A Day at the Market
Well, it finally happened. The water ran dry today. Had to start the generator to pump water up to the gravity feed tanks. I'd gotten so used to reliable water since getting here less than a week ago, that I'd forgotten that going WITHOUT running water is the norm in these kinds of places. The nice thing about water here is that it's fresh well water. Now, there are actually 2 water tables in this area. There's one above bedrock, then one below. The hospital and the residential housing in the area all get it from below bedrock, so that all the contamination from run off doesn't risk their water supply (sweet!). I've not had to use the water purifier I brought, or boil water, or anything. Really shortens the tedious time spent during the day to overcome the inconveniences of remote living.
One of the first things I did today was go through the huge blue shipping container (like what you see sitting on the back of train cars stacked two high) looking for goodies I figured I might find amongst all the donated junk. I wasn't disappointed... 2 colonoscopes, 1 light source (do they actually work?), anesthesia masks, circuits (for building a draw over anesthesia system. Hey, what's this? No vaporizer?!), surgical instruments (I brought a sharpener), vaccuum extracter (for when the bun doesn't want to pop out of the oven after it's done). Looks like this stuff's been sitting in here under the 130 degree summer sun, for a couple seasons (turned out later, it had been about 12 seasons actually). They even had a machine for drilling wells in there. No one here knew how to use it, and we couldn't find any instructions anywhere either. What a waste.
After I got sick of sorting through unlabeled boxes, Suzanne and I went to market to get lemons, bananas (yes, they have no bananas), soap, and cloth for her custom sewn dresses she plans to have made (spent about 15.5 US$ for 10 yards, the taylor will cost about 15$ as well). In the process, we learned how to say "Thank you" in Tchadian Arabic from the fabric salesman who spoke a bit of English. We also learned that buying airtime for your cell phone occurs two ways. One way (the one I assumed we'd find) is to purchase a paper card that has an amount of talk time on it along with a purchase code, entered into the phone and dialed. This programs the minutes onto the phone. I've done this before. It's quick and familiar. The OTHER way is a guy will call your phone, programming it with extra talk time in the process. This of course necessitates you KNOWING your OWN PHONE NUMBER. Which I didn't. I mean, I've never called ME in Chad Africa. I just got here. Why would I need to call me in Chad Africa?! It just makes no sense. So, no minutes for you! (Imagine the "Soup Nazi" from Seinfeld.)
When we got back from the market, James and Jeremy had been working on the hospital vehicle (which hadn't been running very well since someone drove it through muddy water that was a little too deep during rainy season). At this point, the battery was dead, and the starter was questionable. I had recharged the battery the night before, but we still ended up having to push start the vehicle. We knew that it wouldn't make the 8 hour "road" trip to N'Djamena scheduled for the next day... you would never be able to roll start it out of the mud after getting stuck 8 inches deep like we did on the way here.
In the evening, we watched some people play soccer as the sun went down in the background. One of the most memorable sights I have so far on this trip is seeing a goalie who played while hobbling on one crutch. He was quite good, actually. I couldn't tell if it was illegal for him to use his crutch to stop a goal. Maybe people would just accuse him of using it as a crutch. I dunno. Something to think about.
After it got dark, I built the charcoal fire while the ladies got the food ready. Now, have you ever felt like you've been helped enough? One of the guys there felt I was using too LITTLE gasoline to start the charcoal aflame. I disagreed, and had purposely placed the one liter bottle holding the gasoline away from the hole that held the charcoal so that I could focus on fanning the flames with a fan through the channel cut in the concrete and stone that lead to the fire pit portion of the "stove." My "helper" proceeded to add some fuel to the fire and re-light the charcoal after putting down the bottle of gas. Flames promptly shot up to nearly the ceiling, cutting off easy access to the bottle of gasoline he'd just placed on the other side of the charcoal pit. I put aside my anger and tried to quickly think how I was going to get that bottle out of the way, or put out the fire. I grabbed the biggest pot I could find, covered the flames, and quickly reached across to grab the hot plastic bottle to move it to the other side of the cooking area. I didn't say anything... I'd been helped enough.
At some point that afternoon, I noticed that my shoes were missing. VERY distressing. I'd bought them specifically for Africa, and put orthotics in them. I had started wearing a cheap pair of flip flops a bought in the market and left my lace-up shoes in the foyer (where the cooking "stove" area is) so I could come and go more quickly, swap out on the fly when entering the OR, and be more cooler in general because my feet were bear (I also spared myself from washing socks). I swear, these people with steal anything from anybody at anytime for any reason!! Drives me nuts. James and Sarah politely turned down my gift of heirloom vegetable seeds stating that they don't garden here... people steal all your stuff before you get a chance to eat it.
To finish my day, I spent 3 hours trying to get the sink and shower to drain properly. I knew that teflon tape and epoxy putty would come in handy :) Silicon caulking would've been the best answer, but you use what you happen to have eh? Before it was over, Jeremy and I had pulled out 3 small rat sized clumps of gooey hair and mud from the P trap under the sink. This allowed the plunger we used on the shower drain to be much more effective (both of the 2 drain to the same pipe system) and afford the luxury of taking a shower without standing ankle deep in each other's soapy water run-off.
Things you don't want to hear in the mission field: "I give (pronounced gee-ve) you 3 pigs (pronounced pee-gs) and a cow to marry your cousin!"
