Day One of Surgery is Over

Well, day one of surgery is behind me—at least my part.  Anita and I admitted the patients, which means that we checked their blood pressure, checked for any ordered blood work—there is very little— temperature, respirations, pulse and listened to their  lungs and heart.  None of the kid’s parents knew how much they weighed or how tall they were—they have never been weighed or measured at ages 12 months to 13 years.  The same with allergies—the parents looked puzzled since none of them had ever had any medication.  In fact, by asking, it lead to a long explanation of what an allergy is!  Tomorrow, I’m skipping the allergy question to make life easier for all of us.  Informed consent?  Nada.  I asked if they had any questions and that would be no.  I asked parents if they are worried or anxious, no again.  This certainly ain’t Bellevue!

After the admit, we give each mom or patient a small bar of soap, a washcloth and send them to the bathroom to wash their faces FIRST since that’s where they are operating and then the rest of the body.  Teaching them to put on a gown is truly laughable.  They are so sincere and want this so bad and try to be so compliant and helpful.  The ward is full even though we only do 3-4 surgeries daily.  Many are from so far away, have no place to stay and some have never seen a city before and there is also the concern that they won’t come back if they leave. This is the first time many have seen beds, sheets or toilets.  There is a problem with sending some of the patients to the shower since they have never seen one before and defecate in the shower and wash up in the sink!  Our ward is on the second floor with stairs leading out to the dirt yard.  It is strung with clothes lines since the families of all patients are living on the grounds and need to wash clothes, people are cooking and resting on mats in both sun and shade—and it’s hot.  All the women look like they’re ready to go out—the dresses and headgear is beautiful and it is impossible to tell economic class by their dress.

The admit and post care area is together in a big room on the second floor of the pediatric wing.   We walk the patients down our hall, down the stairs the operating room is across the street and down a long hall.  After they recover—today on a mattress on the floor outside the OR since someone took the stretcher (and left the mattress pad), they are carried or walk back to our unit.  The person in recovery is a Norwegian general practioner who is quite a funny guy and it’s good to have him in case anything goes wrong post op.  Also, he is big enough to carry the patients down the hall, past the masses of people in the lobby, the entrance, across the street, through security again to get into our building.

I haven’t seen the operation yet, but during the first and second surgery today, the anesthesia machine stopped working, which for most surgeons would cause a big problem, but I guess surgery went on!  The surgeon, anesthiologist, and recovery doctor have done this before and seem unfazed by all of the problems.  All three are men of unshakable faith that believe that God sent them here and will help.   Before every surgery there is a prayer to keep the patient safe and help the surgeon, anesthiologist, and assistants. 

The real reward came when Abduman, 12 years old, came back from surgery with a horrible cleft lip closed.  I passed his grandfather walking out onto the fire escape with tears in his eyes.  I don’t know if he was worried or just so happy to see his grandson’s face look more normal.  With their cleft lips unrepaired, these kids are extremely discriminated against in addition to the eating and drinking difficulties that they have.  Hard to believe that this little boy got to be 12 years old with such an obvious and severe problem.   

As I'm finishing writing this, one of the Mercy Ship volunteers knocked on our door to tell us that, patient #3, Nassim, 12 years old is in surgery, the cautery machine isn't working and the doctors can't stop the bleeding.  Her husband is an engineer and he ran over to the hospital to see if he can fix the machine that cauterizes Nassim's blood as they operate.  I really hope God truly is watching over all of this because the equipment, electricity, sterility, and lots of other variables make this a very difficult job!   

The transformation to a surgery area

We arrived in Banjul two days ago.  The trip from the airport was our first site of chaos.  Cars, donkey carts, bicycles and all kinds of vendors share the road and roadside.  People are everywhere, in addition to the plethora of vendors, people are waiting for buses, walking, some just hanging around.  Because of it's location at the mouth of the Gambia River, it became a British city, Bathurst, in 1816 to control the slave trade and to protect the River Gambia, the main entrance to the interior of Gambia.  The population swelled and it became a busy port city until independence in 1965.  As the Atlantic coastal cities grew as a tourist spot for winter weary British, newly named Banjul started a steady decline that persists.  The macadam of the streets is visible under the constantly swirling sand and trash.  Like the trip in from the airport, people are everywhere.  Women in ankle length, vibrant colored costumes carry babies strapped to their backs and children of all ages are everywhere. Men loiter in the streets and comment to all white passersby, especially women.

