Saturday in Koutiala

Well, it's another warm day :-)

Enjoyed rounds this morning with Robert, while Craig graciously acted as  my interpreter. I "hear" much of the French, but I don't always pick up on the little things, the "little" aspects which provide the true picture of what is happening. So thankful or Craig's willingness to serve. I like seeing the progression of patients, the returning patients for wound checks, and the new babies born in the night. Always better to see improvement.
No C-Sections last night, and I'm on-call today...so the odds are... 2 am...?

After we finished I went to Peds to see how Jason (Pediatrician) and Kristen (Nurse) were doing. As usual, they were having fun :-) We changed a PICC line dressing together, and saw the babies and children. The boy and girl pictured below are here for chemotherapy. They look so much better than when they first arrived - and both are quite the little characters! Jason and Kristen are as well, but that goes without saying :)

You are looking at 2/3 the CMA team here now, and the entire medical team for the 100+ bed hospital, except for two of the Malian interns.

 Normally there would a CMA team of 35-40 plus children. So, it is a small community at present with various vacations coinciding nicely with the current rebel conflict up North. You don't see many "white" faces in the country at present as tourism is ~completely shut down, and most ex-pats are staying away from the country.

I really enjoy the "team" aspect of working with Saskia (Med Doc/OB-Gyn),  Lisa (Nurse/Anesth), Jason and Kristen as they work with the medical Interns and staff in caring for the patients here. I get to work on "both" sides of the fence - Med and Peds - as the surgical consultant. Sounds like a big deal, but in essence it is helping out wherever they can use me :-)

The toughest thing is seeing children when there is little we can do to help. I won't put their pictures in here - it would turn most people's stomachs.

I will remember the 2 y/o who walks on her hands and feet because she can only see out of one eye. Her other eye is completely replaced by a tumor that sticks out 2-3 inches from her head. Can you imagine trying to learn to walk with only one eye?
She rubs the tumor once in a while and starts it bleeding again. Her mom tries to keep the flies off of her.
In my heart I wanted to take her to the block immediately and enucleate the tumor, but the better treatment would be for her to go through the system already set up in Bamako. It sits like a rock in my stomach that we can't do something for her. She is scheduled to leave Monday.

Or the little 3 y/o girl who came in yesterday with a large tumor expanding across her abdomen. She has a scar along her left side, long and narrow. The parents are quite poor, uneducated, and have no idea what kind of surgery she had in the past. I couldn't find a kidney along her left side, and the tumor appears to involve the one kidney on the right. How long will she live? I plan to obtain a biopsy to check, but it looks like there is little we can do for now. She is quiet and looks tired all the time.
I don't wonder why.

Doctors without Borders is around the corner from here. They send us their complicated patients or the ones who may need surgery. I've thought of working with them in the past, but when I see the attitude and care for the children and women at the hospital here, it is an easy decision to work with groups like the CMA. A place where the patients come and are cared for not just physically, but also spiritually. A place where Jason from Arkansas, Kristen from WI, Lisa from IL, and Saskia from Holland are working daily to see a difference made here - for eternity. These medical servants are living from their heart; not just because it is a slogan on a  wall, or a "mission statement", or somebody somewhere thought it would be nice to treat people well. These men and women live who they are - heart, soul, and body - in a place which gives them the opportunity to express themselves so eloquently.

It has been only two weeks since I landed in Mali. The second time is sweeter.
The days may appear mundane sometimes, but then I catch the glint in a child's eye, see a mom wrap their baby closer to them, or watch a nurse patiently explain for the 4th or 5th time what needs to be done...and I realize that it is in the moments that we truly live life. It is these moments that I live for - to see Life and know God is in it all.
Live the moments.

