Pictures!

I spent all day working on organizing about 2,000 pictures from my trip and have even managed to post many new pictures on the blog! I hope you all enjoy them and sorry for the delay!

Back to reality!

I made it home safely with no issues at all with any of my travel plans! And have been welcomed home by the remains of the massive snow storm(s) that have hit Baltimore in the past few weeks, while I was sweating in Africa!
I hope to get myself organized and then get the photos up of some of the events I have posted about in the past few weeks. But for now I'm back home, safe and sound.....but am missing Africa!

I'm heading home!

It is over....5 weeks and 5 days has come to an end. It is very hard to believe and certainly bitter sweet to say goodbye to everyone and leave! I fly out this evening at 10:35 PM local time....23 hours later (assuming all goes well) I will be landing at Dulles Airport!

See you all soon! And thanks for following the blog of my travels, it has been nice to have everyone's support and comments along the way!

Flora's Umbilical Hernia Surgery!

Well like everything else here, things happen "polle polle"... slowly! At times I am even amazed that anything at all gets done! The truth of the matter is time is taken so lightly that you can only plan one appointment a day because that meeting might take all day! Or might not happen at all.



This being said, after much confusion about meeting times to speak with the head of the orphanage about possible surgery and if they had a preference of surgeons or hospitals...we finally set something up for thursday morning (so I had been told). Then that was pushed to 3pm Thursday (which messed up my whole day of plans, but I would be flexible) At 10am I was about to leave to start my new plans for the day when my phone rings and I am told that the little girl, Flora, and someone from the orphanage are AT St Elizabeth's waiting for me?!?!?! So suddenly my plans changed AGAIN, and now I was off to the hospital for a pre-op consult. This was not the order of events I had imagined in this "polle polle" culture in which I currently live.

I met them at the hospital and take them to the OR for their pre-op exam. Once there I find out that Dr Mosha is doing the same surgery on a little boy right then (10:30) so if we get her chart she might be able to have surgery after him! Wow this was all happening so fast I was impressed yet surprised! I make sure that the orphanage was prepared for surgery today and Mama Vera said they were and they would be happy to have it today. We were sent to get Flora a chart and then return to the OR. I was told they were just finishing up the first (and only)scheduled surgery, but I see Dr Mosha walking around outside. So I think this is a touch strange.

We wait and wait and wait. Finally the other boy is taken out and put in the male surgical ward. At nearly 12, we are told that Dr Mosha has left for the day! So I try to stay optimistic and think this is a good thing because now Dr Ngyza can do the surgery instead! (And if I needed surgery I would want him to do it) He is still on morning rounds, so we wait some more!

Finally around 1pm, Dr Ngyza comes and evaluates her, calling it a 3cm hole in the abdominal wall...and set up everything for next week, as he does not do umbilical hernia repairs!



So in the end, she is to arrive Monday the 22nd at 4pm for admission. Then surgery will be first thing Tuesday morning. My flight leaves Monday night, so I will not be able to stay but have arranged payment and have told the other volunteers to keep and eye on her for me! Fingers crossed all will go well for her!

UPDATE: (3/9/10) I have gotten updates on both of the little girls who underwent hernia repair surgery. (I never posted about the second little girl, but we arranged for another little girl around the same age to have the same surgery on the same day as Flora. Thanks to the volunteers at her orphanage the cost was also covered!)

Janet: It sounds like Janet recovered exactly as expected in Africa. She spent 3 nights in the hospital and went back to the orphanage where she was allowed to sleep in the volunteer's quarters as to not have to share a bed with another little girl while her wounds healed. The volunteers did a wonderful job caring for her and even home schooled her from the orphanage while she was recovering. To my knowledge she is back at school and eating and drinking normally with no complications!

Flora: Unfortunately Flora, who did have the larger repair, did not fair as well as Janet. She was in the hospital for nearly 10 days. I have not heard exactly why but my assumption is the extended stay was due to infection. She was released on Thursday March 4th and returned to the orphanage. A volunteer there, told me that she was a bit slower and a little more shy than the volunteer had remembered. But once the older children returned from school, she perked up and seemed to act like her old self again. I have seen an after picture of her repair, and with the amount of skin she had due to the large hernia her abdomen does not look normal. But in time, as she grows the skin should stretch out, but likely she will never have a "normal" appearing belly button area. On the other hand, she will never have a life or death emergency related to the hernia and for that I am thankful!

In the end both surgeries were a success!

Back at St Elizabeth's

After spending the weekend relaxing at a near by hotel pool! I have made my way back to St Elizabeth for my last full week.