A Day with the Artisans
The fan batteries died somewhere in the middle of the night, and I didn't even notice. That means it's getting cooler at night. Yeah!
Well, the sink seems to have only a minimal leak, so score one for for the expatriates! We'll have to see how long it lasts, and wether or not it requires further attention. I hope not... I've got so much else to do here besides plumbing.
After breakfast we started the OR schedule. We began with a simple hernia repair. Nice, since I could do a spinal and not have to deal with the ketamine side-effects for a change. James is pretty quick with a hernia repair, so I could use lidocaine instead of the small, precious supply of bupivicaine which we would reserve for a longer cases. James does use mesh to repair the many hernias people have here, but the mesh is actually a small piece of a 10$ mosquito net, sterilized of course. It's a much more affordable way of creating a tension free closure, and it's flexible enough to ease handling during placement. As for the anesthesia, I did what I could, with James' translating, to teach the French speaking OR nurse some anesthesia knowledge that could be used after I leave. This trip, we'll keep it simple and limited to regional and ketamine anesthesia.
The next case was a hysterectomy which James said would take longer, so I used bupivicaine. Part way through though, she started complaining of pain and REALLY started to become uncooperative. But, after a syringe full of valium, a touch of fentanyl & midazolam (I'm not sure it's wise to describe how/why I actually had access to those, but, I did have some here), a slug of ketamine, an ampule of promethazine, another of chlorpromazine, and another syringe full of ketamine squirted up into her IV fluid bottle... and Viola!! It went so much better after all that!
I can't remember the next case. I mean, it's not like we keep an anesthetic record or anything. Part of it was that Suzanne interjected a memorable bit of non-medical nomenclature into the operating room conversation. See, what happened was, as we were getting the IV started, administering pre-operative antibiotics, and rolling through the double doors with the patient... James had just finished releasing the sutures on a testicular hernia repair he'd done on a man a few days before. It was a quick deal... done in the foyer, after he unabashedly dropped his drawers and sat down on a stool while James sits down and snip-snip... that was it, done deal. Pant's back up and away he went. So then Suzanne grabs James' stool to bring it into the OR (filled with no one but guys) and without stopping to think if she should be using her INNER voice bluntly announces, "I'm not sitting on that thing after he's had his nut sack all over it!" The sudden silence and frozen forms of the men in the room as they all turned to look at who had just said that was accentuated by the stop action suspension in what otherwise would've been a flurry of activity as we got the case off and running. I think it was the surgeon who broke the silence by offering the observation, "Normally, we refer to it as the scrotum." Still, we couldn't help bust up laughing.
The last case was a woman with a huge fungating tumor on the bottom of her foot that smelled like it had been there for months. Turned out, it had been. James had actually seen her about 3 months ago, taken off a small tumor from her foot and referred her to her local health clinic for dressing changes. We did a mid-foot amputation under lidocaine spinal. And we doubted that she had actually gone for any dressing changes, otherwise she would have been referred back to us for removal of this huge mass preventing her from walking. Oh, and one more thing... she was HIV positive, so when Suzanne caught a bit of blood on her arm and wigged out, it took me a bit of time to calm her down and assure her she wasn't going to die from it and it wouldn't go through her skin. That's Karma. It's what happens when you don't use your INNER voice for certain thoughts.
After that, Suzanne went to break the stress the way any woman on the planet would... go shopping.
I brought out some of the donated instruments for James that I found in the shipping container sitting in front of the guest house. The container had been sitting there for 3 years, by the way. He was very pleasantly surprised by some of what I had found in there for him and the operating room. We're going to have a little bit of Christmas when both of us have a chance to go through it together. It's funny though... most of what is sent over is absolute crap. I mean it. It's the exact same story I told of when I was in all those hospitals in Zambia and Malawi... tons of medical garbage is sent over in the name of "charitable donations." James has a different term for it... "Junk for Jesus." It's like people in the west, at some point in time, find themselves using undesirable instruments/materials while they operate and then have some kind of wicked epiphany and realize that they want to give to Christ's cause the very things they themselves refuse to use. It's kind of like the Life cereal commercial, just with two people in the OR commiserating...
"I don't want to use this needle driver/pair of scissors! They're awful."
"Yeah, they are!"
"Hey, wait a minute... I know! Let's give them to Jesus!"
"Great idea!!"
"Yeah, He'll use ANYTHING!"
"Put these in a box labeled "Donation for Africa."
"I bet we get a tax write off for it too, eh?"
"Yeah, we do. You know, we should do this more often!"
I hate those guys. They've turned Africa into a medical garbage dumping ground, and I'm the one having to wade through it all to sort out what's even remotely any good to use. But this time, I came prepared. I brought a sharpening tool, and those crappy scissors are now nicely sharpened and ready for the charcoal fired autoclave sterilization process tomorrow :) Or tonight. I'm not sure when they actually do it. It seems a bit hot for it right now in the afternoon... it's about 103 F.
