(From Paris With Love)
Arriving in Paris from different points of origin, Suzanne and I had to rendez-vous at the hostel before seeing some sights in the afternoon. We had spoken by phone one last time the day of our departure to confirm our directions to the hostel and our emergency plan to meet up in case we couldn't find the place. Fortunately, we didn't need to execute aforementioned plan. However, it did take me about 3 hours to reach the hostel, and Suzanne 4. This was due to a combination of factors, the most important ones being the fact that neither of us had sleep very much for the past day, neither of us was very enthusiastic about dragging 100 lbs of luggage each through the Paris Metro, up and down stairs and corresponding underground walkways between train lines. I spent my time waiting for Suzanne by wondering the surrounding streets trying to not look too American, too sleep deprived, or too much like a staggaring drunkard who enviously eyed all the baked goodies in every other window store front, drooling as I stared, and wondering when my travel partner would arrive so we could celebrate with a huge lunch before hitting the town.
Finally we got settled into the hostel after a confused discussion with a foreign born Fre-nglish speaking host, who odiferous fragrance filled the room, justifying the idea that the French originate the finest perfumes on earth. He directed us downwind, and downstairs to store our luggage in what looked like a dungeon until after 4 PM when the rooms opened for check in. I nearly fell down the stairs with my 3 bags, and after steading myself on the damp stone/tile steps promptly had a near miss on the low hung archway ceiling that lead around to the left into the crypt below. I hesitantly crept forward as I worked my way through the catacombs, certain that I would see an Iron Maiden or Rack in the room with the luggage. All I found was a sump pump.
Upstairs on the ground floor (not the first floor... that's what we'd call the 2nd floor), we had a concrete box (i.e. "room") with 2 Asian girls staying in the "loft" (a cement cage joined with ours via small spiral staircase in the corner... next to the other cramped corner with small shower and tiny toilet (complete with part of the seat cut off so the lid could actually be put down and not catch on the wall). Clearly, the Asians had yet to master how to keep the shower water from flooding the 3.5 tiles of floor space in the "bathroom," and running out the opening under the doorway and out into our room. But, at least we HAD a shower and toilet. All they had was a sink upstairs.
We went to the Louvre as our first stop, and enjoyed an audio tour of ancient Greece, Rome and Mesopotamia. We saw the Mona Lisa and some of the most important works of art in all of western history. This assumes, of course, you can find them. Now we did actually ask for directions from the Frenchman standing around doing nothing (maybe, just waiting for a reason to go on strike... and do more of nothing) for this one exibit which they claimed was in London. "Oh contrair, mon frer!" I thought. "I've been there, and I've been here... and I can assure you it's HERE!" I thanked them (in French, to be polite) as I bid them aduie, leaving them alone with their prim and proper snickers directed in our general direction. We later found it by accident, without the help of the French.
The architecture of the Louvre itself is something to see. It used to be the home of the French Kings, though for one of them who grew up there, Louis the XIV, it was a bit overkill. So, he built Versailles, about 10 miles away from Paris to get away from it all out in the country.
Upon returning to the hostel, we discovered a whole flock of Asians inhabiting the dining/socializing area... oh, and ONE english speaking guy who showed us how to log into the wireless network set up in the bar across the street so we could send email. There was an expensive email kisok machine there in the hostel lobby, buy why pay for something you can get for free, mon frer? Though limited to 20 minutes, it was an effective mode of communication... which is all we wanted other than a REALLY good night's sleep. In the room, not surprisingly, the floor was flooded again. Dang Asians! Well, turned out the 2 girls in the loft had been swapped out for a pair of Aryan giants (seriously, the cute one was really tall!). Well, at least I could talk with these people.
One drawback of this room we quickly discovered was the fact that EVERYONE on the first floor had to come by ours on the way to theirs. It also was just across the hall from the eating/socializing area. Now, why should that matter? Well, if you're from Asia, and visiting Paris, and it's 1 o'clock in the morning, it actually 7 AM where your brain lives (and lives quite loudly, evidently). So, why not just chatter away making sounds like silverware falling down the stairs to the luggage hold so that everyone from 2 Metro stops around can enjoy your own frivolity? I mean, it makes perfect sense... if you DON'T think about it. Naturally, I ALWAYS travel with earplugs and eyeshades so I was prepared! And fortunately, Suzanne had kept those very supplies from the AirFrance flight that had brought her from San Francisco. So, we were able to largely block out the rude world around us, and dream of ways we could return the favor to these people when we got up the next morning!
The next morning we went out to eat and found very simple fare... a bagette sans/avec butter and/or jam, hot milk/chocolate. Period. Yes, period. "Dude!" I thought, "I forgot all about the dearth of breakfast food on the "continent" (hence the term continental breakfast.") We finished up and promptly left to find a shop open this early that would sell something reminiscent of what I would call breakfast, totally forgetting our vow of revenge toward the Asian chatter boxes.
After filling our bellies with some finer French cuisine we spent the entire day at Versailles. It took 40 minutes to get there by train and 10 minutes to purchase a Paris Museum pass from a snooty tourist office worker. With the pass, we were wisked in VIP style without having to wait with the hoi-poloi who had been told "Let them eat cake." This is where we failed to learn out lesson about not asking for directions, yet again. We were tired, it was the end of another day, we hadn't gotten as high quality sleep as we had hopped for with our new German roommates... we were really tired of walking (though, at least we weren't carrying 100 lbs of luggage each) and we just broke down and against our better judgement, asked (in French). All we wanted to know was where the "sortie" was (i.e. the exit). The French gardner politely referred us to the other side of the garden, where he was certain an exit would let us out toward the road leading back to the kings chambers. 10 minutes later, with no cheese at the end of the maze, we found a locked gate in that general direction. We wondered another 15 before getting out of that area and heading back to the mansion. From there, it was back to the train, and a 30 minute nap on the way to the Eiffel Tower. We ate crepes at a delightful cafe on Rue Cler, got our second wind, and headed to the Arc de Triumph. We climbed to the top and were able to see the light show that is now done at the top of every hour for 10 minutes, lighting up the tower in blue, white sparkles, and the gold stars of the EU.
The next morning saw us embarc on a tour of Orsay Museum via Concord (where they chopped people's heads off in the public square), and the Champs de Elyssee (where the Tour de France bike race ends). We broke for lunch to do some people watching and enjoy some more fine cuisine. While waiting, it was hard not to notice how beautiful the French women are (Suzanne agrees). In fact, the REALLY hot ones have really ugly little dogs. I personally believe it is a trick they use on purpose to accentuate the own beauty. In any case, all I can say is Vive la France! Vive la difference! There was even this one lady, must have been about 55 years old, peddled by on her lunch break from work wearing gold stillettos, fish net panty hose, and matching, short cut, gold leather jacket!
After finishing the most exquisite French Vanilla ice cream I have ever had, we went to see the "Thinker," and "The Kiss," sculptures by Rodin. Then we went on to Napolean's tomb and WW I & II museums. Afterwards, we were hungry again and found another cafe on Rue Cler. Dinner was great, and the snooty lady whose large black dog blocking the waitress's pathway created quite the scene, providing more than adequate entertainment for the evening. The one word I recognized that the waitress said after this woman left was, "Halleluja!" My sentiments exactly. And with that, we went back to noisy-land for an attempt at some sleep.
Prior to going to bed, I tried to check email with my Mac out in the eating area. As I struggled to hack into the system across the street, a sexy accent asked me if I spoke French. At the moment I looked up to see who it was, I cannot tell you how much I wanted to say "Oui." at that moment. You see, the young woman (who switched into an even MORE sexy accent in English) turned out to have competed in the Miss Switzerland pagent before working/traveleing on a cruse ship for the past 5 months. She wanted to charge up her Mac, but didn't have the correct plug adapter for France. I assured her I had what she needed, and came back from my room with my own cord and power adapter. We spent the next 2 hours traveling the world together through photos we'd each taken over the past year, exchanged email, and decided to meet for breakfast.
