Picture Overview of My Week

Warning, last picture is graphic (not for the weak of stomach)! (+ some normal pictures)

I made some friends with the nurses and they taught me how to make fried plantains and onion/fish/maggi sauce.  Mmmmm salt... Apparently I was a weak pounder.  Weak!  

I also semi-adopted a kitten at their place.  It's sooooo cute lying on my lap and just hiding its head! :D

Kid had a pretty bad looking rash, not sure what it is.  Probably Staph?

Very strange ultrasound of a lady who thought she was 8 mo pregnant, but turns out size only fits 16wks.  Very strange b/c on ultrasound, we couldn't see any fetal parts or bones.  And then when we did the pregnancy test, it was positive!  Also didn't look like "snowy storm" in a molar pregnancy.  So right now, we pretty much have no idea what it is.

There's this guy who came in with distended stomach.  Turns out the whole distension is his liver!  The thing that's sticking out all the way below his umbilical cord...  So sad that we probably can't do much for him. :(

The other day, I saw a patient get their dehiscence explored and sewn together WITHOUT anesthesia.  Without ANY anesthesia.  It was the most painful thing to watch.  And all the while, all she did was make some barely audible squeals and prayers.  The most excrutiating part was probably watching them tighten the sutures so that the two edges of skin would come together.  It was NOT pleasant.  

Crazy/Hectic Day...#2

Well, being in the clinic where I see outpatients is not so bad.  I think the scary ones are the ones that need to be admitted right away, like the patient that died.  Another patient came in today and died shortly after.  I was the first one there, and I called the Dr. to come, but I think it must have taken him at least 30 minutes to come (maybe it was only 5 but felt like 30 because i was the only one there at first, well..with a bunch of nurses).  The guy came in and had no detectable blood pressure and not palpable pulses in his extremities.  He also had some bloody saliva coming out of his mouth, which I think was because he was biting his tongue.  Anyhow, there were so many things I wanted to do but weren't available.  I wanted 2 large bore IV's running, at least 16 gauge, but they only had 18 gauge ones in the hand. I wanted him on oxygen, but there's no O2 tank.  When I got the bag mask, there was a leak from somewhere, so it didn't do anything, and when I found the seal and haphazardly used a glove to seal it up, the bottom turned out to be not-inflatable, so it was impossible to get a good seal, which essentially made it useless.  Considering he had almost no blood pressure and heart beat was extremely faint, I started calling for epinephrine or norepi or hydrocortisone, and the pharmacist said there's none.  What the heck?!! No epinephrine?! How can you not have epinephrine?! Then after another 5 minutes, he finally asks if I'm talking about adrenaline, and I'm staring at him saying, "yes, yes, yes!!"  I didn't remember the dose, was flipping through my book trying to find it, and finally I find something, but later on I realized I think I gave doubled what I was supposed to.  Later, when the second dose was given, the nurse gave it IV, yikes....but not that much happened.  By this time, I had called the expat Dr. that just left, and she said it was probably expired.  At least I could hear and feel his heart beat now.  

Finally found out there were oxygen machines available, and they brought the machine, but it turns out the family had to buy petrol, which took FOREVER.  I had wanted to get a glucose level, but the Dr. had it with him, and when he came, he didn't have his glucometer on him.  When we finally got his level, it only said, "low."  By that time, the Dr. took over, gave him a bolus of glucose and lowered his fluids to prevent fluid overload.  By the time the petrol for the oxygen machine came (it was only a blow-by mask), the patient had already started gasping, and I couldn't heart his heart beating anymore.  The Dr. started CPR, but I don't think it was any use because he was only using his hands (not his shoulders), and the bed itself was springy.  So we took the man down to the ground, and I continued his CPR.  Honestly, by this time, I knew this guy had no chance, but we just continued.  We got the oxygen machine on, but by then, it was too late.  100% oxygen sitting there right next to nose was useless if he wasn't breathing at all!  He got a shot of atropine, and nothing happened.  And that was it.  His brother, who brought him in was so stoic, you wouldn't have thought his oldest brother just passed away. Meanwhile, the women started wailing.  They did his "last service" where they stuff all his orifices with cotton, wrap him up in a lapa, and carried him off.

