Everyone keeps asking for pics of Nathan... here you go

Everyone keeps asking for pics of Nathan... here you go

Welcome to the MEGA-POST! You honked, I listened.

The Introduction

Ok, I confess I’m not a very good blogger. Considering my grade in journaling from high school English, my old English teacher would say she could have predicted this. Please stop honking at me!

It’s been difficult trying to decide where to start first on the blog. Since coming to Soddo, I’ve seen more patients than I can shake a stick at but the big issues have been deeper than that. According to books and people who know, I’m starting to forge into the first real bite of culture shock. Frankly, it’s been kind of difficult for the last several weeks. It is rather difficult to describe without feeling like I’m just whining. The best way I can describe it is that, experientially, the whole is greater than the sum of its parts. When I look at all the little factors (different sights, smells, sounds, tastes, different cultural views on work, surgery, etc, new people, new places, stresses at work, loss of familiarity, loss of “places to hide and recoup”, new responsibilities, new challenges, etc), each one by itself is not that big of a deal. However, the accumulation sort of takes the wind out of your sails.

The good news is that I serve a wonderful God who has been gracious and merciful with me. Just as I have a hard time describing the challenge; it is equally difficult to describe exactly how much Christ has sustained me since coming here. Just as the challenge is nonetheless real, God’s strength for me has also been nonetheless real. I’ve seen a lot of good done here and the rough spots, though still quite rough, are slowly improving. More importantly we have seen lives changed. The Bible teaches that, without exception, every person has rebelled against God in sin and has therefore forfeited life. Each day that we receive before our natural death is simply a gift from His mercy. In the end, though, the only hope we have has been offered by Christ in His sacrificial death on the cross for us. He died and rose again so that we might be forgiven and live as well. We have seen patients enter the hospital in a state of spiritual death and leave with new life, changed forever by Jesus. That is very encouraging!

The Drama of the Trauma, a.k.a. Trauma-rama

I’m sitting here rather whipped on a Saturday afternoon after an eventful morning. When I accepted the (much appreciated) offer to work as a trauma surgeon for a year before coming to Ethiopia I had no idea how helpful it would be. As the great Clark W. Griswold of National Lampoon’s Christmas Vacation put it, “if I woke up tomorrow with my head sewn to the carpet, I wouldn’t be more surprised than I am right now.”

I was called at four thirty AM by the on-call resident that there was a patient with a bowel obstruction and by five thirty we were climbing into yet another obstructed Ethiopian abdomen. I have no idea how many obstructions I’ve seen here but it is quite common. Most of them are from bowel twisting on itself and kinking itself off. I suspect it is due to a combination of almost no fat in the abdomen and their high-residue diets. This case involved a part of the colon twisted on itself so severely, that it was as big around as my arm (which way to the gun show?) and very dead. By seven forty-five AM we had removed the dead bowel and given him a colostomy.

Hmmm, beets...
Hmmm, beets…

As I left the OR to see a few patients before one of our weekly resident conferences, one of the residents came rushing into the OR building to inform me that fifteen patients were in the emergency room after a bus crash and were in bad shape. He had one of them in tow on a gurney that was having a hard time breathing. After a quick examination revealing broken ribs on both sides and diminished breath sounds on one side, we pulled him into one of the rooms and placed a tube in his chest, allowing air and blood to escape so the lung could expand. Tasking the resident with settling the patient into our “ICU”, I quickly visited the emergency room.

True to billing, there were moaning, bleeding people on gurneys and benches everywhere. As a resident, I always sort of dreaded the day of the “mass casualty” drill at Baylor (sorry, Dr. Foreman). It’s kind of like when there is a hurricane approaching and, when you watch the news, you see an aerial shot of a highway. On one side, there is bumper to bumper traffic of people trying to get out of way of the storm. But on the other side, there is this one car travelling toward the coast with a surfboard on the rack? Those are the people that become trauma

surgeons. I, however, am one of the people in bumper to bumper traffic. I certainly did my best as a trauma surgeon, but, in all honesty, I earnestly hoped I would never see a “mass casualty”.