Off I went to bed. I should mention though that just before going to bed, I had been approached by the Curry Infused Indian desk worker and asked if, as a favor, I would let a little Chinese girl (who had just arrived without a reservation at 10:30 PM) sleep in my bed with 3 girls in that room so that she wouldn't have to share with 2 guys upstairs in the only other vacant bed. I reluctantly agreed... for one night. Well, when I went upstairs to knock on the door, the guys wouldn't answer or let me in! I came back down and tried to talk to Indian Air De-freshner but could NOT for the life of me convince him I was unable to get into the room (there is only one key for each room. Don't ask me why). Finally, he gave me his master electronic key, which I stomped upstairs with after knocking I don't know how many times before resorting to this. After deftly swiping it and whooshing the door open I found a Spainard, gape mouthed, wondering how on earth his room had been invaded by someone he was NOT expecting. I looked straight at him and asked, "Why wouldn't you OPEN THE DOOR!" He answered with a non-sequitor.
Shortly thereafter, a Chinaman came in who wreecked of rotten Manderine, or socks. I couldn't quite tell, and frankly at this time of the night, I could've cared less... and frankly, as a doctor, I've smelled worse. I settled in on the bottom bunk, the Chinaman up top, and the snoring Spainard off to the other side of the room. For the next 4 hours I could hear and feel the Chinaman shift and toss and turn and he robbed me of my sleep (not that I could hear or see anything). Unbeknownst to me, one floor down, Suzanne was having the SAME experience with the Chinese girl! In retrospect, it is clear that those birds of a feather really should've been flocked together.
Swiss Miss met me for breakfast as I drank hot chocolate and chatted. Ah, the joys of having a beautiful and intelligent, well traveled woman for company. It doesn't get any better than this.
For sights, we saw St. Chapelle, Notre Dame, the Crypt below it, the Pantheon, Trocadero and Eiffel Tower. On the way to the last stop, where we purchased some more vanilla "glasse" to fuel out final evening's activities in Paris, we spotted an balding elderly man with Coke-bottle glasses, seated crossed-leg, smoking like a petite chimney, wearing a blue pin-stripped suit, brown shoes and screaming bleach-white socks. The fashion faux pas was shocking, even to an American like me! His arrogance seemed to suggest, "I am SO French, I can get away with this and STILL look good!" Oh contrair, mon frer. Further on down, as we licked the dripping ice cream we spotted some Arabs dressed in black suits... ALL with brown leather shoes. It was like we were looking at a pack of Doberman Pincers. I was waiting for the voice of Robin Masters from Magnum PI to call out, "Lads! Chase!" After taking a seat under the shaddow of the Tower, we did some more fashion policing (deeply frowning on the Yak's Yak Yellow stocking one woman was parading around in). We cought this one lady in line to climb the tower wearing Rhinestone studded jeans with triangles opening up the side of her legs, followed closely by another lady wearing black stockings with the same style effects. By all apearances, the older lady was the mother of the younger, who also had a todler following her. Enter into the scene an old gypsie appearing lady who seemed to be trying to talk to the younger of the two fashion foibles. It suddenly dawned on us that this was no gypsie working the crowd, but rather Great gram-grams for the 3 generations of Russians we'd been clandestinely peering at the past few minutes. Shocking, but true.
NOTE: Email here creates a great oral vaccuum. We will try our best to make more posts, but can promise nothing. It may be that we'll post everthing after returning stateside :( We appologize to all our loving, loyal fans! We will attempt to open another blogsite, and direct you to it at that time from this blog. Thanks! FVC II
Tuesday, October 14, 2008
Sunday, July 27, 2008
Soap gets in my eyes...
I know, I know... it's been forever since I updated the blog. So, your patience pays off today! Hurah! On with our story:
The next day was spent doing some research on the internet and crunching numbers for financial decision making. What we needed was a reliable supply of anesthetic gases, vaporizers to administer them, oxygen concentrators to suppliment the air people would breath through the vaporizers, as well as replacement parts for the whole breathing system. After all, this is Africa... things break routinely. The connection to the net was so slow though, that it was hard to learn or accomplish much of anything.
I met with the accountant and business manager to discuss oxygen, halothane and concentrator costs. To sum it all up, an oxygen concentrator costs about 700 US$ and can provide 5 liters per minute of oxygen continuously. That same supply of oxygen would cost about 2 US$ per hour. Thus, one concentrator would pay for itself after 350 hours of use (excluding the cost of electricity, which in Zambia, at least, was about 2 cents per hour). in 2007, the hospital's O2 usage cost 19,333 US$, and much of this was probably wasted when staff failed to turn off the tank after the oxygen supply was no longer needed for a particular patient. That annual dollar amount would buy 27 oxygen concentrators, each of which would last 5-10 years if properly maintained.
Now, assuming that electricity is about the same cost here as in Zambia, you could purchase 3 concentrators for 2,100 US$ and run them for 12 hours per day, 365 days per year for 263 US$ worth of electricity, do it for 5 years, and the total cost would still only be 3,414 US$. Therefore, 5 years of oxygen at a cost of 3,414 US$ versus 5 years of cylinder oxygen at last years actual cost of 19,333 US$, would amount to a savings of about 96,000 US$. In others terms, in order to turn an investment of 3,414 US$ into 93,251 US$ (for a total of 96,000 US$), one would have to find an investment that gave a return of 2,700%. I am unaware of ANY opportunity that would yield such returns consistently. Other than changing practice from purchasing compressed, tank oxygen to oxygen concentrators.
Further, a savings of some 93,000 US$ would pay the present day salary of 2 anesthetists for 27.5 years, along with an extra month's salary as a yearly bonus (ignoring yearly inflation).
That weekend at church I met Ted Powers, a 4th year medical student from Loma Linda. He matched there to do anesthesia, though he had interviewed in Nebraska while I was on staff there last year. I never met him when he came to Nebraska, so it is as improbably as it is amazing that we should end up sitting next to each other on the other side of the world.
That night, along with Dr. Mataya, Ted and I went for supper to Dr. Terrie Taylor's house. She's a friend of Mataya's and just happens to be one of the world's leading experts on malaria. She comes from Michigan to Blantyre, Malawi every January through June. She has medical students and research assistants join her regularly, of which 3 were with her this evening. We had a wonderful time eating and talking together all evening. And of course, in keeping with the British tradition, there was even time for tea afterwards.
The next day I tested 3 oxygen concentrators that I found locked in a storage closet. Guess what? They all worked! Well, at least they all put out some gas from the machine that I assume is oxygen. I suppose I could've tried to burn it, or set up some explosive experiment. But I settled on just breathing the stuff and seeing if it raised my O2 saturation measured by the one functioning pusle oximeter in the OR. Maybe I'll try to blow up something next time. I'll check my chemistry books back in the states after I get back, then be prepared for more "kitchen chemistry" type fun when I return to the 3rd world. Now, I should tell you that one of the grounding pins on the power cord is broken, and another missing the air filters, but they do WORK. This was after I'd already asked if the hospital had any concentrators and was told, "We only have two, and one of them is broken." It was also after I had asked to be SHOWN the concentrators... and was taken down a side hall and pointed to an empty oxygen tank. Definitely NOT helpful. In fact, it was somewhere around this time that I had decided that I had been "helped" enough, and that I was going to do whatever needed to be done without asking for prior permission or opinions, as well as believe whatever I thought was likely true about a situation because asking for clarification would only bring a fresh supply of lies, or at the very least obvuscate the truth I was trying so hard to elucidate.