Koutiala, Mali - 


Last post was in Gabon...without much follow up. I'll have to catch that up-to-date soon :-)


Earlier this summer Saskia wrote and asked it I would be able to assist as a back-up surgeon for the Women's and Children's hospital here in Koutiala, Mali. The catch was that there was a coup, then a rebellion up North...all of which upset the country a bit and prompted the US Govt. to suspend all travel for US citizens. It has stayed relatively safe in this section of the country...and now I'm here.


Today I sent a brief update to a couple friends. I decided to use the excerpt following as a post today. Nothing extravagant, but it may give a flavor for the work.

"...Yes, Gao is a bit further north/east - probably about 150 km or more. No disturbances down this way.
There are only 4 singles and one couple left of about 35-40 missionaries not including their children, here in Koutiala, who all work in or for the Women's and Children's hospital. The National staff is still fairly full-tilt, so no worries there.
Thanks for your prayers. Much appreciated.
I'll include a bit of what I shared with my tech, Rhonda earlier today...

"Why Yes! Open Chole's can be fun!! Especially when they are for cholelithiasis and not infection, so good tissue planes and nice anatomy (whew!!). Little blood loss, and an assistant that is brand new, hardly trained except to set up a table, and had never seen a gallbladder. He was excited - calmly excited, as I think he was a bit nervous. It is funny, but "big" cases over here are quite "normal" since nobody knows the difference. I sometimes have to tell the team that it is a "big" case and I need more equipment, otherwise they give me the exact same instruments for a c-section, bowel excision, leg amputation, and cholecystectomy!

I also worked with him to disarticulate a hip and do a leg resection on a lady with Nec. Fasciitis, also removed her dead baby. I think that was a HUGE eye-opener for him. One of my top-5 "worst" cases that I've stored in memory. I don't ever want to do one of those again - and thankfully, will never likely have the chance. She died later in the day. It was her only chance - and if it weren't for the overwhelming sepsis she might have made it. Definitely not a good day on Monday.

...
Hearing what the weather is like there is making me feel a bit guilty. It is hot here, but it is supposed to be hot! My brother wrote me and said he was watering the lawn in front of my house - which means it is REALLY dry. I still see some occasional twigs of green grass around here. Rare though.

Last night it was quite warm as I ate dinner at a Malian family's home. It was typical African, with eating with our hands, and the men inside (where it was warm!!!) and the women and children outside in the cool evening. Kind of wished I was a kid in a way :-) It was some kind of dish made up of a grain, spices and onions, and fish sitting on top of it. Lots of oil mixed in to give the "millet" some substance and make it stick to our fingers.
Afterward we drank a sweet millet/grain type of porridge for desert. Kind of like drinking thick oatmeal, partially cooked, with lots of sugar and a little milk.
Then,...the rounds of HOT Tuareg Tea (the pure tea/sugar combo) poured in shot glasses and sipped loudly (to keep from burning your tongue). Thankfully there was about 15 minutes between rounds to allow the caffeine to kick into place in time for the next shot. Good stuff. 

Jason and our Host

Home around 10:30p in order to put together a lecture for this morning - didn't have any problem staying awake! :-)

Gave a lecture this morning to the nursing students. They seemed to like it. Gives the staff here a break from lecturing as well.

...
Ok - it's quiet here, at the moment. Slow Wednesday. A couple of procedures, barium enema and EGD to do in the next couple of days, and possibly some skin contractures to debride - otherwise only emergent cases expected. So I'm going to work on a lecture or the docs.
"

-- There you go. I know it isn't too exciting. But Life is often lived in the mundane wrapped in eternal perspective.
Thanks, again, for your prayers and I do hope you are having a wonderful summer.
Blessings,
John

Three days - complete

So, we are sitting here discussing ice cream in the middle of the jungle.

And its not even hot out!

While walking to dinner this evening we were discussing just how cool it was after the hard rain this afternoon. It seemed like a "night" rain since it usually rains that hard at night here, not during the day. Day rains are a bit less tumultuous - most of the time.

The guesses on the current temperature ran from 67-72 deg F. Turns out it was 80 deg F.