Oh, well. Now I’m quite thankful for those drills. I took a deep breath, recollected what I have been trained for and learned and, most importantly, tried to emulate what the Baylor trauma surgeons would do. After taking a quick survey triage with Dr. Anderson, the orthopedic surgeon, and Dr. Morad, the ob/gyn surgeon, we appointed the patients to either an OR room, the ICU or further evaluation by the generalist doctor in the outpatient department. Residents were assigned to the ICU, an operating room or the outpatient department. As I bounced around trying to guide and coordinate, the whole team really did a great job given the minimal resources. So far, I believe we have done all that we can. Most people are doing fairly well, though there is a young girl with a severe head injury for whom I’m very worried. Even with a real ICU, I suspect she would have a long road ahead of her, if she could pull through, but with no ventilator she may not survive. If you think about it, say a prayer for Bayush.

All in all, as “mass casualties” go, this was really quite benign. I’m thankful for the easy first run as it has given me good information on how to better prepare for the next one. That’s right, Soddo surgery residents, it’s about time for a “mass casualty” drill!

The Surgery “I’d like to phone a friend, Regis” Clinic

Most surgeons would agree that clinic is the necessary evil to get you into the operating room. Don’t get me wrong, we like visiting with patients (most) but operating is where the fun is. Clinic here in Ethiopia has added a whole new dimension of difficulty. If I can recognize half of what comes through the door, it’s been a good day. There have been a few days where I didn’t see a single diagnosis for which I was trained. It’s not uncommon to see a patient with some huge thing on the face, followed by a man with a crazy wound eating through his skull, followed by a woman missing half her toes with some another crazy wound, followed by a boy who can’t see out of one eye because the rainstorm that just happened twenty minutes ago involved a piece of hail that hit him in the eye (I’m not kidding), followed by a woman who is tiny and thin all over except, from the mid-upper arm down, she is the size of Andre The Giant.

And don’t forget the language issue. If there is a resident in clinic with me, it’s much easier because at least he speaks Amharic well and understands about medicine. Without a resident, it all goes through one of the nurses who, though very nice and helpful, don’t understand or speak English as well. (By the way, we are feverishly working on Amharic to be fluent someday circa 2040.) If all the patients spoke Amharic it would be great, but many only speak their tribal tongue. I’ve had many experiences where I have asked the nurse when was the patient’s last menstrual period, she then speaks in Amharic to the patient’s family member or friend, who then speaks to the patient in the tribal language, a lengthy discussion ensues going back and forth between the patient, the friend and the nurse, and is finally concluded several minutes later with the nurse informing me that her back hurts.

It is definitely a challenge! The sad thing, though, is how advanced everybody’s diseases are. We are seeing a lot of cancer here but, for the majority, all we can offer is palliation. For nearly all of these patients, the disease has already extremely advanced. Nobody just has a little melanoma. They all have massively swollen, ulcerated lymph nodes. We see a lot of esophageal cancer, but so advanced they can’t swallow anything. There is a lot of stomach cancer, but they are totally blocked off and have lost an extreme amount of weight. I’ve actually seen two cases of advanced gallbladder cancer here (I may have seen two in my entire residency).

Tensions run a little high in Amharic lessons... ;)

Tensions run a little high in Amharic lessons... 😉

Home, Sweet Home

However difficult the day, or night, may be, it is always a pleasure to come home. One of my greatest blessings from God is Becca. I wish I could adjust as well as she has! The other day I accompanied her to the local market with one of the ladies who works in our house and I was amazed at how much Becca looked like a pro. We wove through the thatched stalls and she pointed out all kinds of sacks of grains and beans and little things that were used for any number of foods. She is figuring out life here in a wonderful way and she is a true source of strength and encouragement to me. It has been so nice to come home every evening and spend time together. Nathan is growing up healthy and we both love watching him learn about life. He is such a cheerful little guy and a blast to play with. If only there was some way to harness his energy! He plays all day and sleeps all night.

We are really enjoying the other missionaries. It is nice to have a little community to share the times with, both good and bad, and I feel like our relationships are deepening. Again, I’m thankful for all of the supports that God has put in our life.

Thank You

Finally, I wanted to thank all the people who have been supporting us and praying for us. There are some amazing people back home who are really giving sacrificially to make this whole thing possible and we want you to always know that this is your ministry. We pray that we represent you well and that you are proud of us and what you are doing. You have encouraged us more than you know. Please keep prayin

Nathan's Jack Black impersonation from School of Rock

Nathan's Jack Black impersonation from School of Rock

g!

In His service,

Paul

P.S. Becca proof-read this post and felt I should mention that I’m actually doing OK. Granted, I’ve lost a few pounds (you would too if your diet shifted from burritos and chocolate to vegetables and grains) and life has been a little stressful, but we’re happy and feel confident about coming here. I’ve even managed to hook Becca on a video game we can play together!

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