On call day 2 (yesterday)

Started out innocently enough. Did not receive any phone calls overnight, so I slept well.  Rounds went relatively smoothly, especially after Stephen came to help round since his flight was cancelled again. However, around 11:00 am, I was asked to come to Maternity to evaluate a patient. It was a woman with twins at about 20 weeks, but one of the twins had passed away some time ago. Now she is having bleeding and cramping. I put her on bedrest, which is about all one can do. Then there is a woman in the next bed who is laboring, and the nurse starts to push with her. She asks if I want to assist with the delivery, so I come over to help. That’s when I realize the patient is really only 8 cm, and not ready to start pushing. So I have her stop pushing and let her labor more. I go back to try to finish seeing the other inpatients. Just before we finish, the nurse comes to find me again to see two patients in Maternity. One is unsure of her last period, and could be either 30 weeks (by fundal height) or 42 weeks (by her last period).    The other is laboring and almost ready to deliver. Sounds ok, right?

Here’s the other thing I should tell you: there are only two delivery beds in maternity. One was currently occupied by the woman with the 20 week pregnancy. When the second laboring patient came in, she was ready to push, so the first laboring patient had to get up, so the other woman could use the bed to deliver in. Labor patient #1 walked around, or laid on the floor, sometimes buck-naked. Labor patient #2 then starts pushing, but not really doing a consistently good job. She kept refusing to push. Mind you, she wasn’t flinging herself around, she laid still, but just wouldn’t push. She doesn’t speak any French, so I have to talk through the nurse to tell her anything. The nurse is yelling at her to push, and saying some other things I’m sure weren’t polite. At one point when the patient was refusing to push, the nurse actually slapped the patient across the face! I’ve been told that technique has worked in the past here for difficult patients, but it didn’t work in this case. In the mean time, Labor patient #1 is complete and ready to push. So we have them switch places again. 

You may be wondering “How long does it take to change a bed for the next patient on a maternity ward in Africa?”. I’ll save you the trouble. It takes no time at all, because there was no wiping down the plastic covered mattress between patients. (They don’t keep sheets on them.) Labor patient #2 is now on the floor, sometimes grabbing at our legs. This makes it difficult to focus on patient #1. Labor patient #1 starts to push but is going nowhere fast. Labor patient #2 (on the floor) suddenly starts grabbing at our legs again. I start unleash her hand from my leg, when I notice she’s pushing, and crowning. I have dirty gloves on, as does everyone else. I manage to have one clean glove on to help deliver the infant, and Karen (another physician here) gets her gloves on in time to help out as well. The little boy and his mother are doing well. After taking care of the infant and mother, we had to work around the mess on the floor until it was cleaned up. Labor patient #1 isn’t making much progress with pushing, she complains of being too tired to push, so she just doesn’t at all. I end up taking her back for a cesarean section later because she just didn’t making any progress. Perhaps even with good pushing the infant wouldn’t have delivered vaginally, as the infant had a cord around his neck, and the cord was on the shorter side. Both mother and infant recovered well. 

It doesn’t end there. After the delivery of patient #2 and before the cesarean for patient #1, I evaluated the patient with the unknown due date, was asked to see a newborn with a fever. After getting the infant started on antibiotics, before I can leave the room, I’m asked to see another woman who is 16 weeks pregnant with twins (did I mention there is a high rate of twinning here?), who was in the hospital for bleeding, now has abdominal pain, but no bleeding. I get the ultrasound and take a look. Both infants are alive and moving. Placentas appear to be ok. After watching the patient a few it appears the pain is not constant as she says, but actually worsens for a period of time. (They snap their fingers when in pain here, such as during contractions.) I start an IV and give her some meds to try to stop her from contracting, though I fear they won’t work. I find out after the cesarean that she delivered while I was in surgery. 

There were also outpatients to see, but fortunately Stephen saw most of them for me because by the time I finished with all of the above, it was 5:30 pm. Then the night nurse asked us to come evaluate several patients with him. I finally made it home about 7 pm. 

Yet, it didn’t stop there. There is only a small piece of bread left, not enough for breakfast, so I have to make granola, without an oven. It’s now 10:00 pm, and I’m finally going to hit the hay. Good night world.