My next trip into the shower was less than amusing. To me, that is. You'll probably get a kick out of it, though. And, I'm not posting any pictures, so if you're a woman, or if there are small children around, please, feel free to continue reading my blog posts. It'll be OK. Really.
As you know, losing water here is pretty routine. In fact, I can't remember a day during my whole trip where I didn't lose either the power or water supply, or both at the same time. However, this time there was a bit of a caveat to the whole ordeal. This time, I was all soaped up, in a shower with no curtain, when only the cold water ran out (I presume I was still getting hot water out of the small reserve tank). The scalding I received was enough to test my Christianity. I rinsed my hands and eyes the best I could, then carefully made the dripping wet and naked trek to the kitchen. This is where I found the 25 liter reserve water jug and a cereal bowl to finish what is locally referred to as a "bucket bath." These 2 fixtures remained in my bathroom until the day I left the country, once again illustrating that one can never have enough backups in place.
After finishing most of the final rinse cycle, I tried to mix in a little of the hot water, which promptly also ran out. So, I toweled off and got dressed as I heard the sound of rushing water filling the pipes again (which is easy if you just leave the spigots open). So, I figured, "Might as well at least get my face washed with hot water." I splashed it on, soaped up... and of course heard the pipes run dry once again. "I just can't win here!," I thought. "About how far away is that bowel and bucket, and can I get to it without opening my eyes?"
And as for washing my clothes, well... I got back a load from the hospital cleaning department and was shocked to see that nothing was missing. What good fortune! It was only the second proper laundering my clothes had gotten in over a month. The rest of the time they had been washed by hand with a bar of soap, in the shower, sometimes on me, and then rinsed and dripped dry on a line.
So cleaning yourself and your clothes... hard. Getting said self and clothes dirty? Easy. Take for instance the storage garage, where the hospital had well over 150 cardboard boxes of varying sized and shapes dumped in a pile and containing "donations" of medical supplies/equipment from the merciful, kind and thoughtful US of A. (Don't even get me started on the utterly useless JUNK that is dumped on Africa in the name of good will! I mean, how many cardiopulmonary bypasses do you think we do here anyway?! Hint: NONE!!) So, I get in there and try to sort it all out... for 3 days. I was covered with dirt, dust and God only knows which microbes, hoping all the while I wasn't breathing hanta virus through the mask I was trying to wear while trapsing around areas that were obvious living quarters for cockroaches, bats and various other non-flying rodents. But hey, I wanted an adventure, right? At least at the end of it all we had a list of 60 numbered boxes arranged in order that had descriptions listed in an excel spreadsheet that could be searched and sorted according to contents. Christmas all over again. :)
After cleaning up I checked my email. I got a response from UNICEF regarding my inquiry into a supply of affordable O2 concentrators they claimed to supply the poor and needy of the world. It was surprisingly unhelpful. I'll never ask them for help again. I might not even offer any to THEM, actually. Sheeeez.
That night I got ready for bed without water, and wrote in my travel log by right hand, while holding a flashlight in the left.
The next day was spent doing some research on the internet and crunching numbers for financial decision making. What we needed was a reliable supply of anesthetic gases, vaporizers to administer them, oxygen concentrators to suppliment the air people would breath through the vaporizers, as well as replacement parts for the whole breathing system. After all, this is Africa... things break routinely. The connection to the net was so slow though, that it was hard to learn or accomplish much of anything.
I met with the accountant and business manager to discuss oxygen, halothane and concentrator costs. To sum it all up, an oxygen concentrator costs about 700 US$ and can provide 5 liters per minute of oxygen continuously. That same supply of oxygen would cost about 2 US$ per hour. Thus, one concentrator would pay for itself after 350 hours of use (excluding the cost of electricity, which in Zambia, at least, was about 2 cents per hour). in 2007, the hospital's O2 usage cost 19,333 US$, and much of this was probably wasted when staff failed to turn off the tank after the oxygen supply was no longer needed for a particular patient. That annual dollar amount would buy 27 oxygen concentrators, each of which would last 5-10 years if properly maintained.
Now, assuming that electricity is about the same cost here as in Zambia, you could purchase 3 concentrators for 2,100 US$ and run them for 12 hours per day, 365 days per year for 263 US$ worth of electricity, do it for 5 years, and the total cost would still only be 3,414 US$. Therefore, 5 years of oxygen at a cost of 3,414 US$ versus 5 years of cylinder oxygen at last years actual cost of 19,333 US$, would amount to a savings of about 96,000 US$. In others terms, in order to turn an investment of 3,414 US$ into 93,251 US$ (for a total of 96,000 US$), one would have to find an investment that gave a return of 2,700%. I am unaware of ANY opportunity that would yield such returns consistently. Other than changing practice from purchasing compressed, tank oxygen to oxygen concentrators.
Further, a savings of some 93,000 US$ would pay the present day salary of 2 anesthetists for 27.5 years, along with an extra month's salary as a yearly bonus (ignoring yearly inflation).
That weekend at church I met Ted Powers, a 4th year medical student from Loma Linda. He matched there to do anesthesia, though he had interviewed in Nebraska while I was on staff there last year. I never met him when he came to Nebraska, so it is as improbably as it is amazing that we should end up sitting next to each other on the other side of the world.
That night, along with Dr. Mataya, Ted and I went for supper to Dr. Terrie Taylor's house. She's a friend of Mataya's and just happens to be one of the world's leading experts on malaria. She comes from Michigan to Blantyre, Malawi every January through June. She has medical students and research assistants join her regularly, of which 3 were with her this evening. We had a wonderful time eating and talking together all evening. And of course, in keeping with the British tradition, there was even time for tea afterwards.
The next day I tested 3 oxygen concentrators that I found locked in a storage closet. Guess what? They all worked! Well, at least they all put out some gas from the machine that I assume is oxygen. I suppose I could've tried to burn it, or set up some explosive experiment. But I settled on just breathing the stuff and seeing if it raised my O2 saturation measured by the one functioning pusle oximeter in the OR. Maybe I'll try to blow up something next time. I'll check my chemistry books back in the states after I get back, then be prepared for more "kitchen chemistry" type fun when I return to the 3rd world. Now, I should tell you that one of the grounding pins on the power cord is broken, and another missing the air filters, but they do WORK. This was after I'd already asked if the hospital had any concentrators and was told, "We only have two, and one of them is broken." It was also after I had asked to be SHOWN the concentrators... and was taken down a side hall and pointed to an empty oxygen tank. Definitely NOT helpful. In fact, it was somewhere around this time that I had decided that I had been "helped" enough, and that I was going to do whatever needed to be done without asking for prior permission or opinions, as well as believe whatever I thought was likely true about a situation because asking for clarification would only bring a fresh supply of lies, or at the very least obvuscate the truth I was trying so hard to elucidate.
My next trip into the shower was less than amusing. To me, that is. You'll probably get a kick out of it, though. And, I'm not posting any pictures, so if you're a woman, or if there are small children around, please, feel free to continue reading my blog posts. It'll be OK. Really.
As you know, losing water here is pretty routine. In fact, I can't remember a day during my whole trip where I didn't lose either the power or water supply, or both at the same time. However, this time there was a bit of a caveat to the whole ordeal. This time, I was all soaped up, in a shower with no curtain, when only the cold water ran out (I presume I was still getting hot water out of the small reserve tank). The scalding I received was enough to test my Christianity. I rinsed my hands and eyes the best I could, then carefully made the dripping wet and naked trek to the kitchen. This is where I found the 25 liter reserve water jug and a cereal bowl to finish what is locally referred to as a "bucket bath." These 2 fixtures remained in my bathroom until the day I left the country, once again illustrating that one can never have enough backups in place.