I actually saw a few patients in the ER/outpatient clinic. Can you believe it?! Me, an anesthesiologist seeing patients! I know, I know. Weird. Anyway, the last guy had diabetes (just as weird, for Africa) and as James gave him his final instructions, I got a chance to visually evaluate this patient. He was an Arab with a long goatee extending out from under the lower wrap of his turban, wearing longsleeves and pants, (remember, it's over 100 degrees) covered halfway to his knees with a winter parka with fur trim (picture Spies Like Us, minus the Siberian setting). He and his buddy turn to head out the door after the perfunctory ritual goodbyes and handshakes and Asalam Alekahs ( or something like that ). He shakes my hand too, and discouraged because I haven't understood a word he or anyone else has said, I do my best to wish him well, wave good-bye and flatly suggest, "Better bundle up, it's kinda cold out there. Maybe consider adding some mittens to go with your parka... I dunno, it's up to you I suppose. Just a thought. Anyway, see ya!" Of course, not speaking English, he didn't get it. As for me, I cracked myself up, along with every English speaker within earshot.
Things you don't want to hear in the mission field: "No, the nearest place you can buy toilet paper is back in NDjamena. You may have to use your left hand."
Thursday, October 23, 2008
Sunday, October 19, 2008
Rise n Shine & A Day at the River
The next day Suzanne got up and ate porridge for breakfast. It was made of peanut butter, rice/rice milk and a touch of lime. It was quite good actually. I, on the other hand, had a glass of water and suddenly felt the desire to eat nothing else and go directly back to bed. That is, until they called for help to do anesthesia on an exploratory laporatomy for a large abdominal mass, combined with a hernia and hydrocele... so I got up anyway and skipped breakfast to go to work. It turned out that he had an obvious intrahepatic tumor (cancer in his liver) that likely had spread from somewhere else (who knew where), and might even already be studding his spleen (James could feel it with his hand). Bummer. The ultra sound done earlier hadn't seemed to be that bad, but now it was apparent that we were facing a bigger challenge than we had thought.
The tumor involved the entire left lobe of the liver, and a bleeding stink of a mess awaited us should James elect to attempt a partial liver resection (something usually only done by a liver transplant surgeon, and an anesthesiologist equipped with double central lines, 2 dozen units of blood and clotting factors, and pressurized infusion devices to overcome the blood loss as it occurs). We checked a hemaglobin. It was 7.0, the lowest you usually let a patient go before transfusing (and we handn't even begun to cut yet!). After talking with the family, the decision was made to close him up and let him have whatever quality of life he had left instead of risking him bleeding to death as we attempted to cut out this liver tumor. Unfortunately, I had hammered him with enough Ketamine to last several hours, so it would be awhile before he actually woke up to talk with his family.
Suzanne and I did some inventory of the anesthesia equipment and drugs as a way to start building a model by which a hospital wide system could be then implemented. Right now, there are 2 answers to the question of how much of any kind of drug or supply the hospital has. One is, "We have that." The other is, "We don't have any of that." For example, the other day administration was told by some of the workers, "We are having to fill the generator with fuel today, which completely empties our reserve tank." So you see, there is no mechanism by which to tell WHEN to order more of WHAT, and no one tracks the supplies that they use up to do anything. So, imagine discovering that you are out of something at the exact time that you need it most. This, my friends, is Africa!
We went to market to find me some flip-flops to walk around in so that I can get out of my closed shoes and socks... it's much cooler, and easier to change into your surgery pair of shoes quickly. So, we went to Bere market for the first time... alone. We spoke just a little French, and a few words of TChadian Arabic. We were so proud of ourselves and our little purchase. We'll try more advanced stuff next visit.
We've learned from the others who've been here long-term that the best way to stay cleaner and cooler is to shower off (without bothering to use soap... save that for when you REALLY mean business) every chance you get. You also have to watch out for little wounds on your hands and feet (since they get used a lot) because they can easily get infected with bizzare bacteria. And antibiotics can be hard to come by at times, so prevention is MUCH better than trying to get some cure. Which brings me to another point. If you have any weird allergies (ie. Suzanne who broke out on her arms), cortisone, tiger balm has no effect. :-(
Another things that has dawned on us is that cooking has to be done on an as-needed basis continually because there is no refrigeration. Thus, if you want to eat something other than fruit, bread/peanut butter... you're going to have to cook it (without electric stoves), and that assumes that you don't have to go out and buy it (you thought ahead enough to not need to go back to market). Cooking here is done over charcoal stoves that are either wire cone frames that sit on the ground, or stone/brick ovens that have a hole in them that the charcoal is loaded into and fired for the pot that goes on top. And this is NOT the charcoal you've seen in the states... it's charcoal made from trees, not fuel soaked briquettes. And let me tell you... they burn HOT! We realized during the last communal cooking spree (hosted on our 3 stone stoves and 2 wire charcoal burners) that one nice benefit of having concrete floors is that when you spill the hot coals all over the place... the house won't burn down.
Things you don't want to hear in the mission field: "It's not that bad really, except for those first 2 days. I've already had malaria TWICE since I got here!"
A Day at the River
The first Sabbath. Everyone slept in and woke up around 7:30 am. With the exception of nature's alarm RIGHT below our window, Mr. Speckles (aka. rooster). After a quick cold shower and breakfast that consisted of left over porridge, bananas, and bread......off to church we go! We showed up at 8:30 am at church located outside the compound (I should quickly add that when we say "compound," this should in no way be taken to represent anything like David Koresh lived in). It turns out that the first few hours or so are singing sermons. The songs all in French, the tunes memorized (there is no piano) and we were the only white people so far, other than a few college students. There were, however, a few drums, and Franklin was unceremoniously handed a mini tamborine that he had to learn how to play on the fly. It was difficult to follow much of anything, since the service was done in French and translated into the local dialect. The seats were 2 X 12 boards served as pews without backs or seat cushions. This made it harder to fall asleep in the sweltering heat.