Le Travail

I started work this week at the hospital. It’s definitely a big change from the last 8 months of my life, since I haven’t been working during that time. The day starts at about 5:30am, when I get up (grudgingly). I have to leave by about 6:40 am in order to ride my bike the 5 km (3 miles) to the hospital. Fortunately, it’s only about 75F at that time, so it’s not too bad when I arrive for chapel at 7 am. From chapel we go to morning report, which is a recount of patients admitted overnight or over the weekend, and a tally of all in the hospital. This means that after my physical exercise in the morning with the bike ride, I get some mental exercise trying to understand mumbled French. Listening to the vital signs is a great way to practice learning my numbers better. (For example, the french translation for 96 is literally four-twenty-sixteen. This takes practice to get it down straight.) After morning report, we start rounding on patients. This can take anywhere from 2 hours to 3 or 4, depending on the day, what procedures need to be done, and how many interruptions there are along the way. Once rounding is completed, it’s a good idea to stop by your office to see if any patients are waiting to see you. There are designated office hours, but it seems that if you are at the hospital, you will be sent patients regardless of having office hours or not. By this point you are tired, hot, and want a break. It’s likely already about 95F at this time of the day. 

Next, one of the most important parts of the day-LUNCH! Since I live at the mission, I eat the lunch provided at the hospital. So far, it has been at the house of a missionary family, and prepared by a very nice Congolese woman. It’s nice to not have to pack a lunch, or ride home and back since it’s so hot at that time of day. After lunch we may see outpatients or go back and check on some of the inpatients to see if labs have been completed, check on the progress or status of a patient, or other things. This can take the rest of the afternoon to finish. 

The first two days this week were about 11 hour days. Well, Tuesday we were done at about 3:30 pm, but I stayed and talked with my sister via Skype for a little while longer. I didn’t get home until 6 pm both days and was exhausted. I was relieved Wednesday to spend the morning finishing orientation subjects with Stephen, and then was able to go to the market to purchase a few things before heading home for the day. Today is my “alternative ministry day”, so I got to stay home and finish a few things around the house I had not yet completed. I realized today that this week has been more tiring than I first thought, as I went to bed at 8:30 pm last night because I was SO tired. I woke up about 12 hours later, still feeling a bit tired. I even took a small nap this afternoon. Could it be I’m simply not used to working 8-12 hour days in 95F heat and biking a total of 10 km each day? Na. Must be something else. =)

Today I had company for dinner for the first time. It was fun to get to try out some new recipes and prepare a meal for someone else. I discovered it takes longer to make just about anything here than what it does back home. For example, before making dinner, I decided to make some granola because I am running low.  I want to put coconut and peanuts in it. This means I have a coconut that I have to somehow open before I can grate it. With a knife, the countertop, and some brute force, I managed to get it open. I mix in the other ingredients, just up to the peanuts. These I purchased from the market, but I was informed yesterday there may be some which are no good, and should be sorted before eating. So I pour a plate full of peanuts and go about pulling out any that look funny or feel a little spongy, before putting the good ones into the granola mix. Finally I can mix up the granola to bake. Then I made Scalloped Eggplant, which entails sauteing the eggplant before putting it into the casserole dish. This takes more time than I expect, and I have to throw out a few that I burned. It requires milk, which means I have to mix up some powdered milk since you can’t buy milk here. So one more step in the recipe. Meanwhile, I realize I wanted to make rice to go with the meal, and should get that started since it could take 30 min or more to cook. (No Uncle Ben’s minute rice here.) I did manage to get it all made, and all ready about the same time, at about the time I had asked my guests to come. It was a small miracle. 

Tomorrow is Friday. I’m looking forward to the weekend. I’m hoping I will soon adjust better to the heat, schedule, and increase in exercise. But for now, it’s time for bed.

