"Fore!!!!!"

No cases today because of the holiday, so I made my rounds as usual and made sure everything was tightened up on the Orthopaedic Serivce.  My amputation patient got out of bed today for the first time!  It was an exciting moment for everyone.  I actually wheeled her around to introduce her to some of the other amputees I have on service!  They all had heard about her, but no one had met her just yet because she has been in the ICU since she arrived.  It was so nice to see how all of the patients supported her and tried to lift her up, sharing their own personal encouraging stories.  She thanked me for introducing her to everyone.  It was a rather touching moment...

"Shhhhhhh...."

After rounds I went back to the dorm to change and get ready to head out to Firestone to play golf with my friend Monie and his daughter.  For those of you who don't know, Liberia is a major exporter of rubber, and Firestone has a major headquarters here.  I got a whole history lesson on Firestone and the process of growing, harvesting, and preparing rubber-it's quite interesting.  I'm always intrigued by other stuff outside of medicine like that!  The golf course is located on the Firestone farm which is full of thousands of these rubber trees.  They cut a ring out of the bark around the tree and hang these cups on the side which collect the latex as it drips down.  Next the latex is machined into these little pink rubber balls and taken to the factory where they machine them into these sheets of rubber which are then exported.  It's a cool process.  Monie knows alot about it all because he is growing a rubber farm of his own.  They export a lot to China.  It's an extremely lucrative operation.  Anyway, I thought it was cool to learn about...

 

Victor supervising my swing.



Head down...aim for the brown!



The golf course was gorgeous!  It was like we were in a whole other place.  The scenery was really pretty and the atmosphere so quiet and peaceful-I see why people like golf so much.  It can be very relaxing.  When we pulled up, all of the boys there ran up to the car trying to be the first to carry our bags-they're some hustlers boy!!  Those of you who know about my previous golf experiences probably remember how bad I am at it, but today I was on fire!!  There was this local pro who played with us named Victor.  This guy was so smooth!!  He was this skinny little cool Liberian man who was so chill.  I really enjoyed talking with him the whole day!  I had my own personal pro lesson the whole day!!  It was amazing!  He was instructing me on every little thing, and as the day went on my game got smoother and smoother.  It was so much fun!!  On one T-shot I hit the most beautiful shot in my life.  Straight online with nice loft and everything!  Brotha kinda felt like Tiger Hoods!!  They don't have a 'green' here where the hole is located.  It's called 'the brown' because it's actually made of this smooth fine brownish black sand-it was pretty hot!  Victor kept saying "keep your head down and just put it on the brown!"  He was telling me of his days travelling all over Africa and the world playing golf, but he never made a career out of it-he's just content with the simple life of maintaining the course grounds.  The course has been there since the 1930's!  I thought his simple lifestyle was very admirable.  He told me that he sees a lot of potential in my game and wanted me to come back out and play with him so he could show me some more things-it was a nice compliment!  Super nice guy...

Me and Victor-don't he just look like a smooth cat?!!

We had a nice lunch afterwards in the clubhouse and then made our way back to Monrovia.  There were some other guests at the house when we got back, so we ended up chatting the evening away over some Liberian collard greens.  I have to say that Monie and his family have continued to be so gracious to me since my time here.  I've got to give he and his wife a shout out.  I'm very blessed to have met them. 

Today I noticed alot of people registering to vote at the designated places throughout Monrovia.  I hope they were successful enrolling many of the people.  Liberia is on her way.  I have learned alot about the history during my time here-the past, present, and the direction for the future.  I pray Mama Liberia will rise again...

Nice picture from the fairway.

"Do not look where you fell, but where you slipped."

-African Proverb

Swimming in African matrimony...

Setting up for wedding...

