Transition Home

After the three flights and one train ride, I am safely at home in Charlottesville. Compliments to Ethiopian Airlines and their new 787 Dreamliner…really nice plane. And a huge thank you to Claudia and Vicki for not only the ride home from the train station but for taking care of my plants and ‘life’ while I was away.

The only culture shock that I have really had during this trip was walking to the MSF office this morning. There were a film crew shooting an episode of a TV show, police sirens blaring, ambulances, people walking about, and taxis zipping around. It was hard to imagine that less than 36 hours prior I was in a 2 year old country with so few resources, less than basic infrastructure; and NGO’s supporting (as best as possible) the basic needs of food, shelter, and medical care to its population. It is a very crazy world in which we live. I will sum it up with a quote from a friend’s mother, “be thankful…you could have easily been born there instead.”

Thank you all for reading and keeping up with my adventure. I’ll let you know when the next one occurs so that you can follow along. Its now time for bed…work tomorrow at 7a!!

Jeremy

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The Long Trek Home

Well its hard to believe that 6 weeks has already passed! No going away would be complete without a party. Alice the OT manager baked two cakes, and Nicola provided dancing music…all after the surgeries were finished of course.

I headed out of the Aweil umm airport aka huts and an airstrip yesterday and arrived to Juba safe and sound. After completing all of my in field debriefings, and putting the final touches on my end of mission report, I have the day off!

Tomorrow I leave Juba for NYC via Washington DC for the last few briefings on Monday and then arrive to Charlottesville on the train around 9:30 Monday night.

Thanks to all for showing interest in my adventure and sending notes of support. I’m looking forward to getting back to ‘work’ and my boring routines…lol

Best Jmay

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One Last Night

Last night was my longest and most challenging day to date here in Aweil. After a long day and several added gyn cases, I was asked to sedate a 10 year old rape victim for a pelvic exam.

Communication is always difficult because translators often interpret what they think you are saying; or who knows what. Nothing to eat or drink since last night was actually not true….thankfully the staff saw her drinking mango juice and fessed up to her non-NPO status. Emotions were tense and I elected to have her wait the 4 hours until 4p before doing her procedure. Of the roughly 250 cases that I have anesthetized in Aweil, this is the only one that vomited….to the tune of 300ml of mango juice. Today thankfully she seems well and without any clinical signs of aspiration.

I returned to base around 6:30p after she left recovery and quickly ate dinner before seeing the OBGYN and Midwife literally running to the car and heading to check on a hemorrhaging postpartum patient. The OT manager and I headed in behind them. The patient had delivered one of the twins at home, dead, and then came to the hospital for the second delivery. The second child delivered without incident…placentas too delivered without problems. Except no amount of pitocin, methergine, or misoprostil was controlling the hemorrhage.

Upon entering the OT the pulse-ox wasn’t picking up a signal and she was gasping a few breaths a minute. An induction of 1mg of epi, 100mg of ketamine and 100 mg of suxamethonium yielded a successful intubation, a BP and 100% saturations. The uterus was white and soft, Carl was able to ligate the uterine arteries immediately after incision. But despite our best efforts (3 units of whole blood – all that the blood bank had, 7 mg of epinephrine…) we couldn’t correct her coagulopathy. Immediately on arrival to the post op unit she died. It’s a difficult feeling to do everything that you can (without having any FFP, pooled platelets, cryo…etc…or labs other than an Hgb) and having a surgeon do everything he can and still you can’t control bleeding or prevent the death of someone that likely wouldn’t have died if we were in the same situation in the USA with unlimited resources.

Carl’s second maternal death in 35 years of practice and my first. This day made for a long night thinking about what I could have done differently. Thankfully the rest of our night was quiet.

Tonight is my last night in Aweil, and then I begin my slow trek back to Charlottesville. I’m looking forward to relaxing at home and seeing friends!

