Yuka Mission Hospital near Kalabo, in the western provice. From Lusaka, it was a 8 hour bus trip, followed by 2 hours in boat on a tributary of the Zambezi river. For most of the past week I was at the Lusaka Adventist Eye Hospital, where they actually do more than just eyeballs, turns out. They´re pretty well off there so I didn´t do much work there, just a financial analysis to see if we ought to upgrade their equipment, and how long it would take for it to be worth their while financially for having done so.
Here in Yuka, it´s an entirely different story. They have an anesthesia machine, a Boyle´s model, with serial number 1605. The thing was in a closet, and no one knew how to use it. There is no circuit, and no anesthesia gases. I might not have even recognize the vaporizers, except they were labeled with big letters... ETHER and HALOTHANE. They were like nothing I´ve ever seen. They belong in a museum! In fact, I may try to bring them home just to have as my own personal peices, come to think of it.
Well, at the moment, I´m using a wireless connection at the Liuwa Plain National Park Headquarters (legally, I might add). I and a doctor from Yuka, along with a 4th year med. student from Rio Plata, Argentina, are waiting to hear from the medical director of Yuka who had told us to meet him here in town at the district hospital for an emergent operation for a patient who came in a few hours ago to Yuka. The patient, as best I can tell, is septic (38.7 ºC), and has a belly tighter than a drum head due to abdominal perferation (they didn´t take X-rays, and they had to retrive the one, manual, mercury, BP kit from the nurses station so I could measure vitals myself). I checked and was glad to see that at least he had an IV in place. Too bad it was only a 20 g, and was dripping quite slowly. I opened it up wide and asked if it was his first bag of saline, then realized as I spoke the words he should be happy he´s getting any fluids at all. Back at Mwami, they don´t give IV fluids to any but the hypotensive or C-section patients. It´s just not available, and very expensive.
The OR there at Yuka is under repairs, since it started raining in after the roof collapsed a few days ago. The bats love to fly in under the roof of the hospital buildings, pee and poop all night long for years and years until the ceiling rots and caves in. Such is life, eh?
Outside, no snake citings yet :) I did, however (mom, you´ll love this story), meet the red fire ants they have here last night. Fortunately for me, and my scarred for life psyche, there were only 2. But, they both bit me at once, just like the old days, on my legs after I inadvertantly walked too slowly past them. I´ll try to get a pict of these beggers... they travel in hords here, HUGE groups of them. I saw them this morning, traveling about 10 to 12 ants wide, both going and coming in a trail that flatened out the sand. You CANNOT stop and look at them long. They DO notice you, and the DO come after you. I´m having flash-backs just writing about it.
*Dream-like sequence here*
I was about 4 years old, playing in the front yard in Savannah, GA. I didn´t know it, but I was standing on a fire-ant hill, and suddenly, after climbing both of my legs up to my crotch, one of them gave the signal to bite, and so they did... all at once. After that, all I can remember is excruciating pain and being stripped naked faster than a trauma in the ER so I could be washed off.
*End PTSD recollection here*
Back in the present, we´ve been notified that the doctor who asked us to come for surgery here in Kalabo is in a meeting. I asked if the Kalabo hospital could deal with the surgery without us... I mean, they have a hospital with a functional OR, doctors, maybe even a nurse of two on duty, what the big deal? They said the Kalabo doctors are in the same meeting! Trouble is, the power in this region goes out every day at 7 PM until 9 AM the next morning. So, if you want to operate WITH electricity, they´ve only got 1 more hour to go. I also learned that while Kalabo District Hospital does have a new anesthesia machine, there is no one there who actually knows how to use it. :) How convenient.
My guess is this guy isn´t going to get a surgery until tomorrow. And that´s if he lives.
Tuesday, March 11, 2008
First Report
Hi all!
Sorry it's taken a while to get connected, but hey, I was in the middle of nowhere you know?
Here's what's happened so far...