It's been a pretty uneventful weekend-which I really was about due for.  I was able to get some much needed rest after that crazy week I just had.  On Saturday I was invited to go out to Careysburg to visit another farm that actually had a swimming pool.  It was a beautiful day for a nice drive out there and a swim, but I couldn't stay awake to take in the view on the way;  I was dead tired.  When we finally arrived at the facility they were actually preparing for a wedding later in the afternoon!  It was a beautiful setting for a wedding though-was in the hills with a lot of open land and nature (I'd imagine so-we were on a farm!).  Some of the kids we were with ended up going for a swim while the people were setting up for the event-it was a bit awkward as the guests were filing in.  The few of us were dressed in summer swimwear while everyone else was coming in wearing really nice African wedding attire!  They probably thought we were so inappropriate!

Swimming pool.  Packed with people while kids were swimming!

We ended up staying for the procession of the wedding party which was really nice.  There were so many people!  It was cool to see.  Afterwards I ended up sleeping again the entire way home and went to bed at like 8:30pm.  I think the month caught up with me last night.  I got some much needed rest.

Sunday was another restful day for me.  I rounded early this morning and changed the dressing on my amputee patient.  She did very well when she saw it.  So far she's doing great with everything.  Keep her in your thoughts and prayers.  I was supposed to go play football today with the guys, but I spended all morning waiting for the driver to take me there and he ultimately was unable to pick me up.  Bummer...
I was able to take another nap and get some reading done which wasn't so bad.  One of the really cool volunteers left today-Ellie.  She's a retired pediatrician from Seattle who has been here before and just spent another month.  She has such a great personality and is very knowledgeable about the healthcare needs here in Liberia.  We've shared many interesting and stimulating conversations.  I think she and I shared a similar vibe during our time together-she will be missed.  She's definitely a new friend who I will keep in touch with.

We picked up one new volunteer today-a pediatrician from the states.  We all went out to dinner this evening and had a nice conversation.  I hope we didn't scare her with all of our stories.  It can be a bit overwhelming when you first arrive.  At least she's not going to have to deal with the surgical issues on my end!  I think she'll be okay with the kiddies...

I think I'll make it another early evening tonight.  Tomorrow is a national holiday-voter's registration.  A big day here being that elections are coming up soon.  Gotta vote for Mama Liberia.  No surgery tomorrow.  I'm supposed to go golfing-should be fun!  Thing is...I suck at it!

Good night everyone. SHOUT OUT TO MY BRO-IN-LAW THAD!! HOPE YOU HAD A WONDERFUL BIRTHDAY WEEKEND! LOVE YOU!

"Many a man's reputation would not know his character if they met on the street."
-Elbert Hubbard

Peaceful view from pool deck.

Never ending story...

Another great week down.  Very eventful too;  just when I think things are going to get monotonous or boring and I have nothing really to blog about, something new and interesting pops up.  It's like the never ending story! (I used to love that movie..)

I officially met my patient this morning from yesterday.  She's a very nice girl.  You should've seen how many visitors came to see her-the hallways were full of people!  The nurses had to limit the number of people in the room and the amount of time for each visit.  I also got a chance to speak to her dad, sisters, and her fiancee too who all seemed pretty cool.  Everyone is so supportive of her and she seems to be dealing with things well so far.  I'm going to see if I can't arrange for her to get a counselor-may also be helpful.  I asked her what the last thing she remembers was and she said that it was running from the car as it was swerving out of control chasing behind her.  She said the car actually hit her and afterwards everyone was standing around afraid to touch her b/c they thought she was dead.  It wasn't until she reached her hand out to a neighbor that people realized she was alive-told you she was a fighter.

This morning seemed to be spinal cord injury day in the ER.  One guy was rendered quadriplegic after he was swimming in a creek and inadvertently headbutted a log headed downstream.  Another young boy came in with a similar presentation after cutting down a tree when a branch fell onto him. Only difference was that his pupils were fixed and dilated...on to the OR.

I did a surgery on this little girl today who had a fracture of her femur 9 months ago which healed in a bad position and left her with a 90 degree flexion contracture of her knee.  She couldn't bend or straighten her knee more than a few degrees and was basically hopping around everywhere.  I was able to do some soft tissue releases and get her leg almost completely straight, which was really rewarding-her mom was so happy!  The other cases today were straight forward and went well.  It was a nice ending to a pretty tough week-so far...