                                                                                                                           

Between Mumammar al Gadhafi Ave. and Independence Drive sits the mammoth Queen Victoria Teaching Hospital (RVTH), the main hospital complex in Gambia.  According to the tour books, you can do better by going to the private clinic along the Atlantic coast. RVTH  must have been something special in it's day, but now it’s more than a little tatty with peeling paint, the ever  present sand blowing in open windows and again, people everywhere.  It bears no resemblance of what any of us think of as a hospital.  The operating room that we'll be using was dirty beyond imagination.  Walls and floors had to be scrubbed, blood was cleaned from the operating table, patient’s stretchers had torn, thin pads with no sheets.  No oxygen was available in the operating room. Nitrous oxide which is a common anesthesia in the US is too expensive, so Halothane and oxygen are the only anesthesia available--once there is a source of oxygen.  The anesthesia machine leaks so hopefully our surgeon and OR nurses won't get put to sleep also! Broken equipment was pushed against the operating room walls.  Hallways were littered with equipment and people sitting and sleeping along the walls as we walked by.   The lighting is so poor that the surgeon needs to use a headlamp.

The room that Anita and I will be working in to admit the patients and where they will recover had doors hanging off their hinges, the toilet didn't work, no running water, one electric plug worked and wires were hanging from two others, in addition to being filthy and dusty.  BUT the color TV hooked into the one usable outlet was tuned to a Gambian soap opera with the mothers and grandmothers avidly watching. Most of these children, parents, grandparents had never been out of their home villages upriver as much 300 miles, of which less than half of that one road is even paved. 

When Mercy Ship team members started arriving last week, the scrubbing and cleaning began.  The admit area where we'll be working was also painted and using a Disney coloring book as a pattern, a local artist painted Mickey Mouse,  ABCs, Roadrunner and other Disney characters on the walls. .  Once the team found mattress for the WWII style metal beds in a room downstairs, the area was furnished with 24 beds in the one room where all patients will be not only admitted and recovered but since their families have no other place to stay,  they are all sharing the narrow hospital bed with the patient.  Everyone was excited that the beds have siderails that hopefully still go up and down!

It's still not recognizable as an American operating room or admit/recovery area, but 1000% better than a couple days ago.  I have to keep telling myself that this isn’t the US or Britain and these kids will probably die if something isn’t done to close their cleft lips and palates since it’s very hard to eat and keep their bodies nourished to grow.  Some die anyway from malaria or the many disease that are endemic to the area even after successful surgeries.  It’s not a great situation, but it’s the only chance for most of these kids.  First day of surgery starts at 8 AM tomorrow.  Send good thoughts and prayers for all the people involved—they’ll need it!

Goodbye to Iceland

I loved Iceland!  There are about 300,000 people living in a country the size of England with half around Reykjavik and the rest scattered along the coast in fishing and farming villages. The country is such a combination of wild, unpredictable,  sophisticated, friendly and the sheer beauty of the environments can take your breath away.   The diversity of landscape is truly amazing.  It’s similar to the weather—within 5 minutes it can snow, be sunny and cloud up again.  And within a few miles you travel from barren lava fields to deep fjords.  Reykjavik Excursions took us on a snowy Golden Circle tour of the top three tourist sites in Iceland.    Thingvellir National Park is not only the site of the Althingi, the world’s first parliament but where the earth has pulled apart due to tectonic plate movement of the American and Asian plates.  There is a 900 mile rift valley where it’s super easy to see how the earth has simply fallen away as the two plates are pulling apart.  Next stop was Geysir , the original geyser after which all others are named.  In the 1950s unthinking tourists threw rocks into the geyser thinking they could set it off, but only blocked up the flow of water.  After an earthquake in 2000 dislodged some of the rocks, it starting erupting again, but as a shadow of it’s former self.   If it wasn’t snowing, hailing and raining, the area around Geysir probably would have been nice walk though all kinds of geothermal anomalies.  Last stop was Gullfoss, one of the most impressive double cascade waterfalls in the world. The water, lava, and snow combo made a beautiful black and white picture. 

The snow slowed us down considerably and we missed our tour of the greenhouses in Hveragerdi , the town where fruits and vegetables are grown year round in giant greenhouses that are brightly lit most of the day and warmed by harnassing the hot water that bubbles up from the ground everywhere.   Even closed, it was still an impressive site to see. The greenhouse even grows bananas!    The days are pretty dark from Oct to March and without the greenhouses, all produce would need to be imported.  In fact, during our trip, the day would lighten about 8 and be completely dark by 5:30. 

March 1 was National Beer Day.  Prohibition ended in 1989 and Icelanders definitely think it’s worth a celebration.  Fredrick, our evening hotel concierge tried to explain the alcohol habits of the Icelanders, the” runtur”  which takes place every Friday and Saturday night and he’s a big fan.  Alcohol is expensive and the only place to buy hard booze is the “Vin Bud”, 13 state owned liquor stores around Reykjavik.   That’s the first stop on Friday night to get drunk at home and then head to bars and cafes by midnight to continue public beer drinking (beer is much cheaper).  Instead of hanging around one bar, going from bar to bar getting drunker and louder is the norm.  This wild beer soaked party goes on weekly until the bars close early Saturday morning.  Then people hang around outside the “Vin Bud” until 9 AM when the liquor store opens and they can buy more liquor before going home to sleep it off.  Fredrick said Saturday night is a little tamer than Friday.  He also said, “kinda stupid, huh?”  We left Friday morning, so we missed the” runtur”, but not National Beer Day.  The four Icelandic beers that we tried were all excellent!