Le Travail

I started work this week at the hospital. It’s definitely a big change from the last 8 months of my life, since I haven’t been working during that time. The day starts at about 5:30am, when I get up (grudgingly). I have to leave by about 6:40 am in order to ride my bike the 5 km (3 miles) to the hospital. Fortunately, it’s only about 75F at that time, so it’s not too bad when I arrive for chapel at 7 am. From chapel we go to morning report, which is a recount of patients admitted overnight or over the weekend, and a tally of all in the hospital. This means that after my physical exercise in the morning with the bike ride, I get some mental exercise trying to understand mumbled French. Listening to the vital signs is a great way to practice learning my numbers better. (For example, the french translation for 96 is literally four-twenty-sixteen. This takes practice to get it down straight.) After morning report, we start rounding on patients. This can take anywhere from 2 hours to 3 or 4, depending on the day, what procedures need to be done, and how many interruptions there are along the way. Once rounding is completed, it’s a good idea to stop by your office to see if any patients are waiting to see you. There are designated office hours, but it seems that if you are at the hospital, you will be sent patients regardless of having office hours or not. By this point you are tired, hot, and want a break. It’s likely already about 95F at this time of the day. 

Next, one of the most important parts of the day-LUNCH! Since I live at the mission, I eat the lunch provided at the hospital. So far, it has been at the house of a missionary family, and prepared by a very nice Congolese woman. It’s nice to not have to pack a lunch, or ride home and back since it’s so hot at that time of day. After lunch we may see outpatients or go back and check on some of the inpatients to see if labs have been completed, check on the progress or status of a patient, or other things. This can take the rest of the afternoon to finish. 

The first two days this week were about 11 hour days. Well, Tuesday we were done at about 3:30 pm, but I stayed and talked with my sister via Skype for a little while longer. I didn’t get home until 6 pm both days and was exhausted. I was relieved Wednesday to spend the morning finishing orientation subjects with Stephen, and then was able to go to the market to purchase a few things before heading home for the day. Today is my “alternative ministry day”, so I got to stay home and finish a few things around the house I had not yet completed. I realized today that this week has been more tiring than I first thought, as I went to bed at 8:30 pm last night because I was SO tired. I woke up about 12 hours later, still feeling a bit tired. I even took a small nap this afternoon. Could it be I’m simply not used to working 8-12 hour days in 95F heat and biking a total of 10 km each day? Na. Must be something else. =)

Today I had company for dinner for the first time. It was fun to get to try out some new recipes and prepare a meal for someone else. I discovered it takes longer to make just about anything here than what it does back home. For example, before making dinner, I decided to make some granola because I am running low.  I want to put coconut and peanuts in it. This means I have a coconut that I have to somehow open before I can grate it. With a knife, the countertop, and some brute force, I managed to get it open. I mix in the other ingredients, just up to the peanuts. These I purchased from the market, but I was informed yesterday there may be some which are no good, and should be sorted before eating. So I pour a plate full of peanuts and go about pulling out any that look funny or feel a little spongy, before putting the good ones into the granola mix. Finally I can mix up the granola to bake. Then I made Scalloped Eggplant, which entails sauteing the eggplant before putting it into the casserole dish. This takes more time than I expect, and I have to throw out a few that I burned. It requires milk, which means I have to mix up some powdered milk since you can’t buy milk here. So one more step in the recipe. Meanwhile, I realize I wanted to make rice to go with the meal, and should get that started since it could take 30 min or more to cook. (No Uncle Ben’s minute rice here.) I did manage to get it all made, and all ready about the same time, at about the time I had asked my guests to come. It was a small miracle. 

Tomorrow is Friday. I’m looking forward to the weekend. I’m hoping I will soon adjust better to the heat, schedule, and increase in exercise. But for now, it’s time for bed.

Le Travail

I started work this week at the hospital. It’s definitely a big change from the last 8 months of my life, since I haven’t been working during that time. The day starts at about 5:30am, when I get up (grudgingly). I have to leave by about 6:40 am in order to ride my bike the 5 km (3 miles) to the hospital. Fortunately, it’s only about 75F at that time, so it’s not too bad when I arrive for chapel at 7 am. From chapel we go to morning report, which is a recount of patients admitted overnight or over the weekend, and a tally of all in the hospital. This means that after my physical exercise in the morning with the bike ride, I get some mental exercise trying to understand mumbled French. Listening to the vital signs is a great way to practice learning my numbers better. (For example, the french translation for 96 is literally four-twenty-sixteen. This takes practice to get it down straight.) After morning report, we start rounding on patients. This can take anywhere from 2 hours to 3 or 4, depending on the day, what procedures need to be done, and how many interruptions there are along the way. Once rounding is completed, it’s a good idea to stop by your office to see if any patients are waiting to see you. There are designated office hours, but it seems that if you are at the hospital, you will be sent patients regardless of having office hours or not. By this point you are tired, hot, and want a break. It’s likely already about 95F at this time of the day. 