I went out this evening to hang out at Groovie's again and grab one of those good steak sandwiches.  As I was walking to the area in front of the hospital to get picked up, there was a mob of people in front of the ER all worked up crying and screaming over something.  I've kinda noticed by now that when you see something like that here it usually means that someone has been in a really bad accident.  I would've felt remissed if I at least didn't go investigate the situation to see if there was anything I could do.  Apparently this gentlemen who was well known in the community was driving his car and didn't see a disabled semi-tractor trailer in the middle of the lane (no hazard lights on, no reflectors, or flares-remember there are limited street lights.) and smacked right into the back of it full speed.  He laid flaccid and expired in the back of a taxi that had rushed him to the ER-there was nothing I could do.  It was quite a sight-and way to start my weekend off too.

Hanging out in Monrovia.  Guy asleep in back works at club!

I finally made it out and got my sandwich which was just like I had remembered from the other weekend.  It was nice to be out.  Listening to live music and trying to relax.  I actually stayed out pretty late and ended up falling asleep in the club!  On my way back to the dorm we came up on a traffic accident that had just happended a few seconds prior.  A truck had hit a motorcycle carrying three people!  2 guys were just trying to crawl around, but were moving, and the other guy was face down motionless.  I couldn't just breeze past the scene and not stop, so I got out of the car and ran over to assess the situation.  2 of the guys had fractured their legs, but were stable; I helped pick them up and stuff them into a taxi off to the hospital.  The other guy who wasn't moving looked a lot worse than what he was.  He was knocked out for a brief moment, but came to himself and was able to talk to me after a few minutes.  His face was bloodied, but he didn't appear to have any fractured limbs from what I could tell.  I helped haul him into another car and everyone made off to JFK.  It was a weird feeling going through that at 3am.  As I was crossing the street walking towards the accident scene, everyone just let me through as if they knew who I was-it didn't dawn on me until I had gotten back into the car that that indeed was the case.  When I got to the ER behind the rest of the cars, I walked into the trauma bay to give everyone a heads up and found them sleeping!  Another story... I gave instruction as to what each of the patients needed and then proceeded to make my way home.  As I was walking out, some of the people were asking for my number to call me, but I just told them that the nurses know how to contact me if they need to.  I don't even remember falling asleep with my thoughts-the last thing I remember is putting my mosquito net down and taking off my shoes...

You can't make this stuff up man-I'm just living it.  Everyday is a whirlwind of an experience.  It's a good ride though-definitely not for the faint...

"Perseverance is the hard work you do after you get tired of doing the hard work you already did."
-Newt Gingrich

For me...

As many of you can imagine, over the past month I've become quite fond of this blog.  I honestly didn't think that it would become as popular as it has nor would I have expected to have kept it going continuously for this long.  It has been not only a means of communication and sharing my experiences with everyone, but has become a source of inspiration and enlightenment for many; especially for me.  These nightly entries have been therapeutic for me and have allowed me a canvas to express some of my thoughts, experiences, beliefs, principles, hopes, frustrations, and aspirations.  I am honored and humbled that so many of you have chosen to join me on this journey and are able to follow me in spirit.  At some point I will look back at all of this and be able to reflect on my growth, the places I've been and the place where I'm trying to be.  The events of today will stay with me forever...

