Diagnosis Wenckebach

After learning about some heart conditions in Cardiology yesterday, this is what go passed around my class:
Diagnosis Wenckebach
"Hilarious and Educational!"
For my non-med school friends, it's a problem with the electrical conduction of the heart.  It's a second degree AV block - block between atria and ventricles.

List of Interesting Articles/Sites from Friends

• 12.08.19 The voice that comes out of this guy is incredible: cover of Sexy and I Know It (MNZ)
• I like: http://i.imgur.com/NXcvK.jpg (thanks kp!)
• 
• 11.03.13 This clearly shows the destructive nature of the earthquake/tsunamic in Japan: Before and After. (LW)
• 11.03.11 UP! in real life.  :D (MNZ)
• 11.02.16 Cool Illusion on a Building: http://bbs.wenxuecity.com/joke/381687.html (Dad)
• 11.01.24 OMG! I love this lady gaga parody!!!  BUT, before you watch the parody, you need to watch the original lady gaga video. warning - it is....strange, to say the least.
  hahahaha! i love the outfits, the old chinese researchers dancing, and the chinese characters on the tube!
• 11.01.24 Average Asian Aging Process (AS) - so true!
• 11.01.08 Baby animals are so cute! :D Baby Monkey Riding on a Pig  (AL) and Nom Nom Nom (JS)
• 10.12.10 Interesting Sleeping Patterns - Need to sleep less?
• 10.12.07 Cool nerdy talent: PVC Instrument (JW)
• 10.12.05 SNOWTORO! (MNZ)
• 10.12.03 A Father Who Creatively Captures His Kids (KP)
• 10.12.02 Cute video about a boy who has a "condition": Michael Donovan: A True Story (LD)
• 10.11.29 Yay!  Watched Harry Potter 7!  It was a lot of fun, though the ending was very disappointing - darn - they should've just made an uber long one.  Anyhow, this literal trailer is hilarious: Literal Harry Potter and the Deathly Hallows Trailer Parody (KL)
• 10.11.29 Dear First Lady Michele: students write to the first lady.  So cute!  Here's an example, "I think that you should shut down cigarette and liquor companies and try to keep drugs off the streets. Robots may be able to help you." 9 & 10 yr olds (MNZ)
• 10.11.21 Funky Hand Dance - We No Speak Americano (MNZ)
• 10.10.24 How To Be Alone - pretty funny and interesting video/poem (LD)
• 10.10.14 Physician Revives a Dying Art: The Physical (KP)
• 10.10.10 Questionaire shows that most religious people are less informed about religion than atheists (MNZ)
• 10.10.05 Hahaha!  This is so hilarious! PHD version of Most Beautiful Girl in the Room from Flight of the Conchords. (HZ).
• 10.09.30 Never married young adults now surpass married.  It has a quote form a pastor at my church that says 1/3 of people who went to premarital counseling at my church are already living together.  Would've thought church-goers were different...
• Afghan girls dressed up as boys because boys are valued more and have more freedom. (MNZ)
• A hunter _(fill in blank)____ a bear  Such a clever idea!!!  So funny!  When you get sick of adding things...try these words: tickle, eat, hug, soccer, dance, erase, study, watch, drink, dream, hunt, meet, chicken, feeds, sings, call, make, picks, high fives, takes a picture of, fishes with, plays with, and -oh dear - win...ya, wasted a lot of time here... (SD)
• Today we just went over some hyperkalemia question, and a classmate sent out this article about hyperkalemia (high potassium).  After I read it, I exclaimed to my roommate, "Oh my gosh!!  I understand this article!"  And my roommate replied, "So nerdy..." (JP)

Reminder When Things Don't Go as Planned

It's not " 'For I know the plans YOU have for you,' declares the Lord." Instead: " 'For I know the plans I have for you,' declares the Lord. Plans to prosper you and not to harm you; plans to give you hope and a future."


Thanks KP!

Perspective Pictures and Cute Video of Old Couple

Here's a cute video of an old New York couple (Annie and Danny) that I saw on Cup of Jo blog:
http://vimeo.com/12562270
It's talks about their 27 years of love and ends with Danny's terminal cancer.