After eating lunch, we went off the the river for a swim. This was to be a 2 mile walk/ride on horse back (Sarah, James' wife, has 2 horses... one of which Franklin did that lance/drainage job on earlier). Well, for those of you who followed the last trip, you already know that if you are told here that something is 2 miles away, or will take 1 hour to walk to... what that REALLY means is that it's closer to 3-4 miles, and will take nearly 2 hours to get there. This was the case again today. Franklin thought it'd be nice to ride for a while, but the horse wanted to gallop so much it was hard work keeping him from running out of control. The stirrups also dug into his legs, and to be honest, flip flops are not the best for riding horseback.
BUT... we will say it was kind of cool to swim in an African river. You know, always wondering if piranhas or something are going to start eating you (even though, honestly, you know piranhas are only in S America. Just the other side of the world). The current was quite strong, and it took a while for a smaller group to swim to the other side and jump out a tree overhanging the river. Climbing it was half the fun, and then after hitting the water you could just relax and let yourself get swept downstream and back across to the other bank with the others.
The hike back took until after dark. No small thing in a land with NO signs or directions available (why, oh WHY didn't I bring my GPS?!). Fortunately, the ONLY cell phone tower for hundreds of miles around is near the hospital, and after it's dark, and if you're close enough, you can see it in the distance and just walk towards it to find your way home at night. The whole trip left us with several blisters on our feet, and questions as to why we didn't bring any moleskin from Walgreen's, and why Franklin had settled for that european sized 43 set of flipflops instead of looking harder for some 41's.
Our futile attempts at connecting to the internet for email and blogging drained what little energy we had left. We listened to the shortwave radio for some glimpse into what's going on outside our small, remote world (didn't learn much), and then went on to bed. It's been cooler at night here in the south compared with N'djamena. It's actually comfortable from about 3-4 AM until 7:30 AM. Then, you might as well get up because it's going to get hot and sweaty soon anyway.
Things you don't want to hear in the mission field on rounds: "That guy doesn't look so good."
The tumor involved the entire left lobe of the liver, and a bleeding stink of a mess awaited us should James elect to attempt a partial liver resection (something usually only done by a liver transplant surgeon, and an anesthesiologist equipped with double central lines, 2 dozen units of blood and clotting factors, and pressurized infusion devices to overcome the blood loss as it occurs). We checked a hemaglobin. It was 7.0, the lowest you usually let a patient go before transfusing (and we handn't even begun to cut yet!). After talking with the family, the decision was made to close him up and let him have whatever quality of life he had left instead of risking him bleeding to death as we attempted to cut out this liver tumor. Unfortunately, I had hammered him with enough Ketamine to last several hours, so it would be awhile before he actually woke up to talk with his family.
Suzanne and I did some inventory of the anesthesia equipment and drugs as a way to start building a model by which a hospital wide system could be then implemented. Right now, there are 2 answers to the question of how much of any kind of drug or supply the hospital has. One is, "We have that." The other is, "We don't have any of that." For example, the other day administration was told by some of the workers, "We are having to fill the generator with fuel today, which completely empties our reserve tank." So you see, there is no mechanism by which to tell WHEN to order more of WHAT, and no one tracks the supplies that they use up to do anything. So, imagine discovering that you are out of something at the exact time that you need it most. This, my friends, is Africa!
We went to market to find me some flip-flops to walk around in so that I can get out of my closed shoes and socks... it's much cooler, and easier to change into your surgery pair of shoes quickly. So, we went to Bere market for the first time... alone. We spoke just a little French, and a few words of TChadian Arabic. We were so proud of ourselves and our little purchase. We'll try more advanced stuff next visit.
We've learned from the others who've been here long-term that the best way to stay cleaner and cooler is to shower off (without bothering to use soap... save that for when you REALLY mean business) every chance you get. You also have to watch out for little wounds on your hands and feet (since they get used a lot) because they can easily get infected with bizzare bacteria. And antibiotics can be hard to come by at times, so prevention is MUCH better than trying to get some cure. Which brings me to another point. If you have any weird allergies (ie. Suzanne who broke out on her arms), cortisone, tiger balm has no effect. :-(
Another things that has dawned on us is that cooking has to be done on an as-needed basis continually because there is no refrigeration. Thus, if you want to eat something other than fruit, bread/peanut butter... you're going to have to cook it (without electric stoves), and that assumes that you don't have to go out and buy it (you thought ahead enough to not need to go back to market). Cooking here is done over charcoal stoves that are either wire cone frames that sit on the ground, or stone/brick ovens that have a hole in them that the charcoal is loaded into and fired for the pot that goes on top. And this is NOT the charcoal you've seen in the states... it's charcoal made from trees, not fuel soaked briquettes. And let me tell you... they burn HOT! We realized during the last communal cooking spree (hosted on our 3 stone stoves and 2 wire charcoal burners) that one nice benefit of having concrete floors is that when you spill the hot coals all over the place... the house won't burn down.