I went to London to meet with the manufacturer of an anesthesia machine designed specifically for difficult environments (read: the 3rd world). I was unable to visit and train on the machine because I wasn't there on a Teusday, but they sent me a training DVD to my bed and breakfast near Heathrow. So, for several days I re-visited the British Museum (the Rosetta Stone, and the best of ancient Persia, Greece, Rome, India, and Europe), the National Gallery (Van Gough, Monet etc), and took in a Baroque string concert at St. Martin's in the Field, and an organ recital at Westminster's Abbey. Also spent a half day reading at the National Library on halothane and ether anesthesia (that book was an original from c.a. 1850 by Dr. Morton... the one credited with "discovering" ether anesthesia). They also have there Dr. Harvey's book on human circulation, which he published at the age of 36 (I turrn 36 on April 6th). Oh, and Gutenburg's Bible, parts of Da Vinci's notebooks, the Magna Carta, and Galaleo's first published book (yes, they are the originals)... John Lenon's handwritten lyrics for "Hard Day's Night," written on the back of his son's 1st B'day card.
You gotta love London!
Ok, so from there I flew 13.5 hours to Lilongwe, Malawi via Johannesburg, South Africa... after sitting on the runway in London for 1 hour, nearly missing my transfer in JoBerg, and showing up in Malawi sans (def: French for "without") luggage. I was transported another 3 hours by car over what was referred to as a "road" to Mwami Adventist Mission Hospital near Chipata, Zambia, with the assurance that *maybe* my bag would be on the next plane from JoBerg (which would arrive 2 days later). I was greatly relieved (literally) to finish the journey 3 countries, 2 days, and 1 liter of water later. :)
The guest house I was in had 3 medical students on rotation from University Teaching Hospital in Lusaka (the capital of Zambia). They couldn't get enough of discussion on US politics. My room had a mosquito net, fortunately. My own net was in my bag, presumably in JoBerg, along with my DEET and Permethrine repellants, malaria pills, soap, tools and equipment for the OR. Oh yeah... and all my clothes. I did have my video camera though (But, I have no way of transferring images to the blog site, sorry!)
The machine ordered from the UK had arrived just before me, and we set it up right away. I also inspected the ORs and met with the 2 anesthesia providers (approximately equivalent to CRNAs... they trained 2 years in Tanzania, after prior medical experience). They had a Forreger with copper kettle vaporizer and a Boyle's type machine (fiited with halathane and Ether vaporziers). Their main machine was a Drager 2a, plugged into a rigged transformer to get 110v from the local 220v electricity, and hooked to an H class O2 cylinder, flowing 4-7 liters/minute of fresh gas (O2). The halothane is free, from the government, but one O2 tank costs the equivalent of 1/2 a nurse's monthly salary. They have no CO2 absorbent, so then must run high flows. The EKG machine broke last month. They have THREE Masimo Rad7 pulse oximeter machines (YES!!! ) and one crummy Nelcore pulse Ox. They have suction, but don't hook it up much (no yankaur tips). Everyone gets Atropine pre-op, so there's not a lot of slobber. They ran out of Succynylcholine, so they just use a mask for ventilating for the whole case. I showed them how to intubate under deep halothane anesthesia without muscle relaxant, but they were too scarred to do it without me after I left.
The new machine worked well, except the vaporzer leaked out ~20% of the halothane in stock over the weekend. Chewing gum quickly dissolved in halothane, so that solution was not even attempted. I had silicone glue in my suitcase, but that was still lost (I had planned to use it to mount my mosquiot net to the ceiling. Instead, I had to suspent the one that was provided from the light in the center of the room, and the other edges from the curtains haging in front of the unscreened windows). I tried using a metal foil wrapper from a scalpel blade, but the adhesive from the tape I placed on top of it quickly dissolved in a bit of halothane that still leaked out. I then tried a junk screw I found that just fit in the round plastic peice that was where the leak occurred. I could hear the theme from MacGyver in my mind as the leak stopped :) (My swiss army knife was still in JoBerg).