I guess we have adapted when we think 80 deg. is "cool".

Eric and Wendy were wonderful hosts, and Rachel's green beans from Libreville fit the fried rice combo perfectly. After Eric's just cooled from warm brownies, we were content to sit and chat while Esther (10 mo/o) entertained us. Wendy is due with their second baby this summer, and they are very happy that Rachel, Renee's niece who is an ultrasonographer, is here. "Very Happy" is probably an understatement as they would like to know if they should expect a boy or a girl :-)

The guys here (surgery residents) are definitely enjoying both Renee' (Ob-Gyn) and Rachel's expertise. So much so, that the acting-Chief resident asked Renee' to assist on a rather large thyroidectomy today! That was followed up by the removal of a huge uterus, and again with case that Renee' hasn't seen a quite few years :-) Enough to keep her happy for sure!

Rachel (or Rrrrahshell as the residents call her) has been busy going between cases seeing in real live living color the organs and structures that she has, up until now, only visualized on the black/white/gray screen of an ultrasound machine. She has said several times "that doesn't look like the pictures in the book", or "so that's what it looks like!". When she isn't in the OR she is off to other parts (buildings) of the hospital scattered around us to do ultrasounds for all kinds of conditions - even an eye :-) Which, by the way, was still attached and functioning well! She had to explain how she did it!

Fun to still be learning.

The walk home after dinner also included a brief perusal of the heavens - one of the clearest nights I've seen in the jungles. Brilliant stars with the massive milky way stretched out overhead. Beautiful :)

Rachel Thompson walked with us and we started looking for spider eyes glinting back at us from the rocks and grass along the path. Brilliant green glass dots sprinkled along our path. I didn't make Renee' and Rachel G. feel any better to hear our "oohs" and "aahs" as they walked along in their flip flops wondering how many of the critters were actually around!

Speaking of critters, the Thelanders have new pet! They've named him Einstein. I've seen him once, and believe the name "Houdini" would be more apropos. He's one of the largest "mice" I've ever seen - aka, probably fits well in the rat family :-) I keep telling Joanna (the lady of the house) that just because he comes and goes through their attic without invitation doesn't mean they have to hunt him! So far he has eluded three rat trap, eaten all the bait, and never stepped in the glue traps. At the moment, he is still the elusive unwelcome mammal that makes noise over their heads at night. My recommendation to give up the fight and adopt him as a pet isn't making much headway. I'm still on rat patrol call every-other-night in case a trap snaps. I didn't get a chance the swing my machete the first time I chased him out from under a door, but I'm better prepared now - he is definitely big enough to hit (but I'm still calling him a large mouse so as to encourage the pet idea). At least it isn't a snake.

And we haven't seen any snakes thus far. For the record.

To sum up the past three days:

~30 operations over three days with 2-3 residents operating isn't bad at all. I'm doing purely "general" surgery, meaning my operations are Nothing that I "generally" do at home. Prostatectomies, Hysterectomies, Orthopedics, Hand...but I did get in on an epigastric hernia :) Even Renee' is stretching her boundaries like assisting on a large thyroidectomy today! She is good at anything she puts her mind to :) Incredibly good teacher. And the guys are really enjoying her input and expertise. Very blessed to have her with us.

It is fun to work with these guys - all capable, good humored, excellent work ethic, and personable. They obviously know and walk with God. His spirit is evident in the way the work with the patients, and each other. Fun to see their progress over the past few years. Keir (the Director for PAACS - the surgical residency) is doing an outstanding job. We definitely feel blessed to be able to work in assisting in the teaching of the residents and care of these patients.

Never a dull day!

I'll have to talk about that some other time.

And the ice cream... Renee' is going to give me her recipe for Pistachio Ice Cream. And we all thought Breyers 5 Vanilla ice cream would be awesome tonight! And the rain has begun again...

Bon Nuit :)

February 13, 2012

First day of clinic - Successful!