Next, one of the most important parts of the day-LUNCH! Since I live at the mission, I eat the lunch provided at the hospital. So far, it has been at the house of a missionary family, and prepared by a very nice Congolese woman. It’s nice to not have to pack a lunch, or ride home and back since it’s so hot at that time of day. After lunch we may see outpatients or go back and check on some of the inpatients to see if labs have been completed, check on the progress or status of a patient, or other things. This can take the rest of the afternoon to finish. 

The first two days this week were about 11 hour days. Well, Tuesday we were done at about 3:30 pm, but I stayed and talked with my sister via Skype for a little while longer. I didn’t get home until 6 pm both days and was exhausted. I was relieved Wednesday to spend the morning finishing orientation subjects with Stephen, and then was able to go to the market to purchase a few things before heading home for the day. Today is my “alternative ministry day”, so I got to stay home and finish a few things around the house I had not yet completed. I realized today that this week has been more tiring than I first thought, as I went to bed at 8:30 pm last night because I was SO tired. I woke up about 12 hours later, still feeling a bit tired. I even took a small nap this afternoon. Could it be I’m simply not used to working 8-12 hour days in 95F heat and biking a total of 10 km each day? Na. Must be something else. =)

Today I had company for dinner for the first time. It was fun to get to try out some new recipes and prepare a meal for someone else. I discovered it takes longer to make just about anything here than what it does back home. For example, before making dinner, I decided to make some granola because I am running low.  I want to put coconut and peanuts in it. This means I have a coconut that I have to somehow open before I can grate it. With a knife, the countertop, and some brute force, I managed to get it open. I mix in the other ingredients, just up to the peanuts. These I purchased from the market, but I was informed yesterday there may be some which are no good, and should be sorted before eating. So I pour a plate full of peanuts and go about pulling out any that look funny or feel a little spongy, before putting the good ones into the granola mix. Finally I can mix up the granola to bake. Then I made Scalloped Eggplant, which entails sauteing the eggplant before putting it into the casserole dish. This takes more time than I expect, and I have to throw out a few that I burned. It requires milk, which means I have to mix up some powdered milk since you can’t buy milk here. So one more step in the recipe. Meanwhile, I realize I wanted to make rice to go with the meal, and should get that started since it could take 30 min or more to cook. (No Uncle Ben’s minute rice here.) I did manage to get it all made, and all ready about the same time, at about the time I had asked my guests to come. It was a small miracle. 

Tomorrow is Friday. I’m looking forward to the weekend. I’m hoping I will soon adjust better to the heat, schedule, and increase in exercise. But for now, it’s time for bed.

The Market

Wednesday I went to the market for the first time. I rode a borrowed bike there...it’s fine once I’m up on it, but it takes a nice high round-kick to get my leg over the bar (it’s a men’s bike.) It’s been years since I’ve ridden a bike for any significant amount of time and I found it was, well, like riding a bike. =) The market was not unlike other African markets I’ve been to in the past. One stall after another with people selling a variety of things, but often you can buy the same thing from many different vendors. There’s the stalls with onions, tomatoes, and garlic (which you can buy by the clove); the stalls with beans, peanuts, and sometimes green coffee beans (there is a missionary here who roasts his own); then the stalls with plastic shoes, flip-flops, fake designer bags, and other odds and ends; the stalls with plastic buckets, basins, baby bathing tubs, and sometimes other household goods. It’s very crowded, but I found I didn’t have as many people coming up to me to try to get me to buy from them as I have had in East Africa. It was rather refreshing. However, I think it was a rare occurrence. I took a trip down the meat section...it was enough to make me want to become vegetarian. It really wasn’t that gross, it’s just that most of the meat was fish and crocodile, and I don’t care for those. Since it’s part of the staple diet here, I think I’m going to have to get used to it. You could buy fresh fish, smoked fish, fresh crocodile, smoked crocodile, big fish, small fish, catfish and other fish. You can also buy monkey (I hear it tastes great with peanut sauce). I don’t remember seeing chicken, and certainly not beef. There aren’t many cows here, and those that do are brought down from Chad, and are very expensive. If you want beef to put in recipes, you buy canned corned beef. You can also buy “jambon”, which is french for ham, but I’m told it’s really more like Spam.