Here are some really cool Forced Perspective Photos!  (Thanks LW!)

Branchial Cysts and First 2nd yr exam

Ah! Just got done with first exam of 2nd year...and here's something I should be studying instead of blogging about...branchial cysts!  Can you believe people come into the office and say it's been in the family for a long time? That their father, grandfather, or uncle had it?...

Branchial Arch Cyst*

Luckily it's just an embryonic malformation and there's really nothing wrong with it except it looks strange.  It can be easily resected surgically!

Look how translucent it is and how cleanly it comes out!*

*Really wanted to site the pics, but can't remember where they came from

"Fainting" Goats! So funny!

Hahaha! These goats are ridiculous (yes, part of med school experience - YouTube).  
"Very important disease that plagues goats.  It's called myotonia congenita and targets the Cl channels causing sudden paralysis." -MNZ
So funny :D
"Fainting" Goats

Plumpy Nut - Patent or No Patent?

This article makes me so angry at those American companies who don't know anything about Plumpy Nut!!! - which was the therapeutic food for malnutrition produced by the organization I worked for this summer (Project Peanut Butter, run by Dr. Manary): http://www.nytimes.com/2010/09/05/magazine/05Plumpy-t.html?_r=3&pagewanted=1&hp It gives a pretty good background about it.

Child being fed Plumpy Nut in Sierra Leone

It talks about Nutriset, the company that has a patent on Plumpy Nut.  In order to make Plumpy Nut, other charity organizations have to first get a license from them.  There was mention that it was unethical because Nutriset was essentially "starving children" by preventing some large corporations from making their own Plumpy Nut and donating it.  Initially, I held the same point of view, but after working for PPB, I think differently.  There were some points that the article failed to mention:

• Some of the companies suing Nutriset's patent on Plumpy Nut claim that it's essentially like peanut butter and people have been making it for years.  However, it's not true.  It's actually only 25% peanut butter.  The rest of it is a mixture of sugar, soya oil, palm oil, milk powder, emulsifiers, and micronutrients.  The suing companies claim that anybody could have made it, but if so, why hadn't they done that before?  Patenting doesn't always mean it's a new product (which in this case, it actually is), but it can also be using an old product for something different.  
• Plumpy Nut was not a product that just came out of one days work - it's a product that's been under research, evaluation, and remodeling for at least 10 years, which also equates to millions of dollars in research.  Although it's not technically a drug, it is half way between a drug and food.  While people are unhappy that drugs cost so much money and say that pharmaceutical companies are always out for profit, people are also not aware that it costs about $800 million dollars to create just one drug.  Of course, I'm not advocating for pharmaceuticals, and I'm sure they do want to make profit, but I'm just saying that Plumpy Nut did not come free.  One of the purposes of patents is to guarantee that those who do put in the huge amount of money can actually regain that investment back.  Without these patents, people would not be investing in research for drugs, foods, technologies, anything because anybody else can just take that new idea and make profit off of it without having to invest in research money.
• Something that's wasn't at all mentioned is that although these U.S. companies have good intentions to make and give out Plumpy Nut, I don't think they really have any idea what's the main issue.  The problem isn't so much the production of Plumpy Nut, but the DISTRIBUTION of it.  It's just so difficult to actually transport Plumpy Nut to the distance corners of districts in Africa where there is no paved road, electricity, running water, or other "essential" services. 
• Furthermore, even if distribution were easier, Plumpy Nut is meant for children 1-5 who are malnourished.  But if you just distribute it without screening, documentation, and education, people won't understand how to use it, and will in fact sell them rather than treat their kids - it's already a problem in Sierra Leone.  
• The last point that the article did touch on is that having U.S. corporations making Plumpy Nut will actually take profit away from local producers.  In fact, Nutriset has considered taking the patent off developing countries like those in Africa.  

I have to say, I'm easily swayed to think one way or another.  But while I put out all these arguments for Nutriset, I'm not completely advocating for them.  It's just providing the other point of view.  

1 Billion for drugs; 2 Billion for military...per day

In class, we just learned that it costs about $800 billion for a pharmaceutical company to make a new drug...which led me to look up the U.S. military spending.

