Hello again, and sorry again for the delay. The guy in the records room -- "Eddie," allegedly -- didn't pay the bill for the dial-up, so we were sadly Internet-less. It was actually kind of nice, in retrospect, because we were forced to be a lot more disconnected with the world we know.
I've noticed myself saying things like that a lot lately. For example, yesterday, I was explaining different cardiac conditions to some new medical staff. One was "disrhythmia," and so I said that it would be treated by the insertion of a pacemaker. Their reaction: "what?" They almost never do surgery. So I launched into one of my most common sentences; "In America..."
Speaking of surgery, we watched 4 surgeries on Saturday. Actually, I watched three, and then I scrubbed in and HELPED. I didn't cut the guy open, but I did hold it open while the surgeon poked around inside. But I'm not telling that story yet.
I mentioned in my last post that I was going to Bakau (which I misspelled miserably), and we did. It was FANTASTIC. First we went to Janbanjelly, the village that my group leader, Alison, stayed in when she came to the The Gambia in 2007 with Crossroads to build a library. They had arranged a grand festival to commemorate the birth of the Prophet Mohammed, for which they arranged for a great marabout (kind of a spiritual healer) to come to the town. Everyone was decked out in their fanciest, most colorful finery, crowding around the compound where the marabout was sitting.
Only the girls went to Janbanjelly; the guys had stayed behind to be in surgery and to meet back up with us in Bakau. As a result, our group was whisked off to the rest of the women, who were cooking in the back. A little lost, we were immediately handed something to do: peeling a basket of onions. When I say a basket of onions, don't think it was a little basket the size of a basketball. Oh no. It was a giant basket, maybe two and a half feet across, and at least six onions deep. The really strong purple ones. And we peeled them with our fingernails. Once we finished -- and the little girls we recruited to help us do it were way better at it -- we were each given a blossom of garlic (you know, all the cloves together) and were instructed to peel all the cloves out. With our fingernails. Do you have any idea how difficult it is to get all the little white peel bits off of a clove of garlic with only pathetic stubbly fingernails that already have onion jammed under them? Really hard. We smelled AWFUL.
But, stench included, we were taken to see the marabout. We went right past the throngs of jealous (who were writhing with jealousy), through what was obviously the nicest compound in the village, and into the back courtyard, where the marabout was seated in fine, sky-blue robes next to the head religious figure of the village, dressed in the beautiful forest green of Islam. Around them were four boys fanning the great marabout, and over him stood a member of the Gambian Military Police, whose companions were guarding the entry and exit. We kneeled on the prayer mat, and the marabout prayed for us. He asked us for what we wanted -- we all said "success in our endeavours here" and "that our work here will not be in vain" and stuff like that -- and he said another prayer and then announced that it would come true. Some enterprising mother had managed to slip her baby boy in there (aged maybe 6 months) and he stared around looking like young kids do, clearly astonished at the fact he was in this incredible arrangement of toubabs and great religious figures. It was odd enough, but with the little kid, the experience was surreal.
We spent the night in Bakau, and, as a result of some hotel confusion and a lucky encounter between Tammy, Ling Ling, and an American woman who owns a club, we moved into a REALLY nice hotel. The Sae View Garden Hotel in Senegambia, next to DreamPark (a run-down and somewhat creepy amusement park that looks like bad horror movies would be shot there at night -- you know the ones I'm talking about, with machines that run themselves and scary clowns) has a full restaurant, a bar overlooking their POOL, TV, HOT WATER,FLUSHING TOILETS, and rooms that usually run about 2000D/night (~$80) However, we were there for 600D/night/room, and with 2 people/room, I only paid $12. In fact, I didn't even pay it, because it came out of group money. AWESOME. Getting into that pool was the best thing ever. It was the feeling of killing all the germs that you know have been crawling all over you for days. And then I took a shower under hot water... with water pressure.
The beach in that area is kind of sketchy, but we did go to the strip of restaurants, and ate pizza. I also found a little street stand that sold pineapple smoothies. By American standards, they were pretty crappy, but by Gambian standards... look! ICE! IN A CUP!. We went to the craft market, too, and I got some things. I exchanged travellers checks, which was nice, because I finally had money. We went to Kairaba, which is a GROCERY STORE. This was all so amazing that I think that when I get back home, and then to Houston, my brain might explode. Ice in a fridge? Toilets everywhere that all can handle toilet paper and flush and don't smell? COFFEE? Yeah, culture shock on the way back is going to be ridiculous.
The next week, I was in the outpatient department (OPD), which was great. This wasn't the case because of the patients we saw, which were, in fact, often cool. It was because of the doctors who work there.