Things you don't want to hear in the mission field: "It's not that bad really, except for those first 2 days. I've already had malaria TWICE since I got here!"
A Day at the River
The first Sabbath. Everyone slept in and woke up around 7:30 am. With the exception of nature's alarm RIGHT below our window, Mr. Speckles (aka. rooster). After a quick cold shower and breakfast that consisted of left over porridge, bananas, and bread......off to church we go! We showed up at 8:30 am at church located outside the compound (I should quickly add that when we say "compound," this should in no way be taken to represent anything like David Koresh lived in). It turns out that the first few hours or so are singing sermons. The songs all in French, the tunes memorized (there is no piano) and we were the only white people so far, other than a few college students. There were, however, a few drums, and Franklin was unceremoniously handed a mini tamborine that he had to learn how to play on the fly. It was difficult to follow much of anything, since the service was done in French and translated into the local dialect. The seats were 2 X 12 boards served as pews without backs or seat cushions. This made it harder to fall asleep in the sweltering heat.
After eating lunch, we went off the the river for a swim. This was to be a 2 mile walk/ride on horse back (Sarah, James' wife, has 2 horses... one of which Franklin did that lance/drainage job on earlier). Well, for those of you who followed the last trip, you already know that if you are told here that something is 2 miles away, or will take 1 hour to walk to... what that REALLY means is that it's closer to 3-4 miles, and will take nearly 2 hours to get there. This was the case again today. Franklin thought it'd be nice to ride for a while, but the horse wanted to gallop so much it was hard work keeping him from running out of control. The stirrups also dug into his legs, and to be honest, flip flops are not the best for riding horseback.
BUT... we will say it was kind of cool to swim in an African river. You know, always wondering if piranhas or something are going to start eating you (even though, honestly, you know piranhas are only in S America. Just the other side of the world). The current was quite strong, and it took a while for a smaller group to swim to the other side and jump out a tree overhanging the river. Climbing it was half the fun, and then after hitting the water you could just relax and let yourself get swept downstream and back across to the other bank with the others.
The hike back took until after dark. No small thing in a land with NO signs or directions available (why, oh WHY didn't I bring my GPS?!). Fortunately, the ONLY cell phone tower for hundreds of miles around is near the hospital, and after it's dark, and if you're close enough, you can see it in the distance and just walk towards it to find your way home at night. The whole trip left us with several blisters on our feet, and questions as to why we didn't bring any moleskin from Walgreen's, and why Franklin had settled for that european sized 43 set of flipflops instead of looking harder for some 41's.
Our futile attempts at connecting to the internet for email and blogging drained what little energy we had left. We listened to the shortwave radio for some glimpse into what's going on outside our small, remote world (didn't learn much), and then went on to bed. It's been cooler at night here in the south compared with N'djamena. It's actually comfortable from about 3-4 AM until 7:30 AM. Then, you might as well get up because it's going to get hot and sweaty soon anyway.
Things you don't want to hear in the mission field on rounds: "That guy doesn't look so good."
Saleem Maliiko!!
Hi!! Bonjour!! Saleem Maliiko!!
Well how do I (Suzanne) send you emails. Franklin bought a sweet GSM Chinese "iPhone" and we are able to get a SIM card for both internet AND texting AND to call home. So, maybe you will get a text from me or a phonecall :-) dunno if you can text me back though. We flew into N'djamena at around 9:15-ish on Sunday. That was AFTER a suitcase was abondoned, and the following occurred...
We arrived with about 1.5 hours to board the plane. We stopped at the great big display board to see which desk we should check in at, and what gate we'd be board to load onto the plane. We'll our check in was in zone 9, and we were standing in zone 2, so we turned right and started rolling towards zone 9. Immediately, 2 police men/women and 3 French machine gunners stopped us and pressed us and the crowed back about 5 feet, blocking our way towards zone 9. Finally the police chick told us in English about a suitcase that was left unattended 20 meters away (you could look over at it) was a suspected bomb and that they were securing the terminal. OK, I thought... do what you gotta do, right? As we waited at the secured zone, looking at this blue tote bag, we decided it was time to beg the guy at zone 2 to check us onto our flight, but he refused (snooty little Frenchman). He did reassure us that if we were still roped off from zone 9 in another 30 minutes, when they would close the checkin for the flight, he'd take us in. Then, we were hearded out of the terminal as the loudspeaker announced the problem and informed us that all flights were now cancelled! Sweet. Goodbye Chad trip!
We stood outside for about 30 minutes, police cars with the sirens all over the place, while the bomb squad went in to take care of business. We assume they put the thing in a box and blew it to Allah, because the explosion was quite loud (even though the ground didn't shake). Within 5 minutes it was business as usual. We were into the terminal walking past a lady sweeping up some charred paper off the floor, with people sipping wine in a nearby cafe off to the side. Go figure. We made it onto the plane with only 3 minutes to spare, and after grabbing the last copy of the English newspaper with the headline "World Markets Crashing" with figures showing 20-24% losses from London, Tokyo, New York and Germany. Looked like it was going to be a good time to drop off the face of the earth for a while.