They now no longer need any O2 becuase the new machine has an O2 concentrator that can make 7-8 liters/min of O2 and costs about 15 cents per hour to run. When the electricity fails (and it usually does nearly every day), room air is autoatically pulled into the draw-over vaporizer. I made them shut off the concentrator and use room air only while monitoring the pulse-ox. I never saw O2 sats lower than 97 on room air. They will no longer need to buy O2 for the ORs, and it they can get a way to compress the O2 generated there the hospital, they might never need to buy it again... might even sell it to other facilities, and the machine end up paying for itself. Sweet :)
Yes, much of what you think of Africa is true. Yes, it's dirty, hot, and humid. Even in the ORs. Yes, they re-use EVERYTHING. Yes, I saw hemaglobin of 2.9 in a lady with TB and HIV... that was after transfusing 2 units of blood the prior day (they believe she is having a reaction to the ARVs (anti-retro-virals)). Yes, I went without underwear for a week, and wore scrubs. Yes, I did borrow some soap and shampoo, but deoderant is a luxury (at least, based on my own personal olfactory survey of the locals). Yes, I eat mostly the same things every day... often with my own bare *right* hand. Yes, they seem to be facinated by my hair. Yes, one little girl ran away terrified of me and refused to come to her mother's side and say hello. Yes, I bribed the Police with 30$ US after they stopped us once at a checkpoint and told the driver he could either leave his car or his license because we were not carrying red triangles to put on the road in case we broke down (actually, a real possibility)... and yes, he smiled big and let us go. (DEET, 6$. Diesel fuel, 8$/gallon. Freedom from corrupt Police... priceless.) As we drove away I wondered if it was morally wrong to *give* a bribe, or just *take* a bribe. What do you think? Write me! fvcobos@gmail.com
But there is much about it you probably don't understand, the sum of which could fill several books and form a doctoral thesis. For example, you simply cannot understand severe racism until you see it African style. Ever heard of Ruwanda? Remember the Hutu's and Tutsis? Say no more.
The African acapela singing at church is... well, indescribable. I got some of it recorded on video, and will get more as an MP3. I had forgotten how good it sounded (I had been in Kenya 9 years ago and couldn't believe my ears).
I have my one bag now from Lilongwe (The guy at the airport baggage asked me if I was studying Judo... I was wearing scrubs), and am in Lusaka, the capital, for 4 days spread across 2 hospitals. From here we go by Landcruser for 8 hours, then 3 hours by boat on the Zambezi River to Yuka Hospital. It is said to be a place where hyenas, lions and cobras can be found. I won't be looking.
That's it for now. Hasta la Bye-bye.
FVC II
Sorry it's taken a while to get connected, but hey, I was in the middle of nowhere you know?
Here's what's happened so far...
I went to London to meet with the manufacturer of an anesthesia machine designed specifically for difficult environments (read: the 3rd world). I was unable to visit and train on the machine because I wasn't there on a Teusday, but they sent me a training DVD to my bed and breakfast near Heathrow. So, for several days I re-visited the British Museum (the Rosetta Stone, and the best of ancient Persia, Greece, Rome, India, and Europe), the National Gallery (Van Gough, Monet etc), and took in a Baroque string concert at St. Martin's in the Field, and an organ recital at Westminster's Abbey. Also spent a half day reading at the National Library on halothane and ether anesthesia (that book was an original from c.a. 1850 by Dr. Morton... the one credited with "discovering" ether anesthesia). They also have there Dr. Harvey's book on human circulation, which he published at the age of 36 (I turrn 36 on April 6th). Oh, and Gutenburg's Bible, parts of Da Vinci's notebooks, the Magna Carta, and Galaleo's first published book (yes, they are the originals)... John Lenon's handwritten lyrics for "Hard Day's Night," written on the back of his son's 1st B'day card.
You gotta love London!
Ok, so from there I flew 13.5 hours to Lilongwe, Malawi via Johannesburg, South Africa... after sitting on the runway in London for 1 hour, nearly missing my transfer in JoBerg, and showing up in Malawi sans (def: French for "without") luggage. I was transported another 3 hours by car over what was referred to as a "road" to Mwami Adventist Mission Hospital near Chipata, Zambia, with the assurance that *maybe* my bag would be on the next plane from JoBerg (which would arrive 2 days later). I was greatly relieved (literally) to finish the journey 3 countries, 2 days, and 1 liter of water later. :)
The guest house I was in had 3 medical students on rotation from University Teaching Hospital in Lusaka (the capital of Zambia). They couldn't get enough of discussion on US politics. My room had a mosquito net, fortunately. My own net was in my bag, presumably in JoBerg, along with my DEET and Permethrine repellants, malaria pills, soap, tools and equipment for the OR. Oh yeah... and all my clothes. I did have my video camera though (But, I have no way of transferring images to the blog site, sorry!)