Best
Jmay

A Change of Hands

I can’t believe that it is already Thursday!! Its amazing how quickly the time has passed during the last month. Also, I am so glad that I do anesthesia and don’t have the patient load and responsibility of 40-ish patients that the medicine doctors are covering (and double checking that the national staff are actually doing what they are saying they are doing).

After raining all day Saturday, we decided to eat dinner out at the only ‘approved’ restaurant in town, Ethiopian. As funny as sounds its been our only dinner out since leaving home and was really good food. It was just nice to hop into the car (10 of us) and head off compound to enjoy a night out. There are a few pictures attached from that night.

John’s last night proved to be an adventure. Two back to back c-sections, and then they called us in for a manual evacuation of a retained placenta with a hemoglobin of 3.4!! Luckily, he and I coaxed the midwife on duty to do the D&C and dutifully watched his success; while we squeezed in a unit of blood. As sad as I was to see him go, John had a smile on his face that was a mile wide. I really enjoyed my time with him and look forward to connecting in Asheville later this year for a visit.

Carl is his replacement, they did a 10 minute handover at the airstrip, gotta love MSF efficiency…lol. As it seems to go, trial by fire is the best way to enter the Aweil Medical team…while at lunch on Tuesday (Carl’s first full day here) we receive word that MSF-Spain was sending us a maternal transfer. It turned out to be a cow attack…lol…horn through and through two holes in the abdomen, right through the uterus. The people here have no fat or excess anything, so her pregnancy actually saved her life. The small intestines and half of the baby were hanging out of the two lacerations from the horns. We quickly got her into the OR, off to sleep (hand ventilating….), gave blood while Carl performed an exploratory laparotomy hysterectomy c-section combo surgery. She is definitely still in the recovery mode today, but is alive. No liver, spleen, bowel injury what-so-ever…amazing. The second day, again at lunch time, was a c-section. He is getting the picture that anything and everything weird and surprising can happen in Aweil.

Pictures are a few of the the abscesses that have now gotten to the bone, Carl ‘fixing’ the cow attach victim, me with Nicola and Jackson, and the sunset from the compound.

After fun times and hard work its down to one week left in Aweil. So much planning and preparation and now its almost over…quite hard to believe. I will definitely do other missions with MSF but for now I will also enjoy being home getting back into a routine at home.

Enjoy your Thursday,
Jeremy

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Cataracts and More of the Same

Greetings from Aweil!! Its had to believe that Monday marks four weeks in Aweil. I have two weeks to go while John heads home with a very big smile on his face. It has definitely been an amazing month!

Since the last update John and I have fully recovered from our little ‘bug’ and life on the compound has been back to normal. The maternity department has been steady, but not out of control like our first week here. However, we did unfortunately meet a few of the negative statistics that no one wants to personally experience.

As with all things, no prenatal check up leads to all sorts of things at the point of delivery. We had a c-section on Saturday evening for a 13 pound hydrocephalus fetus….approximately 5 pounds of body and 8 pounds of head, the size of a basketball. The physical features were quite distorted and fortunately for all practical purposes the baby drifted off of to sleep after only making it through the night. Another smaller hydrocephalus (although not alive and not nearly as large) arrived with the left arm (and up to the elbow) as the presenting part. Another fatal home delivery that ended in a very difficult vaginal delivery, thankfully under spinal anesthesia, and without having to do a total destructive delivery. Then Tuesday morning there is a frantic call over the OB radio, with the words seizure, low sat, low heart rate….John and I headed into the hospital to find a failed resuscitation and a pulseless patient. In briefings, and in practice, you know that these things can happen but its still unexpected and extremely sad all at the same time.