So on the flight to N'djamena I sat next to this oil tycoon who informed me he was a chain smoker. Approximately 7 cigarettes in one hour. "I'm addicted (pronoune ad-deeee'cted)". So to compensate he decided that getting drunk would be the most logical option to ease the jitters. He kept ordering wine bottle after wine bottle and even ordered me wine bottle after wine bottle. During that time, he managed to not only get hammered BUT to spill red wine all over his trousers. Followed up by what I assume some profanities in French that I have yet to learn. Upon landing we get off the plane on the runway and this bus drives us about 20 yards to the luggage claim/airport. We could have walked that distance. Did i mention its very dark?? Yeah, no city lights (Franklin - Actually, there were, Suzanne just didn't notice them. We later learned that only 5 years ago there really were NO lights in N'djamena). We walk into the airport to go through customs and there are bugs EVERYWHERE! Not a good sign. So the guys in customs didn't speak English (or Engrish, for that matter), we were the last in line, and just stamped our passports and pantomimed that we needed to register with the police within 3 days. Fine. OK, off to get luggage. We met our peeps that were there to pick us up, and apparently there was another person named "Maria" that was supposed to be on the flight. After waiting for several minutes, we decided Maria wasn't even on the plane and continued the journey to our port of call, which was the SIL institute (where we slept that night). Turns out Maria actually was on the plane and somehow was diverted to another room to so called register. (It also turned out that someone felt sorry for this 18 year old white girl that they gave here a nice hotel room overnight, for free.)
We finally were able to rendevous with her at the market in N'djamena. The market let alone the streets AND the so called 'bus' ride are not for people with a weak stomach. The heat, the filth, the poverty was a real eye opening experience. You don't know or can't even conceive what poverty and filth is until you have been to a major city in Africa. Or Tchad.......or what the Chadian Arabic would call Tachaad. I have been picking up a lot of French (doing Rosetta Stone as well) along with a lot of Chadian Arabic. You have to speak the language if you want to make it here.
We had quite an adventure in the capital and quite an adventure on the travel south to Bere. When we reached the first destination of Kelo to rent a 4x4 (because the roads were flooded) a fight broke out. Africans will jump in and carry your luggage and want you to pay them. This was the case with us this time. I have it all on film to show when I return. I am writing you from cellphone-bluetooth-macbook remember?? Uable to post pictures/video yet. We managed to pile luggage for all the volunteers in the back of the truck bed, cram 7 people in the cab of the truck, and 5 people on top of the luggage, clinging on for dear life in the back... true african style. Away we went to Bere on rutted roads and absolute wilderness and wild country. It reminded me of the pictures i would see of remote Africa in National Geographic. We managed to get stuck one time. We crossed a river on a homemade barge that they use ropes to pull across. FINALLY we are at the hospital......14 hours later. So far Franklin is getting over his illness, 4 volunteers have beginning symptoms of malaria. I am ok so far. I feel rather nauseous at night and fatigued. So I have been extra cautious. But all in all.... I really really like Bere. With a nice comfortable matress cot, my mosquito net, I quickly fell asleep. Which was much needed.
First day on the job. The hospital is supposedly "quiet" right now because of a dispute that broke out between some Arabs and the locals that resulted in 5 dead and 14 wounded (stab wounds). All which showed up at the hospital. Most were women, children and a few men. The fight started when an Arab cow wandered into the rice field of a local, a stabbing ensued, followed quickly by revenge over the "dead brother" who fell when stabbed in the field. Later, after everyone else was wounded or dead, he revived. True story. Oh, and did I mention the law? Doesnt exist. Things should be very very busy again by next week though.
I saw a patient that had AIDS who was misdiagnosed at another hospital for Polio. He was so thin and deathly looking. Picture Auschwitz and take it to another level. Then I assisted with a girl who was 14 years old who has AIDS, gastroenteritis, meningitis, malaria and something else. She is very bad off. I was able to help in the Operating room of a patient who had a premature baby the previous night but there was still after birth left inside her. She went into shock and the doctor had to perform a D&C to remove the remaining placenta. The heat in the OR was so intense the sweat was literally pouring off our arms and backs. Towards the end, they switched on the AC (which has to be used carefully or else too much current is drawn and burns out the generator). Afterwards I had to 'milk' her breast down into a cup (because her family wouldn't do it) and feed her premature baby the milk by spoon. All the while the patient was wheezing-breathing loud and basically clinging on to what life she has left. We don't expect her to make it through the night. (She died before nightfall.) Which means the baby won't make it either. I also took another baby outside in the sun because the mother had been stabbed during the fight and couldnt move.....the baby has jaundice. So sunlight 1 time every hour for 15 minutes. No patients and much of the staff only speak french, local language or chadian arabic. My French has increased leaps and bounds in the last few days, along with Arabic.
There was one other case (Suzanne didn't see this one) of a wiry, skinny guy who was... well, just not right. He was wild-eyed, wouldn't hold still, wouldn't sit down, wouldn't talk, and was ALOT stronger than he looked. We tried to lay him down to do an exam and he nearly bench pressed James with one arm (James is about 6' 3") while fighting off another hospital worker with the other arm. James called for the chaplin, who had a special prayer service with him, suspecting he was possessed (let's just say they've seen this kind of thing before, and the chaplin has had to deal with it a number of times). He was seated and in his right mind next time we came through... no other interventions needed. (The chaplin has his own story, we'll try to tell you about it sometime... prior to his conversion, he was a successful, Russian-trained, Islamic terrorist.)