I bought several things while there, from food stuffs to fabric to household items. I found my french very useful for negotiations and even just small talk with the vendors. Yea me! It was nice to use my french and be understood. =) It was very hot, so I was dripping sweat. I had brought a handkerchief with me, but didn’t have it out. One of the vendors took pity on me and gave me a packed of tissues! That was a little embarrassing, but I thought it very kind of him. Perhaps one day I won’t drip sweat so much, and this heat rash on the inside of my elbows and around my neck will go away. I'm told it gets better...

Praises:

Another physician is here, a 3^rd year med/peds resident, for two months. It will be nice to have someone to “learn the ropes” with.

She brought many needed items with her in her luggage, including a new modem for the satellite internet at the hospital. It is now fully functional, which means internet fast enough for skype and posting a few pictures! 

Prayer requests:

She also brought a new oxygen concentrator, but we can’t seem to get it to work. Pray that we can figure out what is wrong and fix it. 

The container with much needed items for the hospital is still in Pointe Noire. They are charging $100/day to store it. There are 37 stamps and signatures (in total) that have to be obtained in order to release the container. We have about 12 so far. Pray that the rest of the paperwork will go through quickly, and they will reduce or eliminate the charges for storage at the time of payment. 

Sights and sounds

Sights and sounds

GONG! GONG! GONG! The first morning I was here, I woke up at about 4:30 am to the sound of a gong being hit repeatedly. I had no idea what this sound was, and was concerned it was some sort of warning signal. After being afraid for a few minutes, I figured if it was some sort of emergency, Joe would have called or come over to my place to tell me. So I went back to sleep. It turns out this daily “song” is the call for villagers to come worship at the Baptist church across the street. This means that around 5am-5:30am, I am serenaded by the baptist church. It is beautiful singing...I just would prefer if it wasn’t at 5:30am. I suppose I should count it a blessing to wake up to praises to God. Then the sun comes up promptly at about 6 am. The sunrise and sunset are relatively short here, being so close to the equator. I have no idea what people are doing up at 6 am, but things are quite lively. I can hear people walking along the road, cars and motorbikes going past, and people walking past my house on their way to wherever it is they are going. After this point, it’s generally difficult to get back to sleep.

By 7am, it’s already warm outside (as in stuffy and uncomfortable to sleep anymore). In some ways this is nice, because there is no hot water, so it makes taking a cold shower comfortable and even enjoyable. I’ve decided to take my shower after breakfast, because I still enjoy drinking a cup of coffee in the morning, and I sweat through every delicious drop. 

So far after breakfast the day has been variable, as this week is for acclimating to Impfondo, life here, and the heat. Next week I will start to follow Joe or Stephan, the two other doctors here. Then my day will start at 7am, with chapel, morning report, and rounds. After that likely I will see outpatients. One day a week I will have an "alternative ministry day," which can be variable in what I do that day. Hopefully in coming months it means I can take a master's class to finish the four classes needed for my MPH.

Monday morning I went to the hospital for chapel, morning report, and a tour of the hospital grounds. Morning report was interesting...I am told it was all in French, but I couldn’t understand half of it. It could have been because they were mumbling…

The non-medical tour of the hospital was to show me the different wards (each has a separate building), administration, the workshop, the fuel shed, the housing, and a few other buildings. It was more focused on where everything is located than necessarily the function of things. The buildings are all spread out, as the campus was originally build as a communist youth camp. This will make being on call interesting and highlights the importance of a good flashlight. =) 

Off campus

Today was the first day since I arrived in Impfondo that I have left the mission compound. I went to church this morning with the Harvey’s-this meant about 10 kids in the back of the truck, and three adults up front. Most of the songs they sang were translations of english hymns, so I could follow along. The service was in French and Lingala. I must admit, it was difficult to follow, even though I had been able to understand the sermons in French in Neuchâtel before I left. However, I was able to introduce myself in French to the congregation. After the service I met several other of the missionaries and a few people who work at the hospital.
For lunch I went to Stephen and Anna’s (Stephen is an EM/Peds doc here, he and his wife have three kids). It was a fun time getting to know them a little bit more. Their kids are fun, too, and had fun telling me about their current cats, Mr. Spots and Coyote, as well as their former cats that just didn’t make it. (Some disappeared.)

