Zeke celebrates his 30th birthday with dancing and singing!
Thursday, January 29, 2009.
What a week. Sorry it has been so long since we’ve written, but it has just been a very busy week, so many things happening, so many emotions, many ups and downs. Everyone is having a difficult time, and yet having a wonderful time as well. This will be a very long blog, but it is covering 6 days, so bear with me!
Sunday, January 25, 2009. Tonight, our relaxing evening was interrupted by a nurse coming to get us because of a gelly-gelly (bush taxi) accident. Eight patients had just presented to the OPD with various complaints after a gelly had been basically head-on’d by a large truck. The passenger in the front of the vehicle was the most injured, with facial lacerations and a right leg injury that we suspected was either a muscle rupture or a femur fracture; either way, a significant injury. The rest of the patients had various lacerations, contusions or abrasions, or mild head injury. We were able to triage everyone and get them all treated in a matter of 30 minutes, with a little extra time for a few of the lacerations. Jules did her plastic surgery magic on the complicated facial lacs, while Lonnie repaired an upper lip and the rest of us managed the other cases. Teamwork. ☺
Monday, January 26, 2009. Today was another trip to RVTH for me, alongside Adam and Amelia. Adam presented “Damage Control Surgery” to the surgical staff and medical students for Grand Rounds, and he was quite a hit. Following, one of the Cuban surgeons, Dr. Felix, took us to see the OR’s, the surgical ward, and to follow up on the patient that Amelia had transported to the A&E department the previous Friday. She was much improved, and had not required surgery. She was very happy to see Amelia again, as was her family. We had a lovely meal at a local restaurant while waiting for our ride back to Bwiam to arrive. We returned just in time to race to our evening clinical lecture, which was Jules presenting a summary of burn care. She used as a case study our patient from the other day who had suffered severe burns, and sadly passed away from his injuries during the night. It was not only a good review of burns and their treatment, but a stimulated discussion of the issues associated with care of a critically ill patient here at a facility with limited resources.
Tuesday, January 27, 2009. This was a wonderful day altogether. In the afternoon, after much hard work in the OPD and scanning, rounding, Adam doing surgeries, we all went to the local women’s group, the Kofa, which Lonnie has mentioned previously. They were making “tie and dye”, which is the process of dyeing fabrics in special patterns. It is very similar to what I call “Jerry Garcia tie dye” in America, but they don’t actually tie the fabric at all, they lie it out on the ground on canvas and twist it around into patterns with their fingers. Then they pour the various dye colors onto the fabric, rather than dunking the fabric into the liquid dye. The result looks nothing like what Jerry Garcia tie dye looks like; it is intricate and beautiful and amazing. We were invited to watch the women make this fabric, as we had seen samples of it and had let them know that we wanted to purchase some from them. What a lively group of women! Greeting went around and around, making sure all of us had Gambian names, and telling us which ones of them we were all related to, then shaking all of our hands and going through the various Jolla and Mandinka greetings over and over. We felt very welcome. The process of the tie and dye was fascinating, and what ended up looking like an absolute mess on the ground turned out to be beautiful and captivating once it was rinsed and hung up in the African sun! We were appropriately enthralled, and shelled out our Dalasi for the materials. These kinds of interactions are so special, and the vision of those women, all smiles, dressed in beautiful colors, will be with me forever.