After finishing most of the final rinse cycle, I tried to mix in a little of the hot water, which promptly also ran out. So, I toweled off and got dressed as I heard the sound of rushing water filling the pipes again (which is easy if you just leave the spigots open). So, I figured, "Might as well at least get my face washed with hot water." I splashed it on, soaped up... and of course heard the pipes run dry once again. "I just can't win here!," I thought. "About how far away is that bowel and bucket, and can I get to it without opening my eyes?"
And as for washing my clothes, well... I got back a load from the hospital cleaning department and was shocked to see that nothing was missing. What good fortune! It was only the second proper laundering my clothes had gotten in over a month. The rest of the time they had been washed by hand with a bar of soap, in the shower, sometimes on me, and then rinsed and dripped dry on a line.
So cleaning yourself and your clothes... hard. Getting said self and clothes dirty? Easy. Take for instance the storage garage, where the hospital had well over 150 cardboard boxes of varying sized and shapes dumped in a pile and containing "donations" of medical supplies/equipment from the merciful, kind and thoughtful US of A. (Don't even get me started on the utterly useless JUNK that is dumped on Africa in the name of good will! I mean, how many cardiopulmonary bypasses do you think we do here anyway?! Hint: NONE!!) So, I get in there and try to sort it all out... for 3 days. I was covered with dirt, dust and God only knows which microbes, hoping all the while I wasn't breathing hanta virus through the mask I was trying to wear while trapsing around areas that were obvious living quarters for cockroaches, bats and various other non-flying rodents. But hey, I wanted an adventure, right? At least at the end of it all we had a list of 60 numbered boxes arranged in order that had descriptions listed in an excel spreadsheet that could be searched and sorted according to contents. Christmas all over again. :)
After cleaning up I checked my email. I got a response from UNICEF regarding my inquiry into a supply of affordable O2 concentrators they claimed to supply the poor and needy of the world. It was surprisingly unhelpful. I'll never ask them for help again. I might not even offer any to THEM, actually. Sheeeez.
That night I got ready for bed without water, and wrote in my travel log by right hand, while holding a flashlight in the left.
Sunday, May 4, 2008
BAH Continued
And now, back to our story!
When we last saw our hero, he was in Blantyre, Malawi where he continues to stamp out disease, and save lives (though, not all the time).
The first full day that I spent at the hospital, the business administrator started taking me around around to give me a tour of the facility. As we walked down the hall to the double doors that entered into the operating rooms, a doorway to my right burst open and the medical director grabbed my arm saying, "Come quickly Dr. Cobos we have an emergency!!"
Dr. Verona is a pediatrician, and she and the two anesthetists were struggling to save a preterm baby who had JUST been born at 33 weeks gestational age (no prenatal care, mom had had vaginal bleeding for the past month, ruptured her membranes yesterday. It was her 4th child). The parents were waiting down the hall to hear of the outcome. I saw the child had a club left foot, and was beginning to have that ominous gray dusky appearance the newborn black children have when they don't get enough oxygen. This, despite the fact that the child was intubated and being ventilated with 100% oxygen. There was no blood pressure cuff. There was no EKG machine. There was no pulse oximeter that we could get to function on those tee-tiny fingers. Of course, even if it had worked it's not like we could have given any more oxygen. My immediate guess was that this child was going to live about 10 more minutes, at best. I listened to the heart and chest with a stethoscope. The heart rate was aproximately 100, and the lungs were not being ventilated very well. This did not surprise me, since the child's lungs were not designed to even function until after at least another month's develpment in utero. If we saved the child, there was no ventilator which could be used for respiratory support.
We decided to continue resuscitative efforts for approximately 30 minutes, after which time we all agreed that further efforts were futile. We stopped, and I drew down the little eyelids for the last time, never having had the chance for light or vision to spark her imagination. Dr. Verona went to explain to the parents what had just happened. I stayed behind.
Later that day, I was able to e-mail my family and friends back home to let them know I was still alive and that my malaria test was negative. It was not my time to die. It had been someone else's.
It had been some time since I had actually had to stand right there and watch someone die. It's hard to explain clearly what all goes through your mind during the experience. And of course, it is different when it's a young child as opposed to an old person, full of years. In the case of the latter, there is consolation in the belief (be it grounded in truth or not) that the dead or dying one had a fulfilling life which is successfully coming to a close. In the case of the former, one is haunted by the fact that this life was barely opened, and an uneasy wonder that had you but acted smarter or sooner an entire world of difference would have been made, and a life full of dreams achieved. These are, as it were, the skeletons in my medical career's closet. Thankfully, they are few and far between. But is it important to acknowledge their presence, if only to crack the door open just wide enough to accept one more silent, small, skeleton.
The next day, much of my time was spent modifying the draw-over vaporizer system they were using. They were using too much cylinder oxygen, and the modifications would allow for them to save money by using less, making up the difference with room air. I have been surprised how much repair work I have needed to do. I've actually spent more time as a repair technician than an anesthesiologist.
The next case was done under spinal rather than general anesthesia. I watched in shock and awe as the anesthetist performed the sterile prep without wearing a mask. Then, he proceeded to place a nonsterile lidocaine jelly on the skin in an attempt to numb it. This was promptly wiped off, as if it could have taken effect in five seconds. Why lidocaine was not injected directly into the skin I have no idea. Before I had a chance to voice my concerns over what I was watching, the announcement was made in English that we were about to pause for a prayer. Given what I had just seen, I felt this was an appropriate intervention, so I just stay quiet.
Things got a little bit busy during the day and I was asked to do minor surgery alone to facilitate completion of the surgical schedule. I removed five Norplant rods from a lady's upper arm, using lidocaine with epinephrine, a scalpel, scissors, forceps, and closed her up with two stitches. I still got a it! I can still cut and sew!
We operated for much of the next day also. I had been scavenging for parts and supplies throughout the OR and nearby storage room, but had not found much useful equipment. The Drager anesthesia machine had three large locked drawers in it, but of course no one had a key to open them. I wonder if anything worthwhile was inside. I pushed the machine away from the wall and looked at the back. There was an opening behind the top drawer which was just large enough for my arm to fit through to reach in behind the drawers. Though the top drawer would open, it would not come out completely (thus, exposing the contents of the drawer beneith). However, there WAS just enough space for me to fit my hand down to the second drawer's locking lever arm. It was held in place with a flathead screw, which was just begging to make friends with my Swiss Army knife. So, with a flashlight strapped my head, the second, and then the third drawer, were opened African style (i.e. they were broken into).
My hope had been that the drawer would hold the power cord for the oxygen/halothane analyzer, or at least a spare set of cables for the EKG machine or pulse ox. All I found were some US 110v power cords, precordial stethoscope heads, paper clips, and some laryngoscope blades that fit none of the handles we had. Well, it was worth a try.
By the end of the day the power cord for the gas analyzer was found by one of the anesthetists. This allowed me to test the oxygen concentrator's performance and evaluate the modifications I had made in their draw over anesthesia system. It was only then that I knew they would be able to save tank oxygen, use the oxygen concentrator instead, and save money without compromising patient safety.