Some other cases were malaria, some were poorly healed fractures that the doctor rebroke the femur, set the leg with pins so the leg could grow to normal size.....other cases included????? It's all a blur now. OH YES! I also helped Lin with the doctor's horse that had an unopened abcess. He stabbed it with a blade and nothing but puss.
The highlight? I was offered a job of being the director of projects for Tchad and Sudan. But that would mean I would have to move to Africa. Right.
Tomorrow's agenda is to do rounds in the morning, do inventory and establish ledgers for accounting. Then order all the medicine for the whole next year. And try to eat something with substance. Today was bread for breakfast, beans and rice for lunch, the locally made peanut butter on bread with a side of sliced tomatoes. All the sweating and moving around I do....must have Big Mac!! I have to run in scrubs or a skirt because your not supposed to show your knees here. SHORTS (not long skirts!).....hello women of Tchad....liberate yourselves!
Time for bed for a shower (cold) and try to sleep off the long day of hard work. Very fatigued and feeling a little sick. Sometime tomorrow I hope to slip away to the local market and have a dress made for about 7 dollars and practice my Arabic. Or French.
"Je veux acheter du robe" Or!! "Nidoor nachri angumaaji (roob)"
OK, until next time, we leave you with a new blog feature we'll be ending with from time to time... Things you don't want to hear in the mission field: "I'll help you wash dishes right after I finish going to the bathroom."
Well how do I (Suzanne) send you emails. Franklin bought a sweet GSM Chinese "iPhone" and we are able to get a SIM card for both internet AND texting AND to call home. So, maybe you will get a text from me or a phonecall :-) dunno if you can text me back though. We flew into N'djamena at around 9:15-ish on Sunday. That was AFTER a suitcase was abondoned, and the following occurred...
We arrived with about 1.5 hours to board the plane. We stopped at the great big display board to see which desk we should check in at, and what gate we'd be board to load onto the plane. We'll our check in was in zone 9, and we were standing in zone 2, so we turned right and started rolling towards zone 9. Immediately, 2 police men/women and 3 French machine gunners stopped us and pressed us and the crowed back about 5 feet, blocking our way towards zone 9. Finally the police chick told us in English about a suitcase that was left unattended 20 meters away (you could look over at it) was a suspected bomb and that they were securing the terminal. OK, I thought... do what you gotta do, right? As we waited at the secured zone, looking at this blue tote bag, we decided it was time to beg the guy at zone 2 to check us onto our flight, but he refused (snooty little Frenchman). He did reassure us that if we were still roped off from zone 9 in another 30 minutes, when they would close the checkin for the flight, he'd take us in. Then, we were hearded out of the terminal as the loudspeaker announced the problem and informed us that all flights were now cancelled! Sweet. Goodbye Chad trip!
We stood outside for about 30 minutes, police cars with the sirens all over the place, while the bomb squad went in to take care of business. We assume they put the thing in a box and blew it to Allah, because the explosion was quite loud (even though the ground didn't shake). Within 5 minutes it was business as usual. We were into the terminal walking past a lady sweeping up some charred paper off the floor, with people sipping wine in a nearby cafe off to the side. Go figure. We made it onto the plane with only 3 minutes to spare, and after grabbing the last copy of the English newspaper with the headline "World Markets Crashing" with figures showing 20-24% losses from London, Tokyo, New York and Germany. Looked like it was going to be a good time to drop off the face of the earth for a while.
So on the flight to N'djamena I sat next to this oil tycoon who informed me he was a chain smoker. Approximately 7 cigarettes in one hour. "I'm addicted (pronoune ad-deeee'cted)". So to compensate he decided that getting drunk would be the most logical option to ease the jitters. He kept ordering wine bottle after wine bottle and even ordered me wine bottle after wine bottle. During that time, he managed to not only get hammered BUT to spill red wine all over his trousers. Followed up by what I assume some profanities in French that I have yet to learn. Upon landing we get off the plane on the runway and this bus drives us about 20 yards to the luggage claim/airport. We could have walked that distance. Did i mention its very dark?? Yeah, no city lights (Franklin - Actually, there were, Suzanne just didn't notice them. We later learned that only 5 years ago there really were NO lights in N'djamena). We walk into the airport to go through customs and there are bugs EVERYWHERE! Not a good sign. So the guys in customs didn't speak English (or Engrish, for that matter), we were the last in line, and just stamped our passports and pantomimed that we needed to register with the police within 3 days. Fine. OK, off to get luggage. We met our peeps that were there to pick us up, and apparently there was another person named "Maria" that was supposed to be on the flight. After waiting for several minutes, we decided Maria wasn't even on the plane and continued the journey to our port of call, which was the SIL institute (where we slept that night). Turns out Maria actually was on the plane and somehow was diverted to another room to so called register. (It also turned out that someone felt sorry for this 18 year old white girl that they gave here a nice hotel room overnight, for free.)
We finally were able to rendevous with her at the market in N'djamena. The market let alone the streets AND the so called 'bus' ride are not for people with a weak stomach. The heat, the filth, the poverty was a real eye opening experience. You don't know or can't even conceive what poverty and filth is until you have been to a major city in Africa. Or Tchad.......or what the Chadian Arabic would call Tachaad. I have been picking up a lot of French (doing Rosetta Stone as well) along with a lot of Chadian Arabic. You have to speak the language if you want to make it here.