I was looking forward to a rather uneventful and light day when I woke up this morning-especially after yesterday's fiasco.  I woke up and had my daily breakfast, chatted a bit with the other volunteers, and made my way over to the trauma bay to check on things as usual.  As I walked into the ER I noticed that there were a lot more people there than usual-and many of them didn't look sickly, but they did look traumatized.  I noticed a young woman lying on the floor on a backboard and both of her legs were completely mangled and deformed!  She laid there-not moving, not talking, barely breathing-as if she was saving all of her energy to fight for whatever life was left in her.  I looked at her and then scanned the ER for the nurses or doctors who could tell me what had happened to this lady, when something had happened to this lady, what is happening to this lady right now-or more importantly, what is not happening to this lady right now!  Two of the nurses were talking to each other and another was writing in a chart.  All I had heard from the other patients and observers in the ER was that she was hit by a car.  Apparently this girl was setting up her goods for sell by the road when there was an accident which knocked a car off the road and into her-completely crushing and pinning her legs.  I wasn't sure if everyone had given up on her b/c maybe she had a head injury or maybe a chest or abdominal injury-if they had exhausted all resources and there was no hope of resuscitating her or what!  I kneeled down next to her and immediately found the answer to my question...

There were no vital signs on her. She had only one small peripheral IV. No oxygen. No cervical spine collar. Only some bandages tied around her thighs.  No antibiotics or tetanus were administered yet.  I checked her pulse and it was very fast and thready.  Manual blood pressure was a systolic of 30.  I jumped up and ran to the nurse, put my hand over the chart she was writing in and told her to get over here and help get this lady more IV access and fluids ASAP!  By this time everyone in the ER had been looking on and one of the doctors told me that they were waiting for an anesthesia consult to come see the patient.  At this point I couldn't wait any longer and stopped trying to get answers from everyone-I grabbed three of the onlookers and told them to grab an end of the stretcher.  We threw a sheet over her legs and torso and bolted straight out of the ER, past everyone in the halls and waiting room, directly to the OR!  Some people were following us all the way to the elevator. 

Once we got up to the OR it was like one of those scenes from the movies.  I was busting through double doors, screaming at people to move out of the way, calling for anesthesia to bring this and that, telling the OR pharmacy to bring meds, antibiotics, tetanus, etc.-all seemingly in one breath.  By the time we got into the operating room, we dropped the whole stretcher right onto the table and I started cutting her clothing off.  The anesthesia team was right behind me and everyone started searching for IV access.  I ran to the head of the bed to try and hook her up to the monitor so that we could get some vital signs.  One of the nurses was sent to get some blood for transfusion.  After all of the lines were in and she was hooked up to the monitors and oxygen, I just had the scrub nurse give me a scalpel and I started debriding all of the nonviable tissue from her limbs.  We used brushes and saline to clean away most of the gross debris and contamination prior to moving her from the backboard.  By the time I had gotten scrubbed and done with the surgical prep, I still couldn't believe that I was staring at what used to be young healthy legs.

She ended up with 2 above-knee amputations.  One side was easy b/c she had completely fractured through her femur.  The other one wasn't so easy b/c she had a pretty big leg that wasn't fractured and I had to saw through her bone with an instrument that definitely wasn't made by Black & Decker!  She ended up tolerating the procedure well and remained stable throughout.  During the case, my phone kept ringing b/c today is my clinic day and I was scheduled to see another VIP at 10am....yeah...
I can't tell you all of the things that were going through my mind from the time I laid eyes on this girl until the time I ran home to change my blood soaked clothes before I went to clinic.  Some of the them are only appropriate for my personal journal.  There are obviously some clinical points that need to and will be addressed as a result of this experience.  But even more prominent in my mind was the future psychosocial ramifications of this tragedy in this 25 year old woman's life.  While it was an impressive injury-I'd never seen anything of this sort before (I think I may have said that already in a previous entry..)-I felt pretty confident that she would make it through the surgery once she was adequately resuscitated.  The hardest part is now.  Imagine waking up early in the morning trying to get an early start on your day and make some money for your family and then, in the blink of an eye, your entire life changes...she is supposed to be getting married in less than 2 months...