Immediately afterwards, all I could think about was how I was stupid and probably exposed myself to some terrible disease because I did CPR with a gauze.  I had asked the Dr. for his mask, but he gave me gauze instead.  I should've just used my TB mask instead of that stupid gauze...or not do the breath part since CPR in Segbwema probably has a success rate of 1%.  The Dr. reassured me the patient probably wasn't infectious, but still, I'm afraid I caught something bad.  Biggest fear is TB or some crazy meningitis bug.  Ugh, I hope I didn't learn my lesson too late.  Pray, pray, pray!!!  Okay, biggest thing is to keep myself safe from now on!  Maybe I was being selfish, or maybe I've become hardened already...after less than a week?  I really wanted to intubate him.  Ugh...there is little of anything!!!

On Relationships

One nursing student asked me if I'm married, and I told her and her friends to guess.  So two guessed that I have a fiance, one guessed I have one boyfriend, and another guessed that I have three boyfriends. HAHAHA!

The marriage culture here is soooooo....different.  I was so surprised about this one girl who's a nursing student here.  She said her husband, a Muslim, is in another city. I asked if he has other wives, she says not yet (She's a Christian), but that he has other girlfriends to satisfy his nature.  When I asked how she feels about them, she says, she doesn't mind...she just asks him to have protection with the other women so he won't bring home STD's. And this is a man she has had FOUR kids with...and hopes to have 4 more.  

Then another girl asked if there were more women then men in the United States.  Haha...I thought the question was so random.  But then she said in Sierra Leone, that's the case because of the war.  

Fat

When I stayed in Freetown for a few days, I had met up with the old PPB factory workers with whom I worked with in the past, It was so nice to see Ali, Marian, and Alimamy.  Ali was just the same, yelling, "Yi Wang!" every time he sees me, and of course, I return with the customary, "Ali Banks!"  When I met up with Marian, the first thing she said was, "You got fatter!"  I was pretty shocked, and kind of appalled by her rudeness, and to tell the truth, I didn't think I was fatter than she was!  But then it turned out that's a compliment.  Haha.  And so here in Segbwema, when they heard I just wanted some fruits and veggies for dinner, they were surprised, and kept on insisting on making me fat by the time I go home.  Oh boy!

Crazy, Hectic Day in Segbwema

Omg! Crazy day today.  I was left here by myself! Myself! My 3rd day?!  The only doctor there decided to drive to Kenema - a place 45 min away.  OMG...ahhhh!  Patient with malaria, diabetes, and possibly typhoid all of a sudden crashed and had altered mental status!  With distended belly... surgical? Not surgical? Perforated? Does he need surgery?  I don't know!  What to do?!  Ah!  Vitals - ok...got vitals. And then called the doctor, said to put in NG (nasogastric) tube...but what?!  Can't find NG tube! No NG tube! Then they found it..ok. And he's diabetic, so we wanted to check blood sugar, but guess what?...the doctor took the glucometers with him when he left!  Ugh....so not helpful.  So I was frantically trying to call the doctor and tell him to come back.  Didn't help his strong accent prevented me from understanding him.  I had the pharmacist come to help out - apparently he does everything when the doctor's gone.  But still...wasn't that helpful.  There's essentially nothing in the pharmacy.  I called the American doctor that left today, but it did not help that her phone RAN OUT OF BATTERY!  But thankfully, the patient came around, and became coherent.  I think he may have had an episode of diabetic ketoacidosis.  Ugh. What a day.

And then I also found that last night the kid who was febrile and had trouble breathing had passed away :'(  So sad!

And in the meantime, I'm also trying to see patients at the clinic. I think there weren't many patients at the clinic.  I had send a patient to get some labs, and I totally forgot about her. Oops. I guess she'll come back tomorrow.  

Oh no, and then I found out a patient died.  This was a guy I had seen in the morning, and the doctor didn't see him because he was on his way to Kenema... I think I might have contributed to his death.  :(  If I had the doctor see him earlier, maybe he would've gotten certain labs back earlier, and then maybe he would've survived.  I don't know.  It was so sad to see his family wailing outside.  His sister was literally rolling on the floor and flailing her arms, and crying, "It is finished!  My only brother is gone!"  It's so sad, he had just finished university and was going to be a teacher.  Apparently he passed away while the doctor was examining him later in the afternoon.  Ah....so sad.  And I really don't know why the doctor left me all by myself (with the nurses, pharmacist, and surgery tech...but still). 

First Day at Nixon Hospital Part 2

Ah! I should always remember that nothing is as planned in Sierra Leone!

