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