I didn't even get to round on the floor patients until later in the day after a long day of clinic.  Fortunately there weren't too many upset patients b/c of the long wait today-the entire community had heard about the accident and knew that I was in surgery all morning so they were relatively understanding-one or two were pushing it though.  More interesting stuff in the clinic, but it's not even worth mentioning, as it pales in comparison to what I witnessed this morning.  I was so anxious to be done with clinic so that I could run upstairs to the ICU and check on my patient.  I literally bolted out of the office as soon as the last patient walked out!  She was doing well and sleeping comfortably when I finally got to her.  All of the nurses had heard the story and seen the pile up from the morning traffic and were asking me how the surgery went.  I felt a chill when I pulled back the sheets to quietly check on her dressings so as not to wake her.  My heart goes out for this one...

As I walked through the halls and out of the hospital I felt like everyone was watching me and could see the concern on my face.  The purpose in my walk.  The passion in my eyes.  They all knew and had heard.  I took a deep breath as I finally made my way out after what seemed like an eternity.  I ran into the general adminstrator of the hospital and she told me how the whole community had come to the hospital, including the press and papers to get the scoop.  Apparently it was a mad house out there.  I told her that the patient was doing ok and was stable presently to which she was very pleased.  She was very grateful and I took the time to express some of my concerns regarding the events of the day.

I went back this evening to check on her and she was still resting comfortably.  I went to the accident site today and the involved cars were still there-totalled right in front of her house!  There were numerous people in front of her home apparently having a meeting of some sort.  It's times like these when that whole sense of community transcends all and uplifts...
I'm sure it will be awhile before the cars are moved from the side of the road-they'll probably be stripped and sit there for awhile serving as a reminder of the events that transpired today.  Not necessarily a bad thing.

I usually don't go back and re-read my journals after I write them for some time, but I may read this one daily for awhile.  Even though words don't do it justice, that's all I have to offer myself as a reminder of what's important in this pilgrimmage we call life; and how I feel when I reflect upon it...thankful.

Thank you for listening.

"Not what we say about our blessings, but how we use them, is the true measure of our thanksgiving."

W.T. Purkiser

Technical difficulties...

Sorry for the delayed entry-rained again last night and the internet went out...

Nothing too crazy in the ER this morning.  I did a debridement of this little girl's leg before I went upstairs to the OR.  During that storm the other night a huge pole fell on her home and a concrete cylinder block fell onto her leg while she was asleep!  It crushed her leg causing a really bad soft tissue injury, but thankfully she had no fractures.  Crazy... 

Little guy's xray from this morning's case!

Today was a tough one in the operating room.  I had some 'technical difficulties' with some of the equipment.  Remember the kid with the 2 femur fractures?  He finally went to surgery today.  On one side, the tools I was using weren't the greatest and I was fidgeting around alot trying to hold his bones together; when I finally got everything where I wanted it, the dang clamps fell off!!  I stayed cool though and got it back together-then right when I was using the drill to make the screw holes  for the plate the drill bit broke off!!  At this point I was like "man!!"  The nurses and anesthesiologists in the room were all smiling, saying "welcome to L.I.B.!!"  It kinda kept the mood lite in the OR when I started using some of the Liberian slang-they all were surprised that I'm learning so much so quickly-it was pretty funny.  Anyway, I was able to retrieve the broken bit fortunately and ended up finding another one the same size which worked.  Next, when I was looking for the appropriate size screw there were no more left!  I had to take longer screws and cut them down to the right size.  Ultimately everything turned out just fine, but it took much longer than I would've liked.  I have to share my intraoperative difficulties as well-don't want you guys to think that every surgery is just a cake walk!  By the end of the case I was sweating like crazy (cutting those screws is tough man) but I was pleased with the outcome-I think the patient was too; he pee'd all over the nurse at the end of the case!!



Struggling to cut screws!