I'm, again, helping at the MCH (maternal child health) clinic. I'm working with a different Midwife than before and it is actually running very smoothly. Other than not being able to speak swahili, I am doing everything the nurse midwives do, in fact she is often asking ME to check her. I'm now comfortable ordering the labs that they order for the pregnant women, giving the appropriate medications based on the lab results, doing HIV and syphilis rapid testing, listening to fetal heart rate, identifying the position of the fetus, and estimating fetal age with my hands.

Yesterday, I discovered a set of twins that had not been confirmed yet. (mainly because ultrasound is not ordered on every pregnancy, only if there is a complication or concern) Two heads, two heart beats. I tried to ask the woman and she said "3 babies" I looked at her confused, then read her medical record and noted that this would be her 3rd child. Ahhh the communication barrier! So I waited for the nurse midwife to return and ask her. She confirmed that twins ran in her family but she was not aware of a twin pregnancy. She seemed excited.

Today, I had my first newly diagnosed HIV woman. :( This was hard, and this is when the communication barrier works to my favor! She was very upset and had a variety of emotions as you could guess. In the end, she says she will go home and tell her husband and then decide together what to do next. We are hoping she returns, but the nurse midwife doesn't think she will. The sad reality!

Also, in my free time, I'm working on getting umbilical hernia surgery for the little girl Cassie and I met last week at our housemate's orphanage. She is 6 and has the largest hernia I have ever seen, the actual abdominal hole is nearly 4 cm in diameter. Cassie and I discussed it before she left and decided we would pay for it ourselves, if they would have the surgery done! So now to try to get that accomplished in 6 days :) or less. Wish me luck! If this one is successful, I will attempt a second little girl who also has one but not nearly as large as the first.

Time at the orphanage

I am back from our mini week at the orphanage(s). We spent 2 days at Good Hope orphanage here in Arusha (I think there are many with this name so don't get too excited if you have heard it before). We spent most of the days in "middle class" at the Good Hope School. This is similar to Kindergarten with children ages 4-6 and there was even one 8 year old whose Grandmother has been holding him back because she doesn't feel his reading is up to speed, but needless to say he is the top of his class. We graded homework, helped them with their in-class assignments and hand wrote their homework in their workbooks each day before they left.







We would return to the orphanage at around 4 in the afternoon and just played with the kids, had dinner, and helped the older kids complete their homework before bedtime.

This particular orphanage has 12 children ages 3 years old to 9 years old and was pretty evenly mixed girls and boys. Cassie and I fell in love with different children (which is good because we wouldn't want to fight over who would get who!) She wanted two of the girls, a 5 year old and the 3 year old. And I wanted one of the older girls who was 6 and a little 4 or 5 year old boy. His name was Living...yes as in the opposite of Dead! I'm not sure I have ever written about the various English words that have been given as names here...but they are very interesting to say the least! :) But all joking aside all the children were so cute and so well behaved!

Living sitting on my lap


Yesterday we actually ended up back at our hospital with the little 6 year old girl I liked so much. She had an infection under her arm that required antibiotics. I think the director was a little upset that I told him that it would require treatment that I was not able to provide. They also have a child who is thought to have a seizure disorder, and a 7 year old with a decent size umbilical hernia. Otherwise the children seem very healthy!

Prisca and Me




Cassie and her little Rachel



Today, we went to a different orphanage with one of our other housemates. This one was mainly young children, 12 months to 5 years and it was a zoo to say the least! We were constantly holding at least one child if not 2 or 3 and all of them had a very bad cold of some sort. Green snotty noses and a very congested cough was true for every one of them. It didn't seem to be slowing them down and I felt no fevers, but this is hard as the temperature is so warm here and they dress the children in sweaters and at times even wool hats.

Well that's it for now....today is Cassie last full day. Tomorrow at this time she will be waiting for her ride to the airport to go home. So next week I am a bit undecided where to spend my time, but will let you know!

Zanzibar

We are back from Zanzibar and had a blast! The weather was sunny and to call it warm would be an understatement, really the only word to describe it would be HOT! Any movement would produce a fine layer of sweat to form. This is ok while you are on the beach with water all around, but in a taxi or in the room at night this becomes a little overwhelming. I think I actually slowed down to "African speed", which is as fast as you need to be on vacation.

My seat on the 12 passenger plane, Co-Pilot Elizabeth

Me, Cassie and Camilla

The beaches were very long and wide, covered with nice white sand. The water was so blue!!! Even bluer than I have seen in the Caribbean. It was also perfectly clear, you could see straight down to the bottom even in the deep areas.
Women walking with fishing net



We went snorkeling on Saturday to a small island on the east side of Zanzibar. And had lunch cooked for us on the beach then headed back to the hotel in the afternoon. The boat ride took just over an hour, one way, so there was a bit more "sun time" than we had expected! Needless to say we all were a bit more pink than tanned that evening, but had a great time!