So the U.S. spends $2 billion per day on military, which is $711 billion per year.  

That consists of 47% of the world's spending on military, which is almost how much the rest of the world spends on military COMBINED.   Pie Chart of World Military Spendings

Everyone Should Donate Blood

Just finished watching an episode of BostonMed where a patient took up several pints of blood because he had fallen 15 ft from a ladder and nearly bled to death.  The massive usage of blood donations reminded of an outpatient case in Sierra Leone:

A patient came in while I was shadowing an outpatient doctor.  It turned out she had been to the hospital before because of vaginal bleeding while pregnant, but she had "ran off" - according to the nurse.  The situation was unclear, and depending on who I talked to, I gathered different information.  One source said she was just uncompliant and went home even though she was placed in inpatient care to be looked after.  Another source said she had no one with her, and because in Sierra Leone, in order to get transfusions, you had to have a relative donate blood, she went home to get someone.  In any case, she came back with a relative, but her condition had progressed to a much worse state (perhaps infection?).  

In any case, for all you capable blood donors out there - GO DONATE BLOOD!!!! It's a really great service we have in the States.  Can you imagine how difficult it would be to have to always take a relative with you when you have to go into surgery, and not even knowing if their blood will match yours? And then to be turned away if you didn't have an eligible donor?  So please, if you are more than 110lbs, haven't traveled to a malaria infested country (among other activities that could get you sick), have enough iron - scratch that - even if you don't have enough iron just eat more spinach - GO DONATE BLOOD!

Mothers at the malnutrition clinic in Kwama

Post-SL Trip: Things I'm Thankful for

Count your blessings! - I know, I know - it's such an overused phrase, but it's so true.  There are just so many comforts of the U.S. that people forget about, and I guess this is just a list to remind me of all the things that I missed.

• Electricity! - I can't imagine how many times we'd be working in the factory and the electricity would just go off and someone would have to go and turn on the generator.  At the house we only had the electricity for 3 hours from 7-10pm from a generator, so there were many times when I'd be doing something where having the lights go off was VERY inconvenient. Or just doing things by candlelight was difficult:
• showering
• brushing teeth
• reading a book
• watching a scary movie - not fun...but the computer ran out of battery too, so didn't get to see the ending --still need to do that...
• vomiting my guts out
• baking
• entering data
• ...
• Internet - especially fast internet! Occasionally there's be internet at a decent speed, but just having internet was a blessing!  But in general, internet was useful mainly to stay in contact with my boss.
• Safe drinking water.  Yes, there were times when I had to conserve drinking water because I forgot to buy enough for upcountry.
• Milk!  Oh my goodness, I can't believe how awesome cold milk is until I came back. mmmmm! There was only powdered milk, which I was okay with.
• Orderliness/organization.  It's amazing how organized America is.  You can just step out on to the road and expect cars to follow the rules, or how you can just go to a store and expect to see the price on the product, and that would be the reasonable price to pay and not have to barter for every single thing.  You can just plan your day and that's generally how it'll go.  There's no saying what the day will bring in SL.  
• Factories/industries: So nice to be able to know that if you want something, you can just find a store for it and buy it.  I just wanted to find spatulas one time and I couldn't find them.  
• Hot showers! Oh man, every time I got into the shower I would think about how nice a hot shower would be.  
• Running water.  Yes, there was mostly running water, but upcountry there wasn't - and I felt kind of guilty that people had to carry buckets of water for us to the guesthouse.
• Food: So many people who didn't have that luxury. :(  There was a girl I talked to who I befriended upcountry.  One night she visited me, I asked what she had to eat during the day and she said she hadn't eaten all day (same as her brother).  When I asked her why, she said her dad had went to the city and didn't leave them any money.  When I asked why he went, she said to visit his other wife. 
• Anesthetics: Watching mothers give birth with no anesthetics has almost made me reconsider having children.
• Having reliable doctors/medicine.
• Blood banks
• ...

But overall, I gotta say that I had it good.  I was in a really nice compound that was fenced, and I got to live with some expatriots who were really amazing people!