The machine ordered from the UK had arrived just before me, and we set it up right away. I also inspected the ORs and met with the 2 anesthesia providers (approximately equivalent to CRNAs... they trained 2 years in Tanzania, after prior medical experience). They had a Forreger with copper kettle vaporizer and a Boyle's type machine (fiited with halathane and Ether vaporziers). Their main machine was a Drager 2a, plugged into a rigged transformer to get 110v from the local 220v electricity, and hooked to an H class O2 cylinder, flowing 4-7 liters/minute of fresh gas (O2). The halothane is free, from the government, but one O2 tank costs the equivalent of 1/2 a nurse's monthly salary. They have no CO2 absorbent, so then must run high flows. The EKG machine broke last month. They have THREE Masimo Rad7 pulse oximeter machines (YES!!! ) and one crummy Nelcore pulse Ox. They have suction, but don't hook it up much (no yankaur tips). Everyone gets Atropine pre-op, so there's not a lot of slobber. They ran out of Succynylcholine, so they just use a mask for ventilating for the whole case. I showed them how to intubate under deep halothane anesthesia without muscle relaxant, but they were too scarred to do it without me after I left.
The new machine worked well, except the vaporzer leaked out ~20% of the halothane in stock over the weekend. Chewing gum quickly dissolved in halothane, so that solution was not even attempted. I had silicone glue in my suitcase, but that was still lost (I had planned to use it to mount my mosquiot net to the ceiling. Instead, I had to suspent the one that was provided from the light in the center of the room, and the other edges from the curtains haging in front of the unscreened windows). I tried using a metal foil wrapper from a scalpel blade, but the adhesive from the tape I placed on top of it quickly dissolved in a bit of halothane that still leaked out. I then tried a junk screw I found that just fit in the round plastic peice that was where the leak occurred. I could hear the theme from MacGyver in my mind as the leak stopped :) (My swiss army knife was still in JoBerg).
They now no longer need any O2 becuase the new machine has an O2 concentrator that can make 7-8 liters/min of O2 and costs about 15 cents per hour to run. When the electricity fails (and it usually does nearly every day), room air is autoatically pulled into the draw-over vaporizer. I made them shut off the concentrator and use room air only while monitoring the pulse-ox. I never saw O2 sats lower than 97 on room air. They will no longer need to buy O2 for the ORs, and it they can get a way to compress the O2 generated there the hospital, they might never need to buy it again... might even sell it to other facilities, and the machine end up paying for itself. Sweet :)
Yes, much of what you think of Africa is true. Yes, it's dirty, hot, and humid. Even in the ORs. Yes, they re-use EVERYTHING. Yes, I saw hemaglobin of 2.9 in a lady with TB and HIV... that was after transfusing 2 units of blood the prior day (they believe she is having a reaction to the ARVs (anti-retro-virals)). Yes, I went without underwear for a week, and wore scrubs. Yes, I did borrow some soap and shampoo, but deoderant is a luxury (at least, based on my own personal olfactory survey of the locals). Yes, I eat mostly the same things every day... often with my own bare *right* hand. Yes, they seem to be facinated by my hair. Yes, one little girl ran away terrified of me and refused to come to her mother's side and say hello. Yes, I bribed the Police with 30$ US after they stopped us once at a checkpoint and told the driver he could either leave his car or his license because we were not carrying red triangles to put on the road in case we broke down (actually, a real possibility)... and yes, he smiled big and let us go. (DEET, 6$. Diesel fuel, 8$/gallon. Freedom from corrupt Police... priceless.) As we drove away I wondered if it was morally wrong to *give* a bribe, or just *take* a bribe. What do you think? Write me! fvcobos@gmail.com
But there is much about it you probably don't understand, the sum of which could fill several books and form a doctoral thesis. For example, you simply cannot understand severe racism until you see it African style. Ever heard of Ruwanda? Remember the Hutu's and Tutsis? Say no more.
The African acapela singing at church is... well, indescribable. I got some of it recorded on video, and will get more as an MP3. I had forgotten how good it sounded (I had been in Kenya 9 years ago and couldn't believe my ears).
I have my one bag now from Lilongwe (The guy at the airport baggage asked me if I was studying Judo... I was wearing scrubs), and am in Lusaka, the capital, for 4 days spread across 2 hospitals. From here we go by Landcruser for 8 hours, then 3 hours by boat on the Zambezi River to Yuka Hospital. It is said to be a place where hyenas, lions and cobras can be found. I won't be looking.
That's it for now. Hasta la Bye-bye.
FVC II
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