They also brought me the cable for the EKG machine which they said wasn't working. The reason was now obvious. The cable appeared to be 30 to 40 years old, with cracked, broken off plastic insulation around each of the leads. The leads had been forming short cicuits, and after I wrapped each cable (what was left of them) with cellophane tape the EKG machine worked fine. :)
Two pulse oximeters were not functioning, and the rumor was that all they needed were batteries. ("Why do they need batteries? They run off the outlet in the wall! Whatever.") The surgeon brought me one battery which he said was supposed to work in them, but that no one knew how to install it. If I could figure it out, I would save the hospital money that was the equivalent of one month's salary for a nurse. Nobody could bring meat tools that were helpful, so I was thankful my Swiss Army knife at all the screws I needed to undo. The inside of the pulse-ox appeared free of physical damage, with only two wires (one red, one black) dangling free. ("Ah, so there's a break in the power circuit. No wonder it "needs" a battery. I wonder if a dead battery would work?") Obviously, this is where the battery was supposed to go. I looked at the battery and quickly saw that the wire connections were designed to fit a different battery. The wires had connectors with two small holes, whereas the battery had connectors that were flat, flush to the plastic housing, with one hole screwed in the middle. Now what? I looked around the room and began to hear the theme from MacGyver playing in my head.
I went back to the Drager machine I had just Africanized and looked in the bottom drawer. I wondered if maybe I could rig a connection using the power cables I had just seen. But, that would require a soldering iron, which they told me they didn't have. So much for that idea. Well, I thought... who says you actually need to solder the thing? I grabbed a couple of the paper clips out of the drawer. These were small and round, I thought. Just what I needed for the wire connectors. I bent the other half of the paperclip flat to match the shape of the battery's connectors. Then, since I didn't have duct tape, I used the cellophane tape left over from the EKG cable repair job to hold the home-made paperclip jumper cables tight against the flat metal posts of the battery. I screwed the whole thing back together again, cliped the pulse ox on the finger of one of the anesthetists, and turned on the power. Viola! The most rewarding thing I'd done in weeks!
Not a bad day's work. It ended with two functional EKG machines, one additional pulse ox, and one gas analyzer. None of which were working before I arrived. People at the hospital thought it was like Christmas!
In the afternoon I went to the maintenance building, where I had been told donated supplies from the US had been stored. The room was steaming hot, filthy, dusty dirty, with stacked cardboard boxes up to my shoulders, all unlabeled, some with cockroaches, others chewed by rats/mice, and filled with donated equipment and supplies (obviously, some no longer sterile). Amongst other things that I found within a few hours were an EKG machine, a new manual suction device (great for when there is no electricity), Ambu bags, carbon dioxide sample lines for the gas analyzer, one-way respiratory valves, tons of masks, airways, and ET tubes, small adult and adolescent blood pressure cuffs, and a brand-new laryngoscope with replacement light bulbs. They were sitting on a gold mine, and they weren't even using it! It reminded me of the stories I heard about rice and other food being donated to starving Africa, only to be left to rot on the docks where the shipments arrived. There is such a lack of organization and lack of personal responsibility that multiple people become the weakest link in a failing supply chain meant to provide equipment and supplies for those in need.
I spent one hour trying to connect to the Internet that night. Eventually the power went out, and the hospital's emergency generator kicked in a little while later. I still couldn't get connected. I decided to walk home and go to bed. The guest house where I was staying with only a one to two minute walk away. It was quite dark outside the hospital, where no generators were running to provide power. Halfway to the apartment the power surged back on and a large cluster of sparks flew from a transformer atop a nearby telephone pole, lighting up the night.
When we last saw our hero, he was in Blantyre, Malawi where he continues to stamp out disease, and save lives (though, not all the time).
The first full day that I spent at the hospital, the business administrator started taking me around around to give me a tour of the facility. As we walked down the hall to the double doors that entered into the operating rooms, a doorway to my right burst open and the medical director grabbed my arm saying, "Come quickly Dr. Cobos we have an emergency!!"
Dr. Verona is a pediatrician, and she and the two anesthetists were struggling to save a preterm baby who had JUST been born at 33 weeks gestational age (no prenatal care, mom had had vaginal bleeding for the past month, ruptured her membranes yesterday. It was her 4th child). The parents were waiting down the hall to hear of the outcome. I saw the child had a club left foot, and was beginning to have that ominous gray dusky appearance the newborn black children have when they don't get enough oxygen. This, despite the fact that the child was intubated and being ventilated with 100% oxygen. There was no blood pressure cuff. There was no EKG machine. There was no pulse oximeter that we could get to function on those tee-tiny fingers. Of course, even if it had worked it's not like we could have given any more oxygen. My immediate guess was that this child was going to live about 10 more minutes, at best. I listened to the heart and chest with a stethoscope. The heart rate was aproximately 100, and the lungs were not being ventilated very well. This did not surprise me, since the child's lungs were not designed to even function until after at least another month's develpment in utero. If we saved the child, there was no ventilator which could be used for respiratory support.
We decided to continue resuscitative efforts for approximately 30 minutes, after which time we all agreed that further efforts were futile. We stopped, and I drew down the little eyelids for the last time, never having had the chance for light or vision to spark her imagination. Dr. Verona went to explain to the parents what had just happened. I stayed behind.
Later that day, I was able to e-mail my family and friends back home to let them know I was still alive and that my malaria test was negative. It was not my time to die. It had been someone else's.
It had been some time since I had actually had to stand right there and watch someone die. It's hard to explain clearly what all goes through your mind during the experience. And of course, it is different when it's a young child as opposed to an old person, full of years. In the case of the latter, there is consolation in the belief (be it grounded in truth or not) that the dead or dying one had a fulfilling life which is successfully coming to a close. In the case of the former, one is haunted by the fact that this life was barely opened, and an uneasy wonder that had you but acted smarter or sooner an entire world of difference would have been made, and a life full of dreams achieved. These are, as it were, the skeletons in my medical career's closet. Thankfully, they are few and far between. But is it important to acknowledge their presence, if only to crack the door open just wide enough to accept one more silent, small, skeleton.
The next day, much of my time was spent modifying the draw-over vaporizer system they were using. They were using too much cylinder oxygen, and the modifications would allow for them to save money by using less, making up the difference with room air. I have been surprised how much repair work I have needed to do. I've actually spent more time as a repair technician than an anesthesiologist.
The next case was done under spinal rather than general anesthesia. I watched in shock and awe as the anesthetist performed the sterile prep without wearing a mask. Then, he proceeded to place a nonsterile lidocaine jelly on the skin in an attempt to numb it. This was promptly wiped off, as if it could have taken effect in five seconds. Why lidocaine was not injected directly into the skin I have no idea. Before I had a chance to voice my concerns over what I was watching, the announcement was made in English that we were about to pause for a prayer. Given what I had just seen, I felt this was an appropriate intervention, so I just stay quiet.
Things got a little bit busy during the day and I was asked to do minor surgery alone to facilitate completion of the surgical schedule. I removed five Norplant rods from a lady's upper arm, using lidocaine with epinephrine, a scalpel, scissors, forceps, and closed her up with two stitches. I still got a it! I can still cut and sew!
We operated for much of the next day also. I had been scavenging for parts and supplies throughout the OR and nearby storage room, but had not found much useful equipment. The Drager anesthesia machine had three large locked drawers in it, but of course no one had a key to open them. I wonder if anything worthwhile was inside. I pushed the machine away from the wall and looked at the back. There was an opening behind the top drawer which was just large enough for my arm to fit through to reach in behind the drawers. Though the top drawer would open, it would not come out completely (thus, exposing the contents of the drawer beneith). However, there WAS just enough space for me to fit my hand down to the second drawer's locking lever arm. It was held in place with a flathead screw, which was just begging to make friends with my Swiss Army knife. So, with a flashlight strapped my head, the second, and then the third drawer, were opened African style (i.e. they were broken into).
My hope had been that the drawer would hold the power cord for the oxygen/halothane analyzer, or at least a spare set of cables for the EKG machine or pulse ox. All I found were some US 110v power cords, precordial stethoscope heads, paper clips, and some laryngoscope blades that fit none of the handles we had. Well, it was worth a try.