For one thing, initially they had said we were going to surgery, but of course, they ran out of suture and there was no more petrol for autoclaving the equipment.  So it was a day of rounding the inpatient patients and clinic.  

Immediately, it was clear that the problems were different from the U.S.  The first lady came in with continued discharge.  We felt her abdomen, and there was a huge mass in her lower abdomen as well as smaller masses elsewhere.  She had actually presented 4 months ago with a mass in her cervix with discharge and told to go to Freetown where there are pathologists to analyze her tissue, but she never went.  So today all we could do was send her to Kenema - a larger city 30 min by car - to do an ultrasound.  When the doctor told her everything, she was sitting there with tears streaming down her eyes.  

Meanwhile, we also had a kid present with possibly scabies all over her body, a nurse with tinea corporis on her inner thigh, and another child with possible pneumonia.  There were also the typical diabetes and chronic hypertension patients.

There was also another man who came in for TB follow-up who still tested positive for TB after 1 months of treatment.  I was kicking myself for not having my TB mask today, but the doctor didn't seem to be too concerned.  Hm...

There was bound to be someone with parasites, and sure enough, there was a man who's stool had S. Mansoni ova in it. It was the first time I've actually seen the egg under the microscope.  It's so gross...and now it makes me afraid to take baths.  

The first thing I saw when I entered the lab was a young man cranking something, which to my amazement, turned out to be a centrifuge.  I had never seen a hand-cranked one before!  I was also amazed to see them do the Wiedel (sp?) test for typhoid fever on a broken piece of tile.

The inpatient wards were pretty standard, nothing too shocking.  But maybe that's just because I only understood half of what they were saying.  I will definitely need an interpreter.  

I also discussed business this morning.  I arranged to have dinner every day for Le 20,000, or $5.  I think it may be considered a lot, but I don't really know.  Ah well, I'll be tired and not want to make food for myself.  I also don't really have a way to make food myself since I don't have a stove.  Although there's the option of borrowing someone's stove and buying some charcoal.  I may try that on the weekends...we'll see how adventurous I become.  

Ah!!! Scary noises = scary bugs...time to sleep!

Arriving at Nixon Hospital, Segbwema

Alright!  After a 5 hr drive, we finally arrived at Nixon Hospital, Swebgwema, where I'll be working for the next 3 months.  I wasn't really sure what to expect, given the only information I could find about the hospital was this tiny blurb on the Methodist Church website, and this really old youtube video from around 2005 of this dilapidated building.  Fortunately, when I arrived, there were several new buildings.

My place for the next 3 months! - on the bottom floor.

The faucets and flusher are just for show.  Got to conserve the bucket water during dry season!

The rain water cachement "well" where I'll be getting my water

First they showed me where I was living, and it was huge!  My bedroom here is bigger than my bedroom at home!  Of course, pretty empty.  The bathroom had a toilet, bathtub, and sink - with the faucet and toilet flusher all for show because there's no running water - just a bucket!  I suppose each day I or someone will help me get water from the well outside.  Unfortunately, I made the mistake of washing my hand towel in the water...so now all I have left for the rest of the day is soapy water.  Sighs. I'll be smarter next time.

Cassava, beans, chicken, and fish for my first meal at Nixon Hospital

Alright...time to get ready for checking out the surgery suite!

Lunsar

What a treat to revisit Lunsar!  I had traveled to Lunsar during my first trip to Sierra Leone in 2009, so what a pleasant surprise to learn that PPB was going to some sites there for a new research project.  Of course I tagged along for the ride.  I only had 15 min, so I decided to revisit our extremely pleasant hosts who were these Sisters at a Convent at St. Peter's Church.  It was so nice to see Sister Bernadette and Sister Eliza who were there when we stayed there 4 years ago.  Sister Bernadette was this cute little Japanese woman who has the sweetest demeanor and Sister Eliza was a tough cookie but also super hospitable.  Unfortunately Sister Bernadette no longer remembered me, but Sister Eliza actually remembered the D-Lab group from MIT!  It's amazing that Sister Bernadette had been in Lunsar for 25 years!  She said she had to go back during the Civil War and for an illness, but she is no longer used to Japan and missed the people in SL.  It's no wonder - people here are so friendly and loving.