Now I’ve come back and taken a nap, and I’m working on writing a little something before I go over to the Harvey’s for Sunday Night Live, a praise and worship service. I believe I’ll be sharing my testimony. It’s good thing I’ve had practice sharing it several times while in Switzerland, so I already have an idea of what to say. 

Yesterday I was invited to a David and Brenda’s for dinner. They have a pet monkey!!! It’s a bit of a long story on how they ended up with a pet monkey, but let’s just say it wasn’t initially a welcome addition to the family. He was in his cage most of the time I was there because apparently he tends to fling poo at strangers. I was thankful he was left in the cage. =) David roasts his own coffee beans, so I had a delicious cup of fresh roasted coffee last night. He even gave me some ground beans for me to have at my home! Mmmmm. So much better than instant coffee. David and Brenda shared more about the hospital last night, as well of a little of their history of what brought them here. We played some games after dinner. I was a little slow on the draw last night, but it was still fun. David and Brenda also provided me with some initial food provisions, so now I can fix a few things at my place. I really appreciate their generosity!

Tomorrow I will get a tour of the hospital, and start work on my papers for a driver’s license. Tuesday I start learning how to drive a manual transmission. I think the plan is to teach me on the truck that all the gears work. One of them is hard to get into second, I believe, and third doesn’t work at all. Wish me luck and pray I don’t ruin the truck! 

I don’t recall if I mentioned it before, but the cargo container is here in Congo, but we have to wait for the Attestation d’Exoneration before we can bring it to Impfondo. The paperwork is coming together, but one important set of documents requires the signature of a man who is currently in France, and no one knows when he returns. Please be praying he returns soon, signs the papers, and the rest of the paperwork goes smoothly so we can get the container here soon. There is quite a bit of needed medical equipment on the container. 

 

Blessings

After such a rough day yesterday, spent on the phone, writing emails, and waiting for news from people at Samaritan's Purse, I finally have a new itinerary for wednesday for the same flights I was to be on yesterday. It didn't cost much more to change the flights, which is a blessing.

Today I went to the airport to put more money in the lockers where I was keeping my bags, and pay for my excess baggage. If you pay in advance, you can get a 20% discount. So this morning I spent 32 CHF in coins to save the lockers for another 24 hours, ate breakfast, met an interesting man from Chicago area who is a musician here to play a concert in southern Switzerland, and proceeded to go pay for my baggage. Guess who was there waiting for me? The same ticket agent as yesterday. Yippee! He was very polite today, and actually kind. I waited patiently while he went through the process of whatever he had to do on the computer for me to pay for my bags (playing solitaire on my iphone helped pass the time; I decided it was a little less frustrating than Angry Birds, since I just need to get three stars on all levels now. =) He actually discounted a little more for the overweight baggage than usual! 

After paying for the bags, he told me I could go over to the ticket kiosk, check in, and bring my bags up and check them in right then and there. J'avais en imposé! I was shocked! (You mean I could have just brought these here on sunday after I arrived on the train and checked them in then? That would have been wonderful to know!) Never would I have thought that I could bring luggage and check it in up to 20 hours before the flight. It's simply unheard of in the US in recent years.  So, I checked in, traversed back to the train station, got my baggage, and checked it. I have one more piece of baggage to check tomorrow, but I no longer have to worry about getting the four big pieces of luggage out tomorrow morning. Hallelujah! 

So overall, je suis très content. I'm happy. It's been nice to have this extra day in Zurich to relax a little before leaving. I was able to write a letter I meant to write before I left. My luggage is paid for and checked, I do not have to worry about it tomorrow. I'll still get to Congo before the flight from Brazzaville to Impfondo. I got to video skype with my sister-in-law one last time before I left, an opportunity I wouldn't have had otherwise. And last but not least, it lets my dad worry less to know I'm waiting here in Zurich and not in Brazzaville. =) I feel blessed. 

Thank you all for your prayers, and your continued prayer support. They have definitely helped me through this situation! Je suis beni! I am blessed!!