In outpatient, everything is happening at once. At around 9:30, when the doctors get in, things start happening. Picture a room, maybe 10x12 (this is generous for the bigger room). Put in a filing cabinet, a standing movable curtain, two tall cabinets, and an examination bed at the side. Put an average computer desk in the middle, and cover it (bizarrely) in fabric with a large pattern of howling timber wolves (for real. it's great). In the middle of the long side, put me, opposite two doctors. On the short sides, put a patient, and behind the patient, standing, whoever they came with. Leaning over my shoulders, put two Gambian medical students or nurses, who are acting as translators. Now have everyone except me start talking. If you're feeling cruel -- or if it's before 10AM, when the power comes on -- turn off the fan.
In comes the parade of patient, following the doctor's call of "Duena!" Next! Conjunctivitis. Endless high blood pressure patients. Diabetes. One suspected meningitis (negative). One schizophrenic 16-yr-old girl. Boils. Scabies. Skin rashes. Skull fracture. A previous week, a broken femur. Horrible burns. Asthma. Pneumonia. Kidney failure with severe edema. Heart failure. All of it (except those maternity-bound and those with rotting teeth or obvious cataracts) come into one of the two small outpatient rooms, and into the hands of the Cuban Doctors.
The Cuban Doctors are two men and four women on a two-year volunteer program from -- you guessed it -- Cuba. Their leader is Dr. Willy (Wilfredo, but the Gambians can't say that), exactly the kind of person The Gambia needs. Long story short, he is heartbroken by the people he sees and who he is often unable to help, but he loves to work here, and still shows a great deal of compassion for all the patients. side note: he has the ugliest haircut I have ever seen in my entire life. No joke. I'll briefly describe it: imagine a receding hairline. You know how it carves out two lines, which are occasionally (and disastrously) attempted to be covered by a comb over? Follow those lines to abut two inches before where a bald spot would start. Now make a square: forehead, two lines, and then boundary before the bald spot. Cut all the hair in that area to about half an inch long. Let all the other hair grow to about three inches long, and let it wave down behind the ears and down the neck (trim it a little shorter over the neck). That's the mental reconstruction of the the modern art masterpiece that is Dr. Willy's bizarre hairstyle.
I'm especially glad Dr. Willy is here because Matt and I had a particularly hard time with one of the patients. One year old, and coming to SJGH right when the tide of patients was going out, she had fallen into the fire where her mother was cooking. About 25% of her body was covered in horrible peeling burns, massive blisters that peeled away in giant curls of charred blackness and revealing pinkness the color of a flushed Caucasian underneath. She was crying continuously, and in the way that means real pain -- not bawling, and not crying because she wanted something, but the unending crying of a little kid in a lot of pain who can't even verbalize it, but nothing you can do can fix it.
She was immediately whisked to the back of OPD, and treated by Hassan, the RN in charge of the unit (I'll probably talk about Hassan again -- he's another one of my favorite people here). She was rubbed with a yellow solution -- iodine for antiseptic -- and then a mysterious cream -- silver sulfanimide. You know when America used silver sulfanamide as an antibiotic? 1930.
Matt and I watched for a little while, and then talked to Dr. Willy. He sees these patients, he says, all the time. And it's horrible. With so many kids, running around while the mothers cook on open fires, it's bound to happen. So what to the doctors do? They want to treat with cyclosporin, but all they have is silver sulfanamide. They want to give a DV5 IV, but all they have is normal saline and some dextrose, neither of which provide potassium. They want to give the child morphine, but instead, they give out what every patient gets, Paracetamol (PCM), more commonly known in the US as acetaminophen. Tylenol.
It's more than enough to harden the hearts of the foreign visitors here. You can see it in the eyes and hear it in the voices of a couple of the Cuban Doctors. But not Dr. Willy, and not really Eliana, and not as much Mayena.
And it convinced me -- I do not want to be a doctor. I don't. I didn't really, before -- I considered it, but I never really wanted to. And now I know I don't want to.
Another thing that sucked about last week was that we were all sick. Me especially: I probably had at least three infections. Four of us (inclusive) vomited spectacularly over the veranda (which is interesting because there's a long delay between throwing up and hearing it hit the ground; sorry to be disgusting, but it's true). Matt was horribly sick, and finally managed to keep down a Cipro and about two inches of bread after a day and a half. I had some mysterious and disgusting bacterial(?) infection on my lips. You know the boundary on the inside of your lips where the skin you see on the outside meets the mucosal membrane that covers the inside of your mouth? For me, that boundary was entirely covered in white oral ulcers. Imagine for me, please, the difficulty you would have eating something if all that is served comes on crusty bread and if you touch the bread with your lips, they bleed. Yeah, it was unpleasant.
Also, someone came into our rooms and stole all of our (Molly, LingLing, Tammy and I) dalasi. Remember how I just said I was able to exchange my travellers checks for the first time, and finally had money, seeing as I exchanged as much as I could because I didn't know what my next chance would be? I lost all my extra American cash, too, and even the clean bills I had saved in a little pocket of my wallet as keepsakes. I had divided it all into four separate stashes, too. One -- of 600D -- was untouched. the rest were gone. In total, I lost about $150 USD. Molly lost all her American cash, too, so she lost more. All told, we are missing about $500USD of cash. Nothing else, though -- it was the epitome of petty crime, and really just served to make us really untrustworthy and rather depresssed.