During our trip up to Lunsar, I also got to hear the story of a fellow PPB worker, SC. SC initially started in Mali to build a new factory, but right before a new mixer was going to arrive, the country had a coup.  I've been so behind in current news, so she had to update me on what happened in Mali.  Here's a summary:

Mali has been a democratic country for 20 some years with two major groups of people: the dark skinned francophones and the lighter-skinned English-speaking Tureg (sp?).  There were also small pockets of terrorists and Islamic extremists, but none that enforced their laws and traditions.  The Tureg had always felt like they were a separate people, and had been trying to obtain independence.  Recently they had obtained armory from Columbus and tried to obtain independence.  The Mali military were unprepared, and unrest developed. The current president's 2 terms were up and the election for a new president was in a month, but a low ranking (and no foresight) military official was dissatisfied with the way the government was handling the Tureg situation and, thus, initiated the coup.  The president was forced out of office (even though he only had 1 month left) and during the power vacuum, terrorists of various sectors including a branch of Al Qada took over 2/3 of the country.  The Tureg initially allied with the terrorist extremists, but due to differing views, they were kicked out of the alliance with nothing - no independence and their land taken over by terrorists. Fortunately SC and her husband were out of the country when the coup happened, but unfortunately, that meant any hope for a new PPB factory and feeding malnourished children in the country with the lowest child mortality (other than Somalie) was destroyed.   

Plane trip to Sierra Leone

Hit me next time I try to go snowboarding the day before a long trip because during my 29hr trip my whole body was sore, especially my right glut.  Obviously I don't work out enough.  

I ALWAYS, ALWAYS get swindled at the airport. The porters always try to "help" people move stuff then demand a tip even though I find them unnecessary. Though I think to myself, "don't let them take your stuff!!!" someone still ends up taking my stuff.  I even got a cart this time to avoid them, but a guy came up and started rolling it to the ferry counter.  Even though he only moved my stuff 100ft, I still felt bad and gave him a tip.  At the other side of the ferry, a guy kept on insisting it was too heavy for me, but I was tired of giving tip and I kept on saying,"no, i'm strong!!" so I grabbed my luggage out of their hand and they saw me rolling away with 4 bags. Booyah!

Yesterday, a black man started saying Chinese to me!  Chinese!  How crazy is that??  Apparently he had done his PhD in China and lived there for 3 years.  It was pretty epic, and he had great pronunciation  Actually, last time I was in SL, I put my Chinese skills to use when talking business with the Sugar Company in the country, which happened to be run by Chinese people.  China is taking over.   

Quotables from Ob/Gyn, Renal (med school)

No matter how intense Ob/Gyn is, it never fails to produce amusing/disturbing stories:

• "This baby is coming out the front door, not the roof!" - Nurse talking about the mode of delivery being vaginal
• A lady got a hysterectomy: "The doctor took out the baby carriage and left in the play pen."
• After hearing about residents complain about how big their babies are and how they aren't looking forward to delivery:
• Friend: "How does that make you feel about giving birth?"
• Me: "Epidural."
• Pregnant woman who's on parole, methadone, and a side of heroin ran away from the labor and delivery unit - literally ran away, as the police trailed behind.
• Resident: "She can't be that difficult to catch, right?  How many 34 week pregnant women are running away in wet pants because she peed herself while vomiting?"
• Foreign objects found in urogyn:
• There was a string-like object on bladder scope that looked like a hanging light switch.  It turned out to be a baby garter snake!  Apparently the guy had been playing with it at his "opening", and lost hold of it. (Cringe, cringe, cringe!)
• Woman found with kidney stones in her bladder, but they had a hard time breaking the stone apart to help it pass.  Turns out she had a mental disease and had been at the beach sticking stones up her urethra.  
• Resident: "I love my husband for doing ENT, but I would just love him more if he did plastics."
• Women came in 8 mo pregnant...and just found out a week ago because she was on contraceptive pills.

Renal Quotables:

• Dialysis:
• Patient: "I'm ready!"
• Dr: "What are you ready for?"
• Patient: "For dialysis!"
• Dr: "Uh...you are on dialysis already"
• Patient: "I am?"
• Dr: "Yeah..."
• (Sighs...that's what end stage renal disease will do to ya)
• Elevator Doors:
• "Each kind of doctor uses the body part they don't use to block doors: Internal medicine docs use their hands, surgeons use their feet, and orthopods use their heads" (from a Surgeon)
•