Icelandic names are worth a couple sentences.  Historically, children were given a first name and the last name was a construct of their father's ( or rarely mother’s ) first name and the ending –son (boys) or –dottir (girls).  ( My father's name is an example of this-Hans Davidson, Hans, the son of David.)  There are also family names that date back to early settlement time. ( Again, my Dad's family name is Slaattebrekk.)  Laws have been passed to stop people from taking a new name either by adding –son or taking the family name of a spouse.  There is also a list of approved Icelandic names that babies can be named unless you want to apply to the Icelandic Naming Committee.  So, chances are,  Anita would have had to pick another name for her daughter Tandi (African for love) or probably Moon Unit would have given the committee a good laugh and been nixed.

We never did see the Northern Lights because the weather conditions were not right.  The tours don’t go out in bad weather because there is nothing to see.

It’s been a long couple of days starting with getting up early yesterday to leave Reykjavik.  Between the ride to the airport, flight to London and transfer from Heathrow to Gatwick—day was pretty much shot.   I went for a walk and realized why our hotel is called the Moat House.  The West Sussex walking path was right behind our hotel and it goes for a couple miles along an obvious moat. Some places I actually walked inside the moat.  No castle anymore but it does make one wonder what it was like before Gatwick Airport was there.  Today was another 5 AM rise to get to the airport and pick up the charity baggage that all of us need to help get to Gambia.  All supplies for the surgeries are brought in by the volunteers. I have never traveled with so much luggage!  So right now,  I’m squished into a coach seat and ready to get to the Gambia. 

PS  It would be nice to be bilingual or multilingual like many of the people we’ve met.  In fact, every Icelander  we’ve met except for the eccentric owner of my favorite restaurant speaks English, but if you have to be monolingual , English is definitely the best language to know!

              

A Short stop in Iceland

When you fly Icelandair, you can stop in Iceland and transfer to your destination flight or you can stay a few days.  We're staying a few days because I want to see the aurora borealis.  I'm traveling with my friend Anita who grew up in northern Sweden and lived with the northern lights, but like most kids, she paid no attention and doesn't remember them.  The flight from Seattle was way too easy for present day air travel.  No lines, searches, or body scans--just a quick 6 hr trip while we slept. The FlyBus that was taking us to Reykjavik had an option of a stop at the Blue Lagoon. So we dug out our swimsuits and  stashed our luggage.  I thought the Blue Lagoon was going to be a touristy, overpriced and quick stop.  It is touristy and pricey, but felt like heaven after our flight--or probably anytime.  The setting is a barren, black lava field with large shallow pools of milky blue, warm, sea water from the geothermal power plant that adds an unworldly feel with smoke stack that spew out more steam to the steam rising from the pools of water.  The high mineral content make for a buoyancy that allows you to float forever.  One of the main minerals is silica which has formed a whitewashed coating all around the water's edge that accentuates the blue water and makes it looks bluer.The silica has formed a hard smooth crust over the lava that has the tough but soft feel of a dolphin's nose--and yes, I've felt a dolphin's nose.  The floor of the pool alternates between hard surface, black sand that quickly falls back into the water, a gooey mud that oozes up between your toes, and a form of hot water loving algae that tickles and I quickly wanted to find a more solid footing.  The same mineral-silica goo is available in several spots for smearing your face to smooth and exfoliate.  It also for sale in the gift shop.  The Blue Lagoon is touted as a medical spa with massage, steam room, and super heated water falls that cascade over your body with a force that makes it hard to stand.  But the best part was the weather--it alternated between raining, snowing, blowing, sunny and hail.  At one point our wet hair was frozen to our heads and covered in hail.  It was an unforgettable experience.

Reykjavik is a compact city of 160,00 people --half the population of Iceland-- but it feels more like a fishing village with restaurants that feature fresh fish.  Saegreifinn is one such restaurant owned by an old Icelandic speaking man who does all the cooking.   It's located on the harbor close to the fishing fleet.  Kinda hole in the wall feel with rough hewn tables and cushion covered kegs for stools. The wall decoration included a stuffed baby seal and a glassy eyed eel. The menu is somewhat limited with 2 soups and kabobs from about 6 types of sea life.  Our dinner was a large basket of warm crusty bread and cultured sweet cream butter, dark red minke whale and the best lobster soup I can ever imagine.  I don't know the status of minke whale in the world, but in Iceland, it is considered a highly desired delicacy that should be cooked med rare and it was a real treat.  It has the consistency of steak but with a sweeter taste.  All this washed down with cold, local beer--there are several to chose from.