Geek Ego Booster

Haha...for all you geeks/nerds out there...
http://sfbayarea.craigslist.org/about/best/sfo/66795671.html

SL Tid bits

Interesting Sierra Leone Facts:
* Seattle gets 3 ft of rain each year.  Sierra Leone gets 16 ft/year - all during the rainy season (June - October)

Typical Rain Day (Note the massive amount of water overflowing everywhere)

* The record LOW temperature is 68 degrees F (19 C), which is the lowest record high of any other african country.
* The average number of children per woman is 6.3.
* Largest export is diamonds, but mostly unpolished, which are of significant less worth than polished diamonds.
* There are no peanut butter or peanut manufacturing companies in the country (sucks for our NGO, Project Peanut Butter)

What to do if you hit someone with your car:
1) Very few people around: take the person to the hospital.
2) Lots of people around, don't even bother getting out and drive away quickly or else you might get killed.
Sierra Leoneons are very nice and friendly, but people forget that they've been through a war.  So when something happens, they fuel each other on, and it can get ugly.  They're really tough because that's how they got through the war.  As someone said, "It's like a switch."  One moment they are the friendliest people, and the next, they're beating someone to death.  Someone I met talked about how they were heading to church when rocks started being hurled around.  Turned out something had caused the people to turned on the police, and the police were retreating.  It's kind of unnerving to know that the police have no control other than creating traffic.

Language fun:
* Bus means cat
* In Krio: e sounds like "a", i sounds like "e", ay sounds like "i"...
* I "flash" you means calling someone briefly to give them your number

First Poda Poda Experience!

Poda Podas are the equivalent to buses, but they are the size of a minivan, and generally hold 20 people excluding the driver.  It was very squished, and you can generally find one guy hanging out the door of the car, watching out for potential passengers.  Along with flowery, colorful designs, they also have interesting phrases on the back like "City Boy," "Madonna," and/or "Jesus is Great."  Yes, they can all be on the same poda poda.  Unfortunately, poda podas are the root of all traffic (well, okay, and police officers).  They just randomly stop in the middle of the road as people jump on and off.  On my poda poda experience, there was a rather large lady who tried to get on, but just as she sat down, she got up and left.  Turned out all the other passengers complained that she was taking too much room, and drove her off the poda poda.  Man, talk about democracy.    Anyhow, it wasn't as bad as I thought it was going to be.  In fact, I think I might incorporate poda podas into my nonexistent repertoire of public transportation.

Practicing Chinese in Sierra Leone

Who would've thought knowing Chinese would've been useful in Sierra Leone.  Even more curious is who would've thought the only sugar factory in all of Sierra Leone is operated by a Chinese family.  Anyhow, after looking up some business jargon on Google Translate and mentally rehearsing some of the things I might say, I think I managed to undergo a small business conversation in Chinese.  And to top it off, I got a free sprite.  We'll see if he really understood what I said after I see the result next week.


Also, before I would get really annoyed when people said "Ni Hao" or "Ching Chung" to me in the streets, and I would pretend I didn't speak Chinese, but then I realized sometimes it's a lot better to pretend I didn't speak English so that people would stop bothering me.  So then when people kept on bother me, I would just break into Chinese.  It really works!

Ah Bunge Di Squirrel

We were driving along the highway from Moyamba to Bo when all of a sudden, my driver cried out, "Ah Bunge Di Squirrel!"  He quickly pulled the car to the side of the road.  We asked, "What?!!" but he kept on repeating the same phrase.  He ran out the car, and by this time, we figured out that he had hit a squirrel.  He must have ran at least a few hundred yards back to check out the squirrel.  As he left the car, I yelled that he didn't have to worry about it and he can just leave it there.  Little did I expect him to return to the car proudly holding the squirrel by its tail.  He laughed as he told us how everyone from the nearby village was begging to have his dead squirrel.  Before we could say anything, he threw it in the car on the floor of the driver's seat.  We yelled at him to get it out of the car, but he said he was taking it to his brother so he can eat it.  How kind of him.  We decided it'd be okay, so we drove with this squirrel corpse and made him take a picture with it.