Later in the evening, it was time for our clinical lecture. Adam had brought the equivalent of ATLS, Advanced Trauma Life Support course, which is the basic training for medical professionals in dealing with any patient that has a traumatic injury. Because there is a large amount of trauma here: traffic accidents, pedestrians struck, falls from height, animal-inflicted injuries, and sadly, teacher-inflicted injuries to children, of which we saw many and had a very difficult time dealing with, we felt it would be a great topic for the staff. We used our gelly accident patients as case examples. Halfway through the lecture, after most of Adam’s questions to the audience were answered incorrectly, he realized that perhaps the subject matter was a bit over everyone’s heads. So he asked someone to volunteer the definition of “trauma”. No one was able to answer correctly! Imagine that nurses caring for patients on their own would volunteer “unconscious” and the definition of what a trauma patient is… So Adam backtracked and started at the beginning, defining trauma and what constitutes a traumatic injury. It was another wake-up call to us about our lack of understanding about the staff’s breadth of knowledge. No one working here had ever learned about trauma or the care of the trauma patient. No wonder we see them doing all the wrong things, they haven’t learned the right things! Certainly their ability to provide exact care according to ATLS is limited given their environment and lack of equipment, however knowing what to do and not being able to do it is very different from not knowing that you’re not doing the right thing. This is all the more reason to continue to share our knowledge and training with those here. As the lecture concluded, we all felt that even though the subject matter was simple, it made a positive impact.
After the lecture concluded, we returned to the house to have a surprise party for Zeke, who is turning the big 3-0 today! We had arranged to have some local women led by Lonnie’s “Gambian mom” Gia, to come by, along with 2 drummers, one of which is Gia’s grandson, to play, sing and dance local music for Zeke’s party. They were wonderful, and we all sat on the back porch, clapping, singing and dancing with them until very late. Julie had brought party favors that made a loud squeaking sound when you blow in them, and the women could not get enough of the sound, blowing into them over and over while dancing around singing “Happy Birthday to You” to Zeke. Zeke was quite animated, joining in the African dance with skill befitting a true Gambian, and even taught the women some of his own moves! It was a very good time, and marvelous to be able to experience the local music and dancing with people like Gia and Seiku, her grandson, to whom we have become so close. Too many JulBrew’s now, time for bed.
Wednesday, January 28, 2009. This was a very busy day with some very sick patients. Julie admitted a 3 year-old boy with high fever, convulsions and coma. She suspected cerebral malaria, which was confirmed with a blood film showing 1+ parasites. Despite the appropriate medication, the baby had 2 further seizures throughout the day and did not improve much. It was difficult to watch him suffering so much while waiting to see if he would get better. Another patient, a woman with an abdominal hernia, unfortunately passed away today from complications of poor blood sugar control. None of our team were directly caring for her, however each of us were involved in her hospital course at some point, and all of us were very emotionally involved in her well-being. It was a somber group that had dinner together tonight after hearing of her outcome. One of the good things about being with a team, though, is the ability to talk through difficult situations such as this and gain perspective, to help everyone cope.
Another patient, a pregnant woman, about 34-35 weeks along she thought, her 10th pregnancy, had had her water break 2 days prior to today. She was having no contractions, but she was no longer feeling the baby moving. She had been admitted, and today Amelia and Dr. Spencer, the surgeon, had performed an ultrasound, showing a good heart rate for the baby, but the amount of amniotic fluid left inside was dangerously low, and the baby was not moving at all, even with stimulation. This is worrisome, for if labor does not progress after the amniotic fluid drains (the water breaks), there is a serious chance of infection to spread into the uterus, or the baby to lose adequate blood flow and oxygenation. A decision was made by Dr. Spencer to start the patient on Pitocin, a drug that stimulates uterine contractions and induces labor, even though the patient did not adequately meet criteria for the induction, and C-section was actually the appropriate course of action. There was no response to the medicine, and when we went back to check on the patient, she was eating a big bowl of rice! A full stomach is never a good idea when someone needs general anesthesia… In any case, the nurse came to get Adam to assist with the C-section that Dr. Spencer had just decided to perform. This was Adam’s first C-section, as in the United States obstetricians perform C-sections, rather than general surgeons. Amelia scrubbed in as well, and although the baby girl required a little resuscitation on her arrival into the world, she was healthy and intact, and currently mom and baby are both doing well. Everyone was very happy to hear the news, as we were all waiting anxiously outside of the OR, and had cancelled our evening clinical lecture due to the events of the day. Everyone needed a happy ending to this trying day, especially mom and baby girl, who will await her naming ceremony in 7 days, when we can all wish her a fruitful and happy life.