By the end of the day the power cord for the gas analyzer was found by one of the anesthetists. This allowed me to test the oxygen concentrator's performance and evaluate the modifications I had made in their draw over anesthesia system. It was only then that I knew they would be able to save tank oxygen, use the oxygen concentrator instead, and save money without compromising patient safety.
They also brought me the cable for the EKG machine which they said wasn't working. The reason was now obvious. The cable appeared to be 30 to 40 years old, with cracked, broken off plastic insulation around each of the leads. The leads had been forming short cicuits, and after I wrapped each cable (what was left of them) with cellophane tape the EKG machine worked fine. :)
Two pulse oximeters were not functioning, and the rumor was that all they needed were batteries. ("Why do they need batteries? They run off the outlet in the wall! Whatever.") The surgeon brought me one battery which he said was supposed to work in them, but that no one knew how to install it. If I could figure it out, I would save the hospital money that was the equivalent of one month's salary for a nurse. Nobody could bring meat tools that were helpful, so I was thankful my Swiss Army knife at all the screws I needed to undo. The inside of the pulse-ox appeared free of physical damage, with only two wires (one red, one black) dangling free. ("Ah, so there's a break in the power circuit. No wonder it "needs" a battery. I wonder if a dead battery would work?") Obviously, this is where the battery was supposed to go. I looked at the battery and quickly saw that the wire connections were designed to fit a different battery. The wires had connectors with two small holes, whereas the battery had connectors that were flat, flush to the plastic housing, with one hole screwed in the middle. Now what? I looked around the room and began to hear the theme from MacGyver playing in my head.
I went back to the Drager machine I had just Africanized and looked in the bottom drawer. I wondered if maybe I could rig a connection using the power cables I had just seen. But, that would require a soldering iron, which they told me they didn't have. So much for that idea. Well, I thought... who says you actually need to solder the thing? I grabbed a couple of the paper clips out of the drawer. These were small and round, I thought. Just what I needed for the wire connectors. I bent the other half of the paperclip flat to match the shape of the battery's connectors. Then, since I didn't have duct tape, I used the cellophane tape left over from the EKG cable repair job to hold the home-made paperclip jumper cables tight against the flat metal posts of the battery. I screwed the whole thing back together again, cliped the pulse ox on the finger of one of the anesthetists, and turned on the power. Viola! The most rewarding thing I'd done in weeks!
Not a bad day's work. It ended with two functional EKG machines, one additional pulse ox, and one gas analyzer. None of which were working before I arrived. People at the hospital thought it was like Christmas!
In the afternoon I went to the maintenance building, where I had been told donated supplies from the US had been stored. The room was steaming hot, filthy, dusty dirty, with stacked cardboard boxes up to my shoulders, all unlabeled, some with cockroaches, others chewed by rats/mice, and filled with donated equipment and supplies (obviously, some no longer sterile). Amongst other things that I found within a few hours were an EKG machine, a new manual suction device (great for when there is no electricity), Ambu bags, carbon dioxide sample lines for the gas analyzer, one-way respiratory valves, tons of masks, airways, and ET tubes, small adult and adolescent blood pressure cuffs, and a brand-new laryngoscope with replacement light bulbs. They were sitting on a gold mine, and they weren't even using it! It reminded me of the stories I heard about rice and other food being donated to starving Africa, only to be left to rot on the docks where the shipments arrived. There is such a lack of organization and lack of personal responsibility that multiple people become the weakest link in a failing supply chain meant to provide equipment and supplies for those in need.
I spent one hour trying to connect to the Internet that night. Eventually the power went out, and the hospital's emergency generator kicked in a little while later. I still couldn't get connected. I decided to walk home and go to bed. The guest house where I was staying with only a one to two minute walk away. It was quite dark outside the hospital, where no generators were running to provide power. Halfway to the apartment the power surged back on and a large cluster of sparks flew from a transformer atop a nearby telephone pole, lighting up the night.
Thursday, April 17, 2008
First Findings of BAH Anesthesia
I was pleased to find 2 functioning anesthesia systems. One continuous flow system (a Japanese machine: Acoma complete with non-functioning ventilator, and one year old soda lime), and the second system, a draw over set-up with a... with uh... well what do you know!? A good-‘ol OMV (Oxford Miniature Vaporizer)! How very quaint ☺
I couldn’t believe it! I’d seen drawings of them in books, but here was the real deal! And *I* was going to get to use it! But then, suddenly, I recognized a group of letters, printed all caps on the top of the dial, next to the word “Halothane.” They struck terror in my little American heart... PENLON.
Say it isn’t so! I hung my head for a few moments, there in the darkness of the humid OR, all alone, and sighed out loud. You see, back in the states, about 2 years ago, our department made the mistake of purchasing 5 new anesthesia machines made by Penlon to replace some of our older Drager machines. We started having serious problems right away... like the ventilator stopping for no reason in the middle of a case, the CO2 absorbant container leaking like it had more holes than Swiss cheese, complete re-breathing of all CO2, etc. We had a “wall of shame” in the faculty office with modified Far Side cartoons that poked fun at the Penlons and our experience with them. It was like I’d come to the ends of the earth, and yet I STILL couldn’t escape this British company’s freaky-fickle equipment. I thought, “Well, the thing looks like it’s a good 50 years old. If it’s lasted this long, maybe it’ll make it another week or so and I can get outta' here without any repeat offences.”
Room 2 was their minor sugery room, and the graveyard for donated equipment. There was a Drager 2A and a Drager AVE (I've never heard of that model). Both had seen better days, and those days were before I was born. I was told that neither worked. And even if they did, I knew that they’d need high flow, compressed oxygen to make them work. Still, it’d be nice to have at least one machine in the hospital that had a ventilator, and could serve as a back up should the Acoma fail (which was likely at some point, given its age and working condition. The Penlon, as much as I hated to admit it, was nearly fool proof and maintenance free. It had only one working part (excluding the screw cap that came off to fill the vaporizer), required no electricity, and could be operated using only room air. A mission hospital’s dream machine, really. At least it would be as long as they LEAVE the OR, and THEN use ether to dissolve the thymol residue that tends to build up as the halothane is vaporized. What I didn't want to hear later was that they opened up a can of ether RIGHT IN THE OR where electricity was flowing through a varied array of frayed wires and cables. If they can remember to take that precaution, then the hospital won’t literally be blown to kingdom come as the ether (a very explosive chemical) drifts down to the sockets, power strips and cables at floor level.
Here at Blantyre Adventist Hospital there are 2 anesthetists. They typically run one OR at a time, and either tag team doing the cases, or more often than not, help each other do the same case. It actually does take 2 anesthetists to do 1 case... one to start doing anesthesia, the other to trouble shoot all the problems that arise while the other one keeps trying to care for the patient. They do not intubate here, and there is no ventilator, so one person has to hold the mask while the patient breathes on their own. So, examples I’ve seen of second person anesthesia responsibilities are: setting up suction after a patient has already vomited, getting drugs drawn up to inject for the treatment of low blood pressure, getting the pulse oximeter to keep work, putting on the blood pressure cuff after induction of anesthesia with halothane... and cycling it once or twice, filling up the halothane because it’s almost gone, adjusting the ceiling lights for the sugeon (no sterile handles for them to do it themselves), going off somewhere to find an oral airway. No, I'm not kidding.
The anesthetist I helped out today barehanded the Tylenol suppository into this kid’s butt, THEN put on gloves to hold the mask again for continuing anesthesia. Good grief. What am I supposed to say to that? Don’t some things go without saying?! I just shook my head and wondered if I really could help this guy learn.
