So.....I may be addicted to surgery

Holy crap! The first time I see a birth and it's an emergency C-section done because the mother was eclampsic! And this time in the operating theatre I actually helped, albeit just a little. I held down one of the woman's arms when she was starting to convulse and sometimes I had to hold her gas mask on, and then I helped an orderly open her legs so he could change her cathater (because the maternity nurse put a pediatric-size cathater in and the bladder was too full for the doctor to get a good grasp on the baby's head). At the time it didn't feel like anything special, except maybe when I was holding the gas mask and I could feel her short, shallow breaths, but now when I think about it I get a rush. During the surgery it seemed very surreal, as if the doctor was just performing a dissection like biology majors do in various labs, except the specimen was bleeding and warm to the touch. And Dr. Spencer was very calm about it all--it's all old hat to him I suppose. I mostly stood out of the way, but whenever I was called over to hold something I was very calm as well. It's only looking back on it that I think it's amazing. Maybe this means I have the needed distance for becoming a good doctor: empathetic but not losing myself in the problem of the patient. Anyway, it was really frickin' cool to watch Dr. Spencer pull the baby out of the womb. At first I didn't think it was alive because it was all grayish (remember, we're talking about an African baby here, not a wrinkly white one) and not moving or breathing. But a midwife and an orderly took the baby aside, used a suction machine powered by a foot pump, and sucked out the mucus in the baby's throat and mouth. Eventually it woke up and there is now a very healthy baby boy with a larger-than-average head. The mother's BP had dropped once the baby and placenta was removed but she was still twitching a bit when she was wheeled out to the maternity ward.

And earlier this week I walked with Dr. Spencer to see a patient with severe lower abdominal pain in her right side. The first (and only) thing I thought of was appendicitis, but Dr. Spencer said it could also be an ovarian cyst or ectopic pregnancy. Anyway, he did emergency surgery and it turned out to be appendicitis (Total points for me: 1). There was actually a seed, maybe baobob, that had become trapped in the appendix and caused the inflammation. It was ready to rupture by the time we did surgery, so Dr. Spencer saved the patient's life. How cool must that be?!? I used to say that I can cut up dead things but I wouldn't trust myself to cut something that's living, but now I think I could do the cutting. It's the suturing that would get to me. Definitely something needed, but the interesting part of the surgery is over by that point. Ah well. I'm just a toubab trying to play doctor with insufficient knowledge and my personal first aid kit (not the one given by Peace Corps, the one I brought with me).

One thing that struck me today though is how similar patients are when they come to the doctor, whether in the states or here. They have a pain, and they want the miracle drug that will make it go away. End of story. They don't want to have to change their lifestyle to improve their helath; they want a pill to make everything better. And the doctors eventually give way and prescribe some sort of antibiotic (today it was mostly doxycycline, which is the anti-malaria medication I had been on that gave me stomach ulcers, so at least the women are safe from malaria for a week or so), which leads to antibiotic-resistance among some of the disease-causing microorganisms, and then things get worse.

When I was in the scanning room watching ultrasounds the orderlies were talking about how some women want the ultrasound (even though it costs 100 dalasis) because they think the scanning wand will actually heal them. That kind of blind faith in medicine and the doctors and nurses who practice it can be scary sometimes. Like when people in village come to me with a health problem, and I have no idea what it is and tell them to go to the hospital, but they think if they sit and stare at me long enough I'll change my mind and give them some aspirin and everything will magicly be better. It's a sort of transfer of the old animist beliefs into medicine, but the "magic" is still there. That's why if people are given medicine to take for ten days, and after two days they don't feel any better, they stop taking the medicine and go to the local marabout for traditional healing. What to do? What to do?

Things that I've been pondering....

Days until Christmas: 23
Days until vacation: 25
Days until Dad's 50th B-Day: 40
Days until my b-day: 72
Days until I go on mail-run: 110
Days that I've been here thus far: 513
Days until the date I can hopefully come home: 182
Date at which there will hopefully be only 100 days left: February 22nd

Life in a Gambian Hospital

I'm back in the Kombos after a long month in village. What with teaching 100+ tenth-graders, weighing babies, trying to organize a night class for hospital staff, working with the Peer Health Club to put on educational skits for the up-coming World AIDS Day (Dec. 1) celebration we're having, still trying to figure logistics out for finishing the well at Babou Jobe, helping my sitemate with her micro-business manual (and her countless venting and "I think this is the first thing I'll do when I go home, no this, no that" sessions), and trying to figure out information about solar panels for the community lodge, I've been busy! I came down to Kombo this week to celebrate Thanksgiving (we ate at the ambassador's house, even though we don't have an ambassador right now), celebrate the 40th anniversary of Peace Corps, The Gambia, and attend the all-volunteers meeting. Needless to say, there were several nights of partying on behalf of fellow PCVs, but luckily these were not at the hostel, so a friend and I did things like making manicotti and layered jello or go to the beach. What is it about living overseas which drives PCVs to unnecessary drinking bouts whenever groups of three or more gather? I have had a few times when I would like to have a drink, but frankly I don't feel safe doing so, especially not around other PCVs (the rumor mill is insane), plus there's a little voice in the back of my head saying "What would your host mother think?" Ah well, everyone needs a way to let off some steam. As long as they don't wake me up whent hey come stumbling in at 4am, it's all good.