The second case was a guy with a 2 week old foot dislocation that needed an open reduction.  It was actually more difficult than I had expected.  For those of you who care, the guy had a subtalar and talonavicular dislocation with a talar head fracture.  After struggling with the reduction I ended up placing an external fixator on him b/c it was so unstable.  The last case of the day was an extensive debridement of that guy I mentioned who had the bad femur fracture and degloving injury to his leg-we convinced him to stay!  After the surgery, he was left with significant tissue loss-poor guy.  I had another surgery scheduled, but we had to move it to Friday b/c it got too late.  Everyday not only am I becoming a stronger person mentally, I feel like my operative skills and experience are improving as well; it's like I'm starting my trauma fellowship early!



Still smiling after a tough case..

I was pretty tired when I finally got back to the dorm this afternoon.  The shower felt great.  I'm going to have to leave my scrubs here when I leave-there's no telling what's soaked into them by now! LOL.  Many people have asked me to leave them here for them when I leave.  One of the guys today told me to leave him my bookbag!

Looks like it's going to be another rainy evening-it's already started coming down again.  Hope to get some good sleep tonight.  I need it after this one...



Me and Kashif chatting.

 

"God will not look you over for medals, degrees, or diplomas, but for scars."

-Elbert Hubbard



Original recipe or extra crispy??!! 11 herbs-n-spices...



The Orthopaedic floor at JFK Hospital-Monrovia, Liberia

 Rounds today were good.  I have to give a shout out to the nurses on the Orthopaedic floor here.  Some of them work very hard.  Considering all the stuff they have to deal with, many of them do a great job.  Here the nurses do all of the dressing changes, unless instructed otherwise.  And from many of the cases I've described, you can imagine that they're not small dressings...sometimes the patients will actually want the nurses to change their bandage rather than me!  They each have 3 rooms with 4 patients each-that's 12 patients; they're really understaffed it seems. 
 


Monrovia Rehabilitation Center (MRC). "False feet!"

I'm having a bit of an issue with bed availability now.  There are a couple of patients who have been discharged, but they can't afford to pay their bills so they can't be released from the hospital.  And there are patients in the ER waiting for beds b/c they need surgery and are just in a holding pattern b/c the patients upstairs on the ward can't go home!  See how frustrating it can be?!!  One guy has been discharged for a week, but his family won't bring the money to pay the remainder of his bill.  He has a family member in the states who supposedly sends money over, but the family just takes the money and uses it up while he sits around in the hospital!  He's really depressed about it-I'm trying to get the social worker to help him out..



Young girl being fitted for her "false foot."



Clinic was clinic today.  Some interesting stuff as always.  It started off a bit unusual though-there were 3 "VIP" patients in a row.  Anyway...so I learned more about this herbalist today!  I had this lady who came to see me complaining of arm pain after she had sustained a humerus fracture 6 months ago.  She was treated by herbie (LOL-I kinda like that one!) who "hauled" on it, but she never got better.  I'm at the point now where I just start asking patients straight up about their experience with this type of medicine, how much they're being charged, why they insist on going, etc.  Helps me understand the culture a bit better.  So she tells me a story of how the herbalist will instruct people to bring a chicken and some oil to him after which he will break the chicken's leg.  He will then "treat" the chicken's leg, and if it heals then the patient will heal their fracture.  If the chicken doesn't heal, the patient doesn't heal.  You should've seen my face when I heard that one.  I then asked her "well, what happened to the chicken??" to which she replied, "he ate it!"  You really should've seen my face after that one!!!  This guy has patients bring him chicken and money!!  She was a good sport about it and realized that she had been dooped.  I made her laugh when I said "...so I guess that means I have to eat your arm now!!"



Members of "Thaaaaaaa Church!!!"

Anyway, I'll take good care of her and hopefully she'll have a better outcome.  I think my last meal here will be some Popeye's or KFC with herbie!  I just need one of you guys to ship a bucket over here!

Short and sweet. Have a good night.

"Patience with others is love, patience with self is hope, patience with God is faith."

-Adel Bestavros

African rain...

Cool looking tree during boat ride on Lake Piso.

 I got my first taste of African rain today! There was this bad storm and it was raining hard and thundering all night.  The raindrops were like grapes!  This morning there were a lot of bushes and twigs all over the place.  The current (electricity as the Liberians call it) was all messed up for a little bit over here, but it was back together quickly.