We had quite an adventure in the capital and quite an adventure on the travel south to Bere. When we reached the first destination of Kelo to rent a 4x4 (because the roads were flooded) a fight broke out. Africans will jump in and carry your luggage and want you to pay them. This was the case with us this time. I have it all on film to show when I return. I am writing you from cellphone-bluetooth-macbook remember?? Uable to post pictures/video yet. We managed to pile luggage for all the volunteers in the back of the truck bed, cram 7 people in the cab of the truck, and 5 people on top of the luggage, clinging on for dear life in the back... true african style. Away we went to Bere on rutted roads and absolute wilderness and wild country. It reminded me of the pictures i would see of remote Africa in National Geographic. We managed to get stuck one time. We crossed a river on a homemade barge that they use ropes to pull across. FINALLY we are at the hospital......14 hours later. So far Franklin is getting over his illness, 4 volunteers have beginning symptoms of malaria. I am ok so far. I feel rather nauseous at night and fatigued. So I have been extra cautious. But all in all.... I really really like Bere. With a nice comfortable matress cot, my mosquito net, I quickly fell asleep. Which was much needed.
First day on the job. The hospital is supposedly "quiet" right now because of a dispute that broke out between some Arabs and the locals that resulted in 5 dead and 14 wounded (stab wounds). All which showed up at the hospital. Most were women, children and a few men. The fight started when an Arab cow wandered into the rice field of a local, a stabbing ensued, followed quickly by revenge over the "dead brother" who fell when stabbed in the field. Later, after everyone else was wounded or dead, he revived. True story. Oh, and did I mention the law? Doesnt exist. Things should be very very busy again by next week though.
I saw a patient that had AIDS who was misdiagnosed at another hospital for Polio. He was so thin and deathly looking. Picture Auschwitz and take it to another level. Then I assisted with a girl who was 14 years old who has AIDS, gastroenteritis, meningitis, malaria and something else. She is very bad off. I was able to help in the Operating room of a patient who had a premature baby the previous night but there was still after birth left inside her. She went into shock and the doctor had to perform a D&C to remove the remaining placenta. The heat in the OR was so intense the sweat was literally pouring off our arms and backs. Towards the end, they switched on the AC (which has to be used carefully or else too much current is drawn and burns out the generator). Afterwards I had to 'milk' her breast down into a cup (because her family wouldn't do it) and feed her premature baby the milk by spoon. All the while the patient was wheezing-breathing loud and basically clinging on to what life she has left. We don't expect her to make it through the night. (She died before nightfall.) Which means the baby won't make it either. I also took another baby outside in the sun because the mother had been stabbed during the fight and couldnt move.....the baby has jaundice. So sunlight 1 time every hour for 15 minutes. No patients and much of the staff only speak french, local language or chadian arabic. My French has increased leaps and bounds in the last few days, along with Arabic.
There was one other case (Suzanne didn't see this one) of a wiry, skinny guy who was... well, just not right. He was wild-eyed, wouldn't hold still, wouldn't sit down, wouldn't talk, and was ALOT stronger than he looked. We tried to lay him down to do an exam and he nearly bench pressed James with one arm (James is about 6' 3") while fighting off another hospital worker with the other arm. James called for the chaplin, who had a special prayer service with him, suspecting he was possessed (let's just say they've seen this kind of thing before, and the chaplin has had to deal with it a number of times). He was seated and in his right mind next time we came through... no other interventions needed. (The chaplin has his own story, we'll try to tell you about it sometime... prior to his conversion, he was a successful, Russian-trained, Islamic terrorist.)
Some other cases were malaria, some were poorly healed fractures that the doctor rebroke the femur, set the leg with pins so the leg could grow to normal size.....other cases included????? It's all a blur now. OH YES! I also helped Lin with the doctor's horse that had an unopened abcess. He stabbed it with a blade and nothing but puss.
The highlight? I was offered a job of being the director of projects for Tchad and Sudan. But that would mean I would have to move to Africa. Right.
Tomorrow's agenda is to do rounds in the morning, do inventory and establish ledgers for accounting. Then order all the medicine for the whole next year. And try to eat something with substance. Today was bread for breakfast, beans and rice for lunch, the locally made peanut butter on bread with a side of sliced tomatoes. All the sweating and moving around I do....must have Big Mac!! I have to run in scrubs or a skirt because your not supposed to show your knees here. SHORTS (not long skirts!).....hello women of Tchad....liberate yourselves!
Time for bed for a shower (cold) and try to sleep off the long day of hard work. Very fatigued and feeling a little sick. Sometime tomorrow I hope to slip away to the local market and have a dress made for about 7 dollars and practice my Arabic. Or French.
"Je veux acheter du robe" Or!! "Nidoor nachri angumaaji (roob)"
OK, until next time, we leave you with a new blog feature we'll be ending with from time to time... Things you don't want to hear in the mission field: "I'll help you wash dishes right after I finish going to the bathroom."
Tuesday, October 14, 2008
Flom Palis Wiff Ruv - The Asian connection.
(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
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
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.
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