I couldn’t believe it! I’d seen drawings of them in books, but here was the real deal! And *I* was going to get to use it! But then, suddenly, I recognized a group of letters, printed all caps on the top of the dial, next to the word “Halothane.” They struck terror in my little American heart... PENLON.
Say it isn’t so! I hung my head for a few moments, there in the darkness of the humid OR, all alone, and sighed out loud. You see, back in the states, about 2 years ago, our department made the mistake of purchasing 5 new anesthesia machines made by Penlon to replace some of our older Drager machines. We started having serious problems right away... like the ventilator stopping for no reason in the middle of a case, the CO2 absorbant container leaking like it had more holes than Swiss cheese, complete re-breathing of all CO2, etc. We had a “wall of shame” in the faculty office with modified Far Side cartoons that poked fun at the Penlons and our experience with them. It was like I’d come to the ends of the earth, and yet I STILL couldn’t escape this British company’s freaky-fickle equipment. I thought, “Well, the thing looks like it’s a good 50 years old. If it’s lasted this long, maybe it’ll make it another week or so and I can get outta' here without any repeat offences.”
Room 2 was their minor sugery room, and the graveyard for donated equipment. There was a Drager 2A and a Drager AVE (I've never heard of that model). Both had seen better days, and those days were before I was born. I was told that neither worked. And even if they did, I knew that they’d need high flow, compressed oxygen to make them work. Still, it’d be nice to have at least one machine in the hospital that had a ventilator, and could serve as a back up should the Acoma fail (which was likely at some point, given its age and working condition. The Penlon, as much as I hated to admit it, was nearly fool proof and maintenance free. It had only one working part (excluding the screw cap that came off to fill the vaporizer), required no electricity, and could be operated using only room air. A mission hospital’s dream machine, really. At least it would be as long as they LEAVE the OR, and THEN use ether to dissolve the thymol residue that tends to build up as the halothane is vaporized. What I didn't want to hear later was that they opened up a can of ether RIGHT IN THE OR where electricity was flowing through a varied array of frayed wires and cables. If they can remember to take that precaution, then the hospital won’t literally be blown to kingdom come as the ether (a very explosive chemical) drifts down to the sockets, power strips and cables at floor level.
Here at Blantyre Adventist Hospital there are 2 anesthetists. They typically run one OR at a time, and either tag team doing the cases, or more often than not, help each other do the same case. It actually does take 2 anesthetists to do 1 case... one to start doing anesthesia, the other to trouble shoot all the problems that arise while the other one keeps trying to care for the patient. They do not intubate here, and there is no ventilator, so one person has to hold the mask while the patient breathes on their own. So, examples I’ve seen of second person anesthesia responsibilities are: setting up suction after a patient has already vomited, getting drugs drawn up to inject for the treatment of low blood pressure, getting the pulse oximeter to keep work, putting on the blood pressure cuff after induction of anesthesia with halothane... and cycling it once or twice, filling up the halothane because it’s almost gone, adjusting the ceiling lights for the sugeon (no sterile handles for them to do it themselves), going off somewhere to find an oral airway. No, I'm not kidding.
The anesthetist I helped out today barehanded the Tylenol suppository into this kid’s butt, THEN put on gloves to hold the mask again for continuing anesthesia. Good grief. What am I supposed to say to that? Don’t some things go without saying?! I just shook my head and wondered if I really could help this guy learn.
Off to Blantyre
I was able to fall back to sleep as it cooled down in the wee hours of the morning, even though I had to lay awake and wonder wether or not I was coming down with malaria. I had been taking my pills faithfully since arriving in Africa, but I had been bitten about 8 times. Seems like I swell up and itch a whole lot more when the mosquitos over here bite me.
The next morning while I was relaxing on the lake shore, an ebony carver met me to sell me some of his wares. I had seen ebony only once or twice in my life, so it took some convincing before I believed he had ebony and not just wood that had been colored by Kiwi shoe polish (a well known trick used in Africa). A little sanding and scraping with my Swiss Army knife convinced me it was for real… along with a consult from some locals. I traded my sandals and some US$ for several good sized blocks that I will carve on my own back in the states.
I got to visit with Iqbal and his family again, exchanging ideas and experiences on all kinds of things. One thing I remember them telling me is that their DVDs have 16 movies per disk! I don’t understand how they could pack that much onto one disk. However, it would stand to reason that if it is truly possible, it is probably something that was designed and engineered by the same Africans that put 26 people in a 16 person mini-bus.
It was about this time that I got a chance to shower and shave for the first time in days. The mosquitos the night before were bad enough that I had sprayed my whole body with 30% DEET, even though I was under a net. They had gotten underneith the net the night before because I had let one edge rest over top of my suitcase, rather than flat on the floor, or tucking it in under the mattress.
The final day arrived for us to be at Lake Malawi. We said good-bye to Iqbal and all his family, inviting them to come stay with us some day. The drive to Blantyre was, as usual, over the three hour prediction, and was yet another bladder testing experience. As we neared the city, past president Bakili Muluzi past us in his motorcade. He’s starting his campaing for next year’s election, and is running for his UDF party’s primary election, in 2 days (not that anyone else is running for the UDF). This guy’s an average corrupt politician, of whom I may tell you some more later. For now, let’s just say I was ammused to see how little armed guards and private security was with him on the roads.
After settling into my guest flat at Blantyre Adventist Hospital, I relaxed and did some reading. I felt a bit dizzy, kinda funny, and fatigued. That night I woke up in a hot sweat, and decided to get checked for malaria the next morning… after all, I was at a hospital, how hard could it be? And, it had been 3 days since the last time I woke up like this. Seemed like it could be P. vivax (a type of parasite that is the cause of malaria), since the best I could remember was that P. falciparum was a every 4th day fever/chills. If I had it, I just hoped the cure wasn’t worse than the disease.
The next morning while I was relaxing on the lake shore, an ebony carver met me to sell me some of his wares. I had seen ebony only once or twice in my life, so it took some convincing before I believed he had ebony and not just wood that had been colored by Kiwi shoe polish (a well known trick used in Africa). A little sanding and scraping with my Swiss Army knife convinced me it was for real… along with a consult from some locals. I traded my sandals and some US$ for several good sized blocks that I will carve on my own back in the states.
I got to visit with Iqbal and his family again, exchanging ideas and experiences on all kinds of things. One thing I remember them telling me is that their DVDs have 16 movies per disk! I don’t understand how they could pack that much onto one disk. However, it would stand to reason that if it is truly possible, it is probably something that was designed and engineered by the same Africans that put 26 people in a 16 person mini-bus.
It was about this time that I got a chance to shower and shave for the first time in days. The mosquitos the night before were bad enough that I had sprayed my whole body with 30% DEET, even though I was under a net. They had gotten underneith the net the night before because I had let one edge rest over top of my suitcase, rather than flat on the floor, or tucking it in under the mattress.
The final day arrived for us to be at Lake Malawi. We said good-bye to Iqbal and all his family, inviting them to come stay with us some day. The drive to Blantyre was, as usual, over the three hour prediction, and was yet another bladder testing experience. As we neared the city, past president Bakili Muluzi past us in his motorcade. He’s starting his campaing for next year’s election, and is running for his UDF party’s primary election, in 2 days (not that anyone else is running for the UDF). This guy’s an average corrupt politician, of whom I may tell you some more later. For now, let’s just say I was ammused to see how little armed guards and private security was with him on the roads.
After settling into my guest flat at Blantyre Adventist Hospital, I relaxed and did some reading. I felt a bit dizzy, kinda funny, and fatigued. That night I woke up in a hot sweat, and decided to get checked for malaria the next morning… after all, I was at a hospital, how hard could it be? And, it had been 3 days since the last time I woke up like this. Seemed like it could be P. vivax (a type of parasite that is the cause of malaria), since the best I could remember was that P. falciparum was a every 4th day fever/chills. If I had it, I just hoped the cure wasn’t worse than the disease.