I hope you guys aren't getting tired of my patient encounters during the morning ER rounds, but I find some of them too interesting not share...
So 2 days ago this guy was involved in a bad RTA and sustained a bad femur fracture and a crazy degloving injury of his leg-his skin and soft tissue were just completely ripped off clean down to the muscle!  A very interesting injury pattern.  When I saw him this morning his leg looked nonviable and I explained to him the likelihood of him losing his leg.  He wasn't trying to hear it and was pretty insistent on saving his leg and didn't want to be admitted; I wonder if the herbalist or country doc is keeping a blog like this one!!  I'd love to read it...
                                                                                

Trying to drive through Red Light!!

 We had our weekly grand rounds conference this morning.  The Ob/Gyn Service gave a presentation on gestational diabetes and screening during pregnancy.  I think I mentioned before the heavy emphasis placed on perinatal care here-it is much needed.  There was a very intense discussion that ensued between the visiting physicians and the Liberian doctors here; basically they were going back and forth about modalities for screening and prevention amidst limited resources.  They don't even have a robust supply of glucose strips here to even screen for diabetes, and many visitors come here emphasing how important it is to check glucose levels.  It goes in this repetively frustrating cycle and I think it seemed to come to a head today.  They went on for about 20 minutes talking about what should be done and what needed to done, trying to come up with solutions-by the time I left the conference I wasn't sure if any solution or action plan was even agreed upon...

Cool painting that Justin bought at Mamba Point

 I only did one surgery today.  My other scheduled case was cancelled by anesthesia-more blood issues.  I've become facil at operating within this system.  Working as a surgeon in a developing country like this you really have to be somewhat malleable.  Everyday I'm learning to become a more versatile and adapting surgeon.  Since I had an early operative day I went back to check in on the trauma ER and found some stuff to do.  A young girl had come in with a huge laceration on her leg that needed to be washed out after some acid substance fell onto her leg-sometimes I don't understand how some of these patients get into the stuff they do!  Anyway, I did a debridement of her leg in the procedure room of the ER since no one was around to pay for her to go to the operating room.

I was able to run a few errands today and made it to the grocery store again.  I was wearing my scrubs at the time and this guy stopped me and asked if I was from Mt. Sinai in New York-he was an American!  He had previously seen some of the Sinai team out here and he is here working with the US Embassy.  He was a cool guy too-gave me his card and invited me out to the embassy to hang out!!  You never know who you're gonna meet!

Craftsmen in downtown Monrovia

I went to try this restaurant tonite for dinner called PA's Ribhouse.  They had an upstairs with really nice food for USD (US dollars) and a downstairs with LD food (Liberian dollars)-guess where I ate?!!  Dem' LD ribs be bangin'!!! LOL!!  I had a pleasant dinner watching a little soccer with some of the locals. I'm learning some of the slang-I swear it just sounds like geechi or gullah that I'm used to down south back in the states!

Hope everyone's week has gotten off to a good start.  Nite.

"You can easily judge the character of a man by how he treats those who can do nothing for him."
-James D. Miles

Beautiful beachside at Robert's Port



Strong names...great convo...better haircuts!



Trying the haircut thing one more time...I wasn't in a hut this time!

Keeping it rollin' guys...another fulfilling weekend!  I trust you all are being enriched following my experiences as much as I am sharing them with you.  Saturday morning rounds were uneventful.  Everyone from Friday's surgeries had good nights and the rest of the orthopaedic service is doing well.  Remember that guy I mentioned with the really bad forearm infection?  He's not doing so bad surprisingly!  His arm is showing signs of improvement.  It's remarkable how resilient some of these patients are even in spite of all that they go through.

Me and friends at beach right down the street from Thinkers!