Our snorkeling boat


The next day we read our books, went for walks, and did some shopping at the local artisan booths on the beach. I think we got some pretty good deals too :) We are mastering the art of haggling.


While we were without power most of the time, the hotel did run a generator at night after 6pm until just after midnight and then would turn it on again around breakfast time for a few hours. The food I think reflected the lack of power, it was good but not great due to not having refrigeration at all times. Also ice cream (which is clearly a must in this type of weather) was VERY difficult to come by....but as you might have guessed we found it!

Doors of Zanzibar

So we are back home now, and our plan for this week is to go to an orphanage Tuesday through Thursday and return to the hospital on Friday for Cassie to say her goodbyes. She leave Friday evening!!!!

I'm not sure when I will get pictures up, but am thinking about trying to get some of that together next weekend....so sorry for no safari or Zanzibar pictures yet!

My week in the OR

HAPPY BIRTHDAY CASSIE!!!

I know today is only Thursday but I have completed my week in the OR, because we will be flying to Zanzibar tomorrow (Friday) morning. Yes, it is true that Zanzibar continues to have no power (going on 2 months now) and pumping water is just becoming an issue, but the hotels are still open and the planes are still flying there. So bottom line is we are GOING! We will return Monday and then spent the next week at a local orphanage assisting with daily cares of the children and assessing some of the children for illness/disease.

So my OR rotation was very short, but we also had very few surgeries which made it feel very long. It, like everything else here, definitely runs on African Time! When I arrive in the morning and ask what surgeries we have I am told I'm too eager, and that they don't know yet. When I ask at 10am they typically say, "we haven't heard" or "Not sure, but I think something is coming" Usually we don't know until the patient arrives and is practically laying on the surgery table. And yes they walk into the OR by themselves and get on the table and then (in rare case) are knocked out using god knows what. But it usually starts with laughing gas, and if you are lucky you get something IV. They do not have any sort of monitors on the patients unless they are intubated (which as you guessed they also rarely do) in which case that merely apply a pulse ox to the finger to measure the heart rate and the oxygen saturation.

Operating Table

Surgical Scrub Closet

Surgeries I have witnessed:
Hemorrhoidectomy (not to be graphic but I'm pretty sure this man will not be able to pass stool again in his life!!!)
C-section ( a cute little baby boy around 7 lbs was born! The c-section was elective!!! something we do share in common!)
T and A (removal of the tonsils and adenoids on a 3 year old boy)
Cataract Surgery (they actually do this while the pt is awake and cut/ use cautry/ replace the lens with a mad made one and close with stitches on the eye ball!)
Eye Infection on a 7 year old boy (he was intubated! but woke up in a lot of pain, not pain meds are given until post op once they wake and it is just Motrin or Tylenol if you are lucky)
Lypoma (fatty tissue deposit under the skin) I scrubbed in for this case, it was very basic and the procedure went well. But again only local numbing was used so there was no monitoring of the patient. When we were finished the patient (and 70ish year old female) was sweating a lot and wouldn't wake up. I won't go into everything that happened after this, as it is highly disappointing to see the lack of knowledge and understanding that surrounds these situations! Bottom line is we moved her to the woman's surgical ward and a few hours later she was more responsive but not "normal" as of when I left this afternoon.
Lypoma Surgery

Lastly 3 patients that I met on rounds Monday of this week have passed away! The sad reality of it all!

Until I return from ZANZIBAR!!!!!

SAFARI !!!!!!!!

Well I'm back, in one piece. No limbs were taken by wild animals or anything like that, although at times the animals were seriously close enough to have done so with a single movement.

We, Cassie and I, joined two other volunteers from local orphanages on Wednesday morning and headed off to Lake Manyara National Park. We dropped our stuff at the camp outside of the park and left the cook, Moses, behind to sent up camp and prepare dinner. We had box lunches that we ate on the way. Then our driver, Saudi, took us into the park. We saw Hippos, Baboons, Giraffes, Elephants, Silver Back Monkeys, Blue Monkeys, Mongooses and lots of birds! We even had an elephant begin to chase after us, as we had accidentally cut him off from his pack! He was a straggler and we did not notice him, until I heard something and turned around to see him beginning to run towards the jeep. I quickly told the driver who started the jeep promptly and moved to the side of the road. After the elephant passed, he calmly said he had seen him in the rear-view mirror!!! :) Even so I'm glad I said it when I did! I will say he had no fear and maintains that elephants are not dangerous to humans, UNLESS they have babies! Which they all did!!!!!