Friday, April 4, 2008
All's well
Hi all,
Just a quick note to say I'm fine. Internet access in Malawi has not been as good as I was told it would be. I will try to post again, after typing things out in a Word file, for a quick cut and paste job.
Bye for now!!
Just a quick note to say I'm fine. Internet access in Malawi has not been as good as I was told it would be. I will try to post again, after typing things out in a Word file, for a quick cut and paste job.
Bye for now!!
Tuesday, April 1, 2008
Lusaka to Salima
We got up the next day at about 0430 to make it to the bus station by 0500, for the 0600 bus. You can reserve a ticket the night before (which we did), but you cannot purchase a ticket early. I’m told it confuses them. Their system of selling tickets is out of a carbon copy notebook. There are no computers anywhere at the bus station. In fact, the Juldon bus company’s “office” is a press-board shack with a tin roof. The dimensions are roughly 4 feet wide, 7 feet high, and 8 feet deep. I couldn’t tell how the guy got in there. We bought our tickets and pressed through the crowd of advertisers to squeeze towards the bus. See, as soon as you drive into Lusaka bus station, you are inundated by people shouting the praise of their bus company, and desperately urging you to buy a ticket from them, and not their wicked competitors. The first time I came here, it nearly frightened me... now that I understand what’s going on, it’s tolerable.
8 hours later we arrived at Chipata. The Mwami hospital mini-van that was SUPPOSED to meet us was no where to be seen. Was I surprised? Nooooooooooooo! Jim called on the cell phone. No answer (no surprise). He sent a text, no reply (no surprise). 1 hour later we hired a taxi to drive us there. How long will this take,” I asked. Of course, I already knew how long. I had ridden the road before. I was just curious to see how badly the driver would lie, or how badly he would estimate the travel time. “20 minutes.” Hmph. Just what I suspected. Off by 100%.
We got to Mwami 45 minutes later.
Once we arrived I checked in on how the new machine was doing. The anesthetist told me it was doing just fine, even the halothane leak had stopped. I suspect that the thymol preservative had plugged the hole as small amounts of halothane leaked out over the past 2 weeks. However, a huge leak had developed in the old Drager 2A. I took a look, confirmed what I had been told, and quickly realized that there were no tools to disassemble the thing and try to repair it. They’d have to use the 50 year old Boyle’s machine as their back up, like they did before the glostavent arrived.
I went to bed, again, face down. It was hard to sleep without the fan I had become accustomed to during my time in both Lusaka and Yuka. I couldn’t tell if it was me I smelled, or just memories of the people I’d spent the past 2 days with on the bus.
The next morning, the Ang and Peduche families (Philipinos, both) and I loaded into the Toyota 4 wheelers to drive to lake Malawi (WE left on time, and bought fuel legally! Where’s the fun in that?
It took about 25 minutes to enter/exit Malawi/Zambia. The guy on the Malawi side recognized me and said, “Hello Mr. Cobos!” I hadn’t even given him my passport yet. (It pays to have friends in high places!)
After getting to Lilongwe, we stopped at 4 or 5 stores to buy stuff for the weekend. Most of the businesses are owned by Indians or Mid-easterners. A large procession was passing through the main street, mostly in purple. I had forgotten it was Good Friday (purple being the symbolic color of repentance, used generously in Catholic festivals).
We arrived at an estate on the shore of lake Malawi, near the city of Salima. Our hosts are a wealthy Muslim family who happen to live back in Chipata, Zambia and have been patients of Mwami. They invited the doctors to join them for the long holiday weekend at this retreat, which they themselves hadn’t stayed at for over a year. We stayed in 2 guest duplexes (3 other Philipino families joined us), next to their own main, large, house. Local workers cleaned for us, and it reminded me of Africa’s old slave age.
The first thing you notice about ANY building that Islam has anything to do with in all of Africa is... it’s clean. And in Africa, that stands out like a sore thumb. A beautiful, magnetic, sanitary sore thumb. I love it. Ah, to be clean :)
Iqbal’s family came to Zambia nearly 100 years ago, as negotiators between the Zambians and the English. Now, they’re traders, and run a farm with 500+ employees. They dismiss dishonest workers on the first offence (stealing is a major problem, and they claim they could write a book over 1000 pages long describing all the methods the Zambians have stolen from them).
The electricity went out, as usual. It was hot, and I couldn’t sleep in the heat. Eating a big Philipino dinner hadn’t helped either. I woke up in a sweat about 2 AM.
8 hours later we arrived at Chipata. The Mwami hospital mini-van that was SUPPOSED to meet us was no where to be seen. Was I surprised? Nooooooooooooo! Jim called on the cell phone. No answer (no surprise). He sent a text, no reply (no surprise). 1 hour later we hired a taxi to drive us there. How long will this take,” I asked. Of course, I already knew how long. I had ridden the road before. I was just curious to see how badly the driver would lie, or how badly he would estimate the travel time. “20 minutes.” Hmph. Just what I suspected. Off by 100%.
We got to Mwami 45 minutes later.
Once we arrived I checked in on how the new machine was doing. The anesthetist told me it was doing just fine, even the halothane leak had stopped. I suspect that the thymol preservative had plugged the hole as small amounts of halothane leaked out over the past 2 weeks. However, a huge leak had developed in the old Drager 2A. I took a look, confirmed what I had been told, and quickly realized that there were no tools to disassemble the thing and try to repair it. They’d have to use the 50 year old Boyle’s machine as their back up, like they did before the glostavent arrived.
I went to bed, again, face down. It was hard to sleep without the fan I had become accustomed to during my time in both Lusaka and Yuka. I couldn’t tell if it was me I smelled, or just memories of the people I’d spent the past 2 days with on the bus.
The next morning, the Ang and Peduche families (Philipinos, both) and I loaded into the Toyota 4 wheelers to drive to lake Malawi (WE left on time, and bought fuel legally! Where’s the fun in that?
It took about 25 minutes to enter/exit Malawi/Zambia. The guy on the Malawi side recognized me and said, “Hello Mr. Cobos!” I hadn’t even given him my passport yet. (It pays to have friends in high places!)
After getting to Lilongwe, we stopped at 4 or 5 stores to buy stuff for the weekend. Most of the businesses are owned by Indians or Mid-easterners. A large procession was passing through the main street, mostly in purple. I had forgotten it was Good Friday (purple being the symbolic color of repentance, used generously in Catholic festivals).
We arrived at an estate on the shore of lake Malawi, near the city of Salima. Our hosts are a wealthy Muslim family who happen to live back in Chipata, Zambia and have been patients of Mwami. They invited the doctors to join them for the long holiday weekend at this retreat, which they themselves hadn’t stayed at for over a year. We stayed in 2 guest duplexes (3 other Philipino families joined us), next to their own main, large, house. Local workers cleaned for us, and it reminded me of Africa’s old slave age.
The first thing you notice about ANY building that Islam has anything to do with in all of Africa is... it’s clean. And in Africa, that stands out like a sore thumb. A beautiful, magnetic, sanitary sore thumb. I love it. Ah, to be clean :)
Iqbal’s family came to Zambia nearly 100 years ago, as negotiators between the Zambians and the English. Now, they’re traders, and run a farm with 500+ employees. They dismiss dishonest workers on the first offence (stealing is a major problem, and they claim they could write a book over 1000 pages long describing all the methods the Zambians have stolen from them).
The electricity went out, as usual. It was hot, and I couldn’t sleep in the heat. Eating a big Philipino dinner hadn’t helped either. I woke up in a sweat about 2 AM.
Subscribe to:
Posts (Atom)