A few thing that I've found interesting and you might not care about at all:
Iceland is one of the few places in the world with no prehistory.  There were no indigenous people living on Iceland when it was "discovered" by Irish monks and then settle in the 900's by Norwegians and their Irish slaves.  (Someone said it was settled by the most boring people in the world accompanied by the drunkest.) 
All the land was allocated within 10 years of settlement by the Norse and those property lines are still there.  There is a written history of all of the land transactions and they actually know the names of these early landowners.
In late 900s, the world's first parliament, the Alping, was formed and is still the form of government in Iceland.
Iceland remained isolated from the world until WWII drug them into the 20th century. The Icelandic language is so closely related to ancient Norse that the text of ancient manuscripts is readable by modern Icelanders
There are so many -"dottir" and -"son" common surnames that the phone book is by first name since there is a limited number of last names.
The sagas--stories of the early heroes-- make our origin myths seem dull.
Even though the Icelandic kroner lost  half it's value during the 2008 financial meltdown, it's still expensive here

It's snowing and I'm off to explore.

What little I know about The Gambia....

Before planning this trip I didn't know where The Gambia was.  I actually thought I was going to Zambia!  On the west coast of Africa, tiny, anglofile Gambia is completely embedded in francofile Senegal .   My grandson pointed out that Gambia resembles a finger being poked into Senegal. For some reason, it's The Gambia, not Gambia, but for the sake of easy reading, I'm acknowledging the "the" and omitting it. The area has a long history of nomadic people, great empires, and a thriving local slave trade that morphed into the Portuguese, French, English and American slave trade.  The boundaries of the African countries were defined far from Africa by the Europeans in 1845.  England apparently didn't want Gambia since it was just a small strip of riverbank along the Gambia River, far removed from other British colonies and had no resources to easily exploit, but no else wanted it either so it remained a British colony until it's independence in 1962.  The Gambia has had the usual political, social and economic upheavals shaking off colonial rule to become an independent county.  Today, it has a stable, but oppressive government and is one of the poorest countries in Africa in spite of  thriving resort cities on an idyllic looking white sand coast.

Trip Preparation.

As I sit down to write this, it's chilly and snowing outside so the thought of 85 degrees and white sand beaches is sounding pretty good right now-even if it's a working trip to Africa.  Preparation started several months ago, and like most long trips, there's a lot to do before leaving.  Tony and Ann (T&A),  with Mercy Corp have been doing most of the organizing.  It's like being on a tour with someone else taking care of the details.  They send long email telling me what to do, what to pack and what to print out to take with me. I have letters from Mercy Corps stating that I'm  part of a team working at the Royal Victoria Hospital in Banjul, the Gambia Immigration Department with an entry Clearance, a Letter of Acknowledgement from the Gambian Ministry for Health and Social Services welcoming me to Gambia and thanking me for providing humanitarian support to the people of Gambia.

Also needed was a trip to the travel clinic for immunizations required and recommended for Gambia, in addition to antibiotics for a plethora of bugs that are common in Africa as well as the usual flu and respiratory infections that we can get anywhere.  Gambia is Sub-Saharan Africa so I needed shots for yellow fever and  typhoid, in addition to having polio, tetanus, DPT and hepatitis A & B  up to date.  I will be taking doxycycline for malaria prophylaxis while I'm there and for awhile after getting back. I didn't elect to be immunized against were meningitis and even though there is a cholera outbreak in that part of Africa, the immunization for cholera has not been approved by the USDA.  That would have meant a trip to Canada where it's readily available.

 T&A also made my reservation to fly to Banjul, Gambia from London, and provided me with the name of travel insurance for people doing humanitarian work that is much cheaper than anything I could buy and it has good evacuation insurance! They have also graciously answered some pretty stupid questions from me and  others.  

All the supplies and equipment for surgery are being brought by us, so Thomas Cook Airlines has given all participants permission to have an extra 20 kgs of "charity baggage".  Someone packs these bags in England and they are delivered to us at our hotels in London.  We need to look inside--there are people that feel the need to repack them-- so we can tell British airline agents that "yes, I packed all of my bags and know what is in them".  I'm also taking lots of stickers, coloring books, pens, pencils and writing tablet plus some outdated medical supplies from work.

So, I'm prepared and ready for this adventure!

The Gambia, Africa, 2011

I'm off to Africa for a 4 week stint at the Royal Victoria Hospital in Banjul, Gambia. I will be working with kids and adults in the cleft lip-cleft palate clinic.