Monday, February 27, 2012

A long time coming...

So I realized it's been almost two months since I've posted something to my blog. In order that you know I'm still alive, and I'm still here, I thought I better update the site. Here's the news:

1. I'm returning to the US for about 5 weeks, arriving March 9th, leaving April 10th. If we haven't already arranged a time to get together, and you'd like to get to see me, please respond and let me know. I don't really plan on leaving the tri-state area, so visits outside of IN-MI-OH are less likely to occur.  I'm excited about this chance to see my family, meet my two nieces who have been born in my absence, and reconnecting with family and friends. Please be praying for me during this time, as there will be sure to be some reverse culture shock. If you see me and really want to know how things are going, please try to ask some specific questions, such as 'what's the hardest part about being there?', 'what's your favorite thing about being there?', 'what's the weirdest thing you've seen or heard?', etc, and more than just, 'How is it?'. For those who just want a general answer, you can ask the latter question. Please try and be supportive as I may have times I'm a little moody, or tired or reclusive. My life here is quite different than my life I had back home, and so it will take some adjusting. 

2. I've been doing more surgeries in the absence of a trained surgeon. There are still quite a few skills I would like to learn, and really could use some more help with clinical decision making with who to operate on, when, and how to handle some of the post-op complications. (Hint hint, Dr Noveroske-come help!) Some things I learned while a resident, some I'm learning by experience, and some I learn from books. If any of you surgeons I know want to come for two weeks, a month, a few months, I'd love it! (and so would the other docs here) We had a surgeon with Samaritan's Purse come in Nov-Dec of this last year and I learned quite a bit from him. I finally was able to see the hernia sac in repairing inguinal hernias (to that date I thought they just made it up...). He also taught quite a bit with ultrasound, and help us acquire a new portable machine through Samaritan's Purse and money we received from UNHCR (United Nations High Commissioner for Refugees). It is SWEET, and allows a clarity we never had before. There are three probes that we purchased with it-abdominal, small parts, and cardiac. Now I'm only wishing for an intracavitary probe so that I can do vaginal ultrasounds on early pregnancies. But since most women here are really thin, I can usually get a good enough image with the abdominal probe. 

3. We are almost always in an energy crisis here at the hospital. I haven't talked about it much in the past, but we have three systems for power. 

1)A generator, which costs $14/hour to run, and depends on diesel that comes up from Brazzaville on boats, which is dependent on sufficient rain to bring the level of the river high enough for the boats to come through. We are at the end of dry season, which means there is little diesel left in town, and it will be a few months before the river is high enough for the boats to come up. 
2)Solar power-we have multiple panels that pull in solar energy (which works well as it is so sunny here), except it requires a)good batteries to store the energy and b)an inverter to convert the stored power into usable power (from DC to AC). Being as our energy requirements are pretty high, this requires two large inverters. Between the batteries and the inverters, we haven't been able to keep a good charge in the batteries in a few months, which means sometimes the power goes out during the night. When there is no electricity, the portable oxygen concentrators don't work, and the incubaters for the preemies don't keep heat. Some of the problem has been ameliorated by a grant from the US to install a large oxygen concentrator with 6 bottles for storing oxygen, which we place strategically throughout the hospital for use when there is no current. We are the only place within the whole Likouala region with oxygen and incubators. We put the preemies on the mom's chests to keep them warm when we have no current for them. However, the concentrator relies on generator power for use, and can take 1-2 days for the bottles to fill (they hold 2000L of oxygen, which goes fast at 2L/min). So there are benefits and downsides. This last year we received the same grant again, and now we are working to purchase the materials to redo our electrical system with larger solar panels, better batteries and inverters, with enough current that we should not outgrow this system for the next 10 years, despite any improvements/expansions we may make. There are two people stateside who have planned and designed this system, and they are working to order the parts. There is a team coming this spring to build a new power building. Also, this new system can automatically switch back and forth between the three electric systems depending on the current needs of the hospital. 
3) SNE, or the national power company, also supplies power. They turn the power on for 1/3 of the city almost every day, for usually 2-4 hours at a time. Currently we are not getting all the current possible because someone stole the cable that connects us to the power. To replace it is very expensive. We think either someone working at the hospital stole it and sold it, or someone working with the power company took it and sold it. So, we have a temporary cable which doesn't bring as much current as usual. In addition, during rainy season, we have many lightening storms, which have a predilection for striking the hospital or the mission. So during rainy season the power problem is confounded by almost weekly repairs to the system due to lightening strikes. So, please be praying for our current, for the people planning the new system, and for protection that it is not struck by lightening and lasts as long or longer than we hope.

4. There is currently a Cholera epidemic in our region. There have not been many cases in Impfondo, but there have been around 100 cases in several outlying villages. Be praying that this will be controlled soon, and the messages about good hand-hygiene, safe food handling, and clean water get out to all the region. Not only these things decrease the risk of cholera, but also other diarrheal diseases.

5. I've been working on learning Lingala in the last few months. It took a good 7-8 months here before I could get to the point that I had room in my head to learn Lingala along with everything else I was learning. It's coming along slowly but surely. Most of what I know only works in the hospital, so get me out in town, and I'm lost if I can't ask you 
1)if you've had a fever, 
2)if you are eating and drinking ok, 
3)if you are having diarrhea or vomiting, 
4)if you are peeing and pooping, and 
5)if you are standing and walking.
6)I can tell you to come, go, stop, wait, and be quiet. All of which I think are rather important. ;-)
7)I can say 'take off your clothes' in three languages now. Never thought I would be able to say that...or need to use it.