 I tried to take a nap after I rounded, but got a call again that someone was coming into the ER who was injured playing tennis.  I ended up having to go back to the hospital to see the patient.  Turned out that the patient's friend is some bigtime guy who now wants to support the HEARTT program that I'm here volunteering through!  They were apparently pleased that everything worked out and  were able to be taken care off when I was there.  Gotta always take care of everyone the same-never know when a "VIP" might come through for you! LOL!



"Kashif Alexander," Lydia, and "David Alexander!"

I was invited to another friend's home Saturday afternoon to hang out.  Another amazingly beautiful home (I still have to get used to the social stratification)!  Our host Joyce and her husband were so gracious!  She had all this great food (I finally had fufu and soup-Saturday Liberian dish!) and chocolate and wines (I didn't drink any) that I couldn't pronounce.  They had this really nice sitting garden with a gazebo which was the arena for one of the best social gatherings I've had in a long time..

So the best part of the evening was meeting 3 gentlemen with really cool names.  We were acting all silly like we had these strong sophisticated names.  We all were introducing ourselves using our first and middle names shaking each other's hands like we were all important and stuff!  It was too funny!  It was like: "Good afternoon sir, I'm Kashif Alexander.  Well nice to met you, my name is David Abraham!  Ok gentlemen, my name is Abraham Albert-Lee.  And your name young man?? David Alexander!"  I don't know how it ended up turning into all that, but it was hilarious!  2 of them were there with their wives who were clowning!  They were like "I don't know why you guys are acting like your names are that tight!!"  Guys will be guys!  Anyway, speaking of great names-you should've seen their faces when I told them the name of my nephew and niece: Thadius Kristopher and Trinity Kyla!!  Bout knocked their socks off!! LOL.  I guess you had to have been there...

Look J-me and Adei!  Doing great!

We all sat down in the garden and were just talking about everything under the sun: Liberian socioeconomics, education, politics, relationships, healthcare, finance-everything.  We sat there for like 4 hours just having a very stimulating dialogue full of commentary, disagreements, agreements, jokes, etc.  I haven't had such an invigorating conversation like that in a very long time!  It was quite enriching!  I guess we were all trying to engage ourselves in this deep conversation b/c we thought we had these great names! They were all professional businessmen into petroleum, diamonds and gold, real estate and tourism.  It was cool to get all of their perspectives and insights on different things.  Good guys...

Today was a busy day.  I've been having a problem with the ATM machine close to the hospital so I got one of the drivers to carry me to an ATM at Mamba Point Hotel.  And it worked!  What a relief!  He then took me to the grocery store and then to grab brunch at Rozi's.  I've heard so much about Sunday brunch there and have been waiting to try it.  It was really good!  Before I went there I stopped by the barbershop-a real barbershop-to get a haircut.  I have to admit that I was a bit nervous especially after my first experience (you guys remember).  The shop was pretty cool though.  It reminded me of the barbershop I used to go to when I was a kid-Mr. Jerome's (R.I.P.).  There were people there waiting, socializing, and laughing with each other and the barber.  There was a light pepper dusting on the floor with all of the hair.  The clippers were humming.  It seemed like this place was one of the cornerstones of the neighborhood just like mine was when I was a kid-where you could go and just relax, renew, and get fresh after a hard week's work.  Amazing cross cultural institution-the barbershop.  Much better this time around.  Much better.

I was supposed to go to the beach with some friends from the hospital at noon so I was running trying to do everything early this morning, but I wasn't picked up until like 1:45!!  Same ol' thing even over here!  We were packed deep in the car too-I was really getting the Liberian experience today!  By the time we made it to the beach I had to get ready to leave-I had plans to go visit a friend's farm later in the afternoon.  Turns out that the beach was right by Thinker's Beach where Lydia and "Kashif Alexander" were (Kashif partly owns the resort there-Thinker's Village) so I caught a ride out to the farm.  It was about 45 minutes away on 168 acres-gorgeous.  I had some more traditional food and got a nice tour of the place.  It was so peaceful.  Gave me time to catch up on my writings