With all of the ‘negative’ things above, it is nice to share that I had a little bit of a change of duty the last two days. The hospital that we work in, is a Ministry of Health hospital, and we manage the maternity and under 15 yr old patients. The other departments are all managed and supported by the State. On the property of the hospital, other NGOs (None-Government-Organizations) come form time to time to perform various health campaigns. This week two ophthalmologists from Kenya (via Michican and Alabama) have hammered our 400 cataract patients…..Dr O, I think only you could keep up with this pace!! They had two pediatric patients (5 & 9 yr old) that needed sedation in order to get the block placed and to perform the surgery. They contacted my Field Coordinator and asked for anesthesia support and I was happy to offer a hand to their project. These kids were ‘born’ with cataracts and tomorrow will ‘see’ for the first time. The 9 yr old may have less of a response as the surgeon explained that the neuro-pathways between the brain and eye stop ‘forming’ between 9-10 years old, but the 5 yr old will likely gain complete sight. It was a ketamine / diazepam ‘MAC’ that took several hours for each of them to recover from but the rewards for those kids will be worth the painful IV placement and the few hours of feeling like they are coming off of an LSD trip!

Be thankful if you can read this blog, because that means that you didn’t have to walk 10 miles to get medical care today. I will admit that I am ashamed of the USA, these people are willing to give anything for a chance at having healthcare, yet we are shutting down the government in order to prevent access to healthcare. Politicians should be hung and quartered for allowing the country to get into the position…..ok enough with that rant!

A few pictures of: the only diaper I’ve seen in South Sudan, a happy patient that no longer needs anesthesia for her dressing changes (and who has no idea what a whale is…lol), Paul making us popcorn, and another dressing change patient.

Hope that all is well with everyone back home,
See you soon
Jeremy

& 9yr old)

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It’s Friday!

Hopefully everyone’s week is winding down nicely and you are all ready to enjoy some cool fall temperatures. All I’ll say is that I’m jealous!

I am finally settled into a nice routine, I mean really, I just don’t see why UVA operating rooms can’t start until 830-845a?? Would it kills us really?? And John will enjoy scheduling a late morning Tee-Time…

I will admit, though not a coffee-a-holic, I definitely miss that part of my ‘old’ morning routine. We do have coffee…Nescafé, and even some grounds but they don’t measure up to Higher Grounds! John has shared his folgers silk and that is surprisingly the best tasting morning brew here.

It’s amazing how the time clips past, I’ve got 3 weeks left?!?! And John has around 2 weeks remaining. To our luck, (as we have both caught and begun the recovery from the ‘Aweil MSF Compound’s Obligatory GI Bug’) the c-section rate is back to it’s previous rate of 2-5%. Births are still between 10-15 with somewhere around the same number of intrauterine fetal demises each day (some way early and others near term). A few of my burn / abscess patients have progressed on and are now only needing dressing changes in the surgical tent (that I had previously sent a picture of).

I’m including a photo of:
the hospital front gate, Nicolas (my anesthetist colleague), what happens when you are malnourished with a major wound and have shall we say thick skin (it’s not Stevens Johnson’s…but those are intact soles of his feet that were peeled off of…with completely intact skin under it), the pushing /delivery area…note the squatting area in the corner!! A new snake bite on a 3 yr old’s thigh, and a small portion of the warehouse where all of the supplies are kept! MSF definitely provides support to its missions!

Well it’s time to relax here on a Friday afternoon! Thanks for the emails, notes on wordpress, and a few face times! Miss you all and look forward to seeing everyone soon! But until then Aweil definitely needs me more!

Xoxo jmay

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The Weekend and Monday

Good morning all,

Just thought that I would send a few photos of things around us….

The big truck..notice no front windshield…brings us food and supplies from Juba. For only $6k it drives supplies for the hospital and compound on the 600 mile journey in only 2 days time once every couple of months.

The Tuk-Tuk getting a tire change….the market on the walk to the hospital. The Map of the hospital…kids that are always wanting a hand shake and hello when I arrive to their ‘IPD’ in patient department. The generators that give us light 24/7!!

John and Kayo hard at work during a C-Section.

The weekend was nice, we were able to leave the compound and explore the market. Lots of interesting wares, food, clothes etc. Only 1 c-section Sunday afternoon left us with a nice and relaxed weekend. Monday was busy as expected with my typical burns and dressing changes; while John accepted a transfer from another MSF hospital for a gyn consult.

It’s now dinner time and time to relax and wind down.

Best to you all
jmay

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