Renee', Rachel, and I (aka. Ree'johnal) survived the first day of clinic here in the jungles of Gabon. "Survived" might be pushing it a bit, as it was a quite enjoyable day with a nice number of patients (steady stream), an excursion to the Ob-Ward for a check on a delivery, multiple ultrasounds for Rachel, and Renee' was in high form with most of the cases in her expert field :-)

The Residents worked efficiently and saw quite a few patients - ranging from a little boy with a swollen arm (and likely Lymphoma), a man with a huge prostate (and likely cancer), women with various uterine anomalies, infertility, and a man with colon cancer and an "apple core" lesion, to name just a few. The 2nd yr resident effortlessly reduced the jaw of a lady who "yawned" three days ago - and her jaw stuck open. They tried unsuccessfully to reduce the dislocation where she lived, then it took three days to get here from her village. She was quite relieved to have a bit of anesthetic and have her jaw back in place. Little things like that make a person's day much better.

By the way, you can't close your lips with your jaw dislocated.

Three days.

Occasionally someone asks why I would come here. I most often refer them to these blogs. It is easier than trying to sum up an answer in one sentence.

But, in short, I come because I have been blessed to have the privilege of the opportunity to work with these residents, nurses, staff, and missionaries. God opens the door - and by His grace, I just walk.

Now - getting here this time was a bit of an adventure for Renee' and Rachel! They started at about 2am last Thursday - flew from Indy to Washington DC, met with the representative of Gabon at their embassy to obtain a visa, flew to Atlanta where they met up with me, flew across the ocean, ran through the Paris airport to be the last people on the airplane to Gabon, and finally arrived 36 hrs later in Gabon in time for dinner - but without their luggage. It didn't quite make the quick trip through the Paris airport.

A few hours later we were up and off to the airport again to fly across the equator, down, deep into the jungle, to the mission hospital. As we flew over our usual stop with the african airlines I commented to them (i.e., yelled as loud as I could into the back of the plane) that from that point we would have needed to drive another 2 1/2 hours. About 12 minutes later we landed. 12 minutes vs. 2 1/2 hours. Crazy.

Ever wonder why I enjoy flying? :-)

The gals were very glad Joanna T. is such an incredibly kind hostess - after 2-3 days of travel they were ver ready for a change of clothes. And, thankfully, our luggage arrived last night before midnight.

Speaking of midnight - just before then I received a call from the house next door. It seems a certain rat has been stirring in their attic for at the past few days. Traps and glue have not been successful in trapping the beast. However, a few hours into the wee hours of the morning, the phone rang and I was scurrying up into the attic myself to see what was banging around in the dark.

Turns out the rat had eaten all the bait, successfully avoiding the traps, and had been industriously chewing away at a large plastic travel bin. I caught site of the critter as it made its exit, just before I could swing my machete. I would have slept better having bagged the beast of the night, but instead had to go back to bed for an hour and wonder about better options. Just before dinner tonight we made one more foray into the attic - but still not rat, and I reset one of the traps.

We are going to win the contest before the trip is over. Or else Keir (Joanna's husband) will come home and solve it for us! The kids and I had fun hunting for it this evening anyway :)

Tomorrow will be a full day. Three OR's are scheduled for four residents along with Renee' and I. Rachel will be busy with Ultrasound I'm sure - she is quite a good teacher and the residents are enjoying her teaching immensely.

Somehow I'm scheduled on two hysterectomies and Renee' is scheduled on a thyroid - so it should be interesting for the both of us!

So, the week has started. Good food. Good fellowship. Good work. And a whole lot of thankfulness to be here at this time. Thankful for God's faithfulness as we have looked into the many faces of hurting people. I know there are tough times ahead. And I'm thanking God for his grace and love already.

I mentioned the lady with her jaw stuck open for three days...because it is one of the easier things to talk about. There are more painful examples, but that will do for now.

Thank you for your prayers. God IS good. Thankful for what He does through each of us.

John