AN ASIDE: He was truly amazing! He was able the drive the car on less than ideal roads, avoid animals and spot, I swear, every animal that we passed even if they were hiding in the tall grass. In the Serengeti many times he would stop the car and the four of us would be dumbfounded looking around at open fields. He would very matter-of-factly say "do you see the lions?" We would still look around knowing what we are looking for and couldn't always see them! So he was great!





Back to the safari: Wednesday night we camped at Lake Manyara and stayed up late talking to the cook. The next morning we headed to Serengeti National Park. We arrived in the afternoon and once again ditched the cook and our belonging to go out and find animals. We must have only been in the park for 5 minutes before we saw our first group of lions. It was a group of 3 males taking a cat nap in a dried up waterhole, right next to the road. Apparently not bothered by the cars at all.

While we are on the topic of lions, we averaged seeing 8 lions a day while in Serengeti. Four of those sightings lived less than 1 km from our camp site that we were staying in both nights while we were there! But we never saw them at camp, only heard some Hyenas at night!



Other animals we saw in the Serengeti include (and I'm sure I will forget plenty of them) elephants, giraffes, hippos, gazelles (3-4 kinds), wilder beast, water buffalo, a leopard, impalas, ostriches, antelopes (3-4 kinds), zebras, warthogs, the largest flight bird (the name escapes me), a fox like animal, lilac rollers (birds), guinea fowl, hawks, falcons, a small field mouse of some kind, camels and donkeys ( both of which have been domesticated by the Maasai people while live around the boarders of Serengeti national park). It is also note worthy to say that almost all of these animals we also saw baby versions of, it is apparently a great time for baby animals in the national parks! All were very cute!




The leopard sighting was probably the best part of the 2 days in the Serengeti. We watched him for over 2 hours! This might sound boring but he was constantly on the move and had attracted almost EVER tour jeep in the park! Our driver was great at anticipating his moves and almost always placed us directly in his path. At one point we could have honestly reached down and touched him! I have pictures! Oh and another slight aside, our drivers favorite phrase "Taking more pictures, Taking more pictures" He would say this when really lucky things happened and we would end up with rarely seen animals extremely close to the vehicle. This happened a lot on the trip!!!!


On Saturday afternoon we left Serengeti and headed to Ngorongoro crater. We camped at the edge of the crater over looking the animals and wildlife below. That night was the most "interesting" as it is common to have wild pigs, water buffalo and elephants at the camp during the night. Lucky us we had all 3! It started with pigs smelling the tents. We had been given a very serious warning about keeping food in the tent at this particular campsite due to these pigs! So you better believe we made sure there was nothing edible in the tent. But it was the water buffalo that kept us awake! They came right up to the tents and would rip the grass out of the ground with such noise! It was incredible. They also would walk right up to the tent screen take a deep breath in then blow it out with great force! I was still awake reviewing pictures when they arrived so falling asleep was not easy. Then once I had fallen asleep about 1.5 hours later Cassie woke me up telling me there were buffalo outside the tent. I assured her that I knew that and I helped calm her fears, as I had done for myself several hours prior.


We woke at 5:30 the next morning to have tea and leave for the crater so we could see the sunrise! In the crater we finished our last animal of the big five by having 4 different black rhino spottings. This is a very high number of spottings as there are estimated to be only 20-25 rhinos living there. We also added hyenas, a cheetah, a serval cat (which we were told is very rare to see at all) and flamingos to our already growing list of animals! It is interesting to point out that the only animals that are not in the crater but are in the Serengeti are giraffes and impalas because they can not make the trip over the steep terrain, it is also rare to see female elephants inside the crater.




We left the crater and headed home, but stopped on the way at the "snake park" of Arusha. It has snakes, crocodiles, tortoises, and some birds. The enclosures for the animals were more interesting to me than the animals themselves. I took more pictures of how unsafe the enclosures were than of the animals I think! They had added some safety features, but obviously as an after thought, likely due to problems they had had! Also included in the price of admission was a Maasai cultural museum tour. This was very interesting to hear what they taught the tourist about themselves yet what I have learned about them at the hospital was very different in some cases!

And to end, today I went back to the hospital to begin my surgical rotation. We had no surgeries so I went on grand rounds and learned about every patient who is there. Yes, one doctor rounds and writes orders on the entire hospital (except he is not responsible for Labor and Delivery)That was about 50-60 patients. So it took most of the day. Tomorrow is general surgery day, so hopefully I will get to see some interesting things.

I hope to add some pictures soon, but it might be awhile before I get back to the coordinator's house to be able to do that.

Until next time...