The biggest thing that's happened to me this month is that Hawa came to visit. Hawa is a four-year-old girl who had a very gross malignant skin ulcer for the last three years! Her mother said the "wound" just appeared (maybe it started as a burn from boiling water) and everytime they went to the doctor the wound ended up covered in iodine or just bandaged, but regardless they were sent away each time, and because the wound was itchy, Hawa scratched at it with her dirty fingernails and the wound spread. So I went with the mother and Hawa to the hospital where my toubab status pushed her to the front of the line, and some volunteer Cuban doctors thought she might have anthrax so they signed an admittance paper and told me to take her to the "ward." When I asked which ward the doctor just said "the ward" and shooed me away. So one of my friends who works in the lab took us first to the pediatric ward, but that wasn't it. Go to the surgical ward, so we went to the surgical ward, and that was the correct place, but Hawa could only be admitted if the surgeon cleared the paperwork, so then we had to go to the surgical clinic and get in line. Again, my toubab status assured that we were at the front of the line, but we waited more than two hours for the surgeon to come. After 11 he came, but hospital staff kept pushing their friends through the door to his office while everyone else was waiting patiently (Gambians are very patient people; they're used to waiting). However I, at this point, was quite frustrated and finally just knocked on the door and went in. Meanwhile one of the nurses closed the door on Hawa's face. Once she and her mother were allowed in and the surgeon looked her over, he agreed she needed surgery and signed the paperwork. So once we had Hawa safely established in the surgical ward I rushed off to school to teach my lessons, then ran home and ate a quick lunch while I informed my host mother as to what was going on, then back to the hospital with lunch for Hawa and her mother. Hawa's mother asked for a few things like clothes so I returned that night with necessities. The next day Hawa was supposed to have surgery, but because her hemoglobin level was low she would need a blood transfusion. So in between classes I ran home, talked with some people, and found a way for Hawa's father to come donate blood, only to find out at 2pm that the surgery had been canceled and the father didn't need to give blood because a donor with her blood came in a gave blood. Her surgery would be the next Tuesday (as surgeries are done Tuesdays and Thursdays). So we waited until Tuesday, but Tuesday brought with it generator problems, so the surgery was canceled again. On Thursday everything was a-okay so Hawa was the first surgery that day (I requested time off from school and had permission from the surgeon to attend the surgery). Hawa came kicking and screaming, but with some laughing gas quited down. Once everything was ready and I was thinking how much like a doll Hawa looked, Dr. Spencer came in with his rubber boots. Using a lamp that looked more like a flashlight for lighting, the scrub nurse cleaned the area (with soapy water) and dried it, then Dr. Spencer began. It took several passes with the scalpel to make it through the tissue, and Hawa bled so much for someone her size--clamps were just blossoming around the wound--and at one point I aided the surgery (I grabbed adrenaline to put on the cut area to help stop the bleeding). After removing the diseased tissue and cutting it up for preservation and testing (it may be cancerous), Dr. Spencer pulled out an inflammed lymph node the size of a lima bean. It was crazy. Once the bleeding was under control, Hawa was bandaged and the clean-up started. First removing the clamps, then wiping up the blood--some of which pooled under the gurney and congealed into a sheet which was partly stuck in her hair--then one more sweep over with the soapy water, cover her up and wheel her away. I stayed for two more surgeries (during the last of which, the power gave out and Dr. Spencer tried to continue blind while the scrub nurses ran around trying to get the power to start up again), then visited Hawa, who was still asleep. Off to school for classes, and when I returned she was awake, in some pain, and in the middle of her blood transfusion. She was not at all happy with me. For the last week we've been waiting to see how the wound heals, and if everything is healthy then Dr. Spencer will perform a skin graft. Meanwhile, Hawa is running around and happy. Whenever I visit she likes to beat up on me and we tease each other in Jolaa: "ow, ow jakuut!" "nje? haani. ow. ow jakuut!" ("You, you are bad." "Me? No, you. You are bad.").

During the waiting period I was extremely frustrated and emotional, feeling like if anything goes wrong it's my fault for convincing Hawa's mother to admit her, and the world is such an injust place for not letting Hawa receive the medical attention she needs without a toubab bringing it to her, etc. Upon reflection though, the clinics and hospitals she went to before were not as big as Bwiam's, and probably not even staffed by doctors. For awhile I was mad at the doctor for not doing the surgery, thinking he was making excuses, but once I was in the operating room and witnessed what he is up against, I have a profound respect for the work he does with so few resources. The shopital has three generators, two of which are supposed to be functional at all times, but all three are having problems. Meanwhile the director of the hospital is the only person taking care of these administrative issues; he has no help. And the patients just blindly believe whatever they are told because they aren't as educated as the nurses and doctors (none of the doctors are Gambian, they're all either Nigerian or Cuban volunteers). They call the nurses "doktor" because they don't know any better. Meanwhile, many of the nurses are actually still in training. For patients staying overnight in the hospital, they receive one meal a day, and that is for the patient, not the family. There is a cantina on the hospital grounds, but that's for the staff, not family. There are seven beds to a room, no chairs, and nothing to do all day. I brought some Newsweek magazines for surgical patients so they could look at pictures and such, but the nurses took them. Families from the area bring lunches and dinners to their people in the surgical ward, so everyone shares meals. The people on the ward become like a family since they spend at least two weeks there at a time. It's great to be a part of that and greet everyone when I come to visit Hawa.

Kasumai kep!