But I'm getting better. I found my knifeand flash drives, which I thought had vanished with the cash. I showed the Cuban Doctors and they diagnosed it in about two seconds -- of course, I can't read their handwriting, so I'm trying to find it online -- and they wrote my a script for some antibiotic. I only have one blister on my lip now, and the ones all over my soft palate (they moved) are going away. (Still gross, right? Sorry). And on Saturday, I went to surgery. I told you I would get to this point, and it only took me 58 minutes of typing.
Alison and Tammy went back to Serakunda with our passports to get them re-stamped (stamps are only good for 30 days), but the rest of us met Dr. Jones, a highly respected surgeon from Banjul. And I say it right here and now: Dr. Jones is an incredible person. Born in Freetown, Sierra Leone, he is fluent in English, French, and Japanese in addition to his local language. He trained originally in Britain for general and then orthopedic surgery, then came back to Sierra Leone and was the only resident in the major hospital, serving four surgeons at once. He was immediately promoted after residency to head the surgical ward of the largest hospital in Sierra Leone, in which he was personally responsible -- by himself -- for 125 beds. He later travelled around, working at other hospitals in West Africa, before he applied for -- and won -- a fellowship to learn the burgeoning field of Neurosurgery. In Tokyo. For which he had to learn Japanese, and he was there for a year. One of the most respected people in the whole of West Africa, Dr. Jones currently works in Banjul, and travels to other regional hospitals to perform surgeries where needed. At 68 years old, he celebrated his 48th wedding anniversary last week.
And not only did he let us watch surgery -- all 7 (Ling Ling was too sick to come) watch at once, he let us scrub in and ASSIST. CUTTING PEOPLE OPEN. I didn't cut anyone open, as I said, but I did get to touch someone's femoral artery.
The first surgery was disappointingly boring. A 10-month old baby girl had a prolapsed rectum -- imagine pooping so hard that part of your rectum comes out, like those toys that have jelly inside an elongated donut-shaped bag of plastic that squirt out of your hands. (If you're my brother, it squirts out of your hands and bursts on the wall of the living room, staining it blue and glittery. Remember doing that, Mitch? You were grounded). We thought the surgeon was going to resection the colon -- chop a section out -- but he just inserted a ring of nylon that followed the sphincter muscle. Hopefully, that will make the anus small enough that the rectum can't come out any more, and will reattach to the mesentary in the next 6 months before the stitch is removed.
Also, I forgot to mention: these patients are under local anaesthetic only. Lidocaine, like the dental surgery. Which becomes an issue when I talk about surgery patient #4.
The next two patients were hernia patients, which is by far the most common surgery in West Africa. It's a tear in the faschia, so, for example, when the patient coughs, the membrane underneath (which has been stretched by wear) inflates like a balloon. It would actually be really cool -- a fun party trick -- if it didn't hurt. The solution is to cut into the body, through the faschia, and find the membrane. Cut open the excess (it looks like a bag), suture the excess away. Then close it back up.
I assisted on the second patient, a man with an indirect femoral hernia. I got the good spot to stand in -- I could look into it the cut really easily. I got to poke and prod, and held back the skin when he sutured the cut back closed -- and then I cut the suture to finish.
It was the fourth surgery, though, that was really cool -- a hydrocoel of the scrotum. This is not particularly interesting in and of itself -- it's a localized fluid buildup caused when the lymphatic system doesn't remove liquid from an area. What you do is cut into the area, drain the excess fluid, turn the tube (which has expanded, balloon-wise) inside-out (so fluid contacts a new cellular surface, which will; absorb it), and close it back up. This guy had a good amount of excess fluid -- it was larger than a grapefruit.
Matt and John scrubbed in, local aneasthetic -- that's right, just local, not general -- was applied, and Dr. Jones made a neat, 2-inch lateral incision. he reached his fingers in a pulled the faschia apart. Underneath was the hydrocoel -- dark purple under a cloudy white membrane. Dr. Jones explained how they were treated, and then offered to pull it completely out of the incision, so we could see the entire coel, and started pulling, Matt leaned forward to help hold the forceps, and the hydrocoel burst. All over Matt.
Clearish, yellowish liquid, thin like water and odorless, splashed about eight inches into the air and at least two feet sideways, soaking Matt's scrubs from about his collarbone to his knees. It was disgusting.
It was also hilarious. Even for Matt.
The matching hydrocoel on the other side was reduced by suction without removing it from the incision, unfortunately, because it would've been awesome to get John, too. The surgeon also apologized -- and grinned -- because he didn't burst it on purpose. He says.
I really didn't do this story justice at all, and I promise to tell it better in person. Right now, though, I'm really tired and the crazy raging thunderstorm subsided, so I'm going to bed.
Next post: the Medical Ward. Preview: say hello to reconstituted penicillin!
PS Elizabeth: 3 hrs and 1o minutes til HP6. I'll see it with you on August 10th!