Thursday, January 30, 2009. Thursday was a slower day, as everyone was a little drained from the day before. We spent the morning rearranging flights, as our team’s time here at SJGH is coming to a close very soon. Amelia, Adam and Jason leave tomorrow, and the rest of us are slated to leave on this coming Tuesday.
Lonnie and I had the privilege of meeting two dignitaries today, both of whom stopped by the hospital to meet the team of American doctors who are currently volunteering at SJGH. The first was John Bojang, the Chairman of the Sulayman Jungkung General Hospital Board of Directors. He is a Gambian, who previously has served as Secretary of State, as well as the Gambian Ambassador to many countries. He talked to us for over 30 minutes, praising our work and our initiative to come here and bring a team to serve their community through the hospital. In light all of our difficulties here, it was helpful to hear some encouraging words, especially from a man of his experience. Later, we were invited back to Mr. Badgie’s office to meet the Secretary of State for Health, who had also come to meet us and view the new solar panel installation, as well as the Chairman of the Community Based Medical Program, the Cuban-run medical school that has 4 sites here in The Gambia, training Gambians to be physicians in the Cuban medical curriculum. SJGH is one of their sites, new in the last year. The Chairman and the SOS were very interested in speaking with us about a possible collaboration between DMAG and themselves and their medical students. We brainstormed about the best way in which to contribute, and are thinking about trying to assist them in acquiring textbooks and online study resources and journals for their curriculum. I think it would a great way to help, and would enable us to contribute to the education of the doctors that will be working here, so that problems like what happened the previous day may be avoided in the future. Something to think about.
In the evening, Lonnie and I gave our Education Committee lecture, “Infection Control Through Handwashing”. It was a spirited discussion of the most basic of necessities at any hospital: handwashing. Obviously in a facility without 24 hour running water this can be a difficult thing to enforce, however we feel that this change needs to happen in order to create an environment of health and cleanliness that will subsequently transfer our into the community, and really prevent the spread of disease. Often it is necessary to start way at the bottom. It was a bit delicate, trying to discuss the conditions here without offending anyone, as things we brought up to them, such as livestock roaming around campus littering feces and giving birth at all hours and places, dirt all over every surface, never being cleaned, linens being reused between patients, and dirty towels used to wipe hands, are sensitive subjects when dealing with differing cultures. We only know what we are used to, what we know the standards are at home, which we feel are absolutely necessary to prevent the spread of disease in a hospital setting. The audience was very receptive to the lecture, and asked many thoughtful questions, never appearing upset about the subject matter. They seemed just as frustrated as we about the conditions and their lack of materials with which to wash their hands properly. Lonnie and I are hopeful that DMAG’s project idea of starting a handwashing education program and raising funds for supplies such as hand sanitizer, paper towels or personal hand towels, and soap will be able to go forward. It seems as though we would have the support of the staff, as well as the support of the administration. I am sure that much planning is needed, however, and we will certainly have our work cut out for us in the coming months after our return.
Friday, January 30, 2009. Sadly, one of our ranks, Julie, is sick. Again. I’m not sure who you have to offend to get sick twice on one trip while others sailed through without even a sniffle, but Julie must have done it! Nothing life threatening, but we hooked her up to some IV fluids last night and she’s feeling better today. Thank goodness, she has suffered enough, what a trooper. (Julie says hi mom, and don’t worry, she’s feeling better! She’ll be home soon!)
Today we send Adam, Amelia and Jason off to the airport while Julie, Zeke, Lonnie and myself stayed back here in Bwiam to continue. We are sad to see half our team leave us, but happy that they are safely on their flight and taking off as I write this.
There may not be any further blogs for this trip, as we will depart Bwiam soon and there will be no more satellite modem to use for uploading. I hope that everyone who has been tuning in has been enjoying the blogs in some way, and thank you all for your support. We have enjoyed all the comments, thank you for those as well. We will see you on the other side of the pond very soon!
∼Sue
(I love you mom and Grace! Thanks for your support!)
Adam and Amelia performing a C-section
A Kafo women's group member making our tie and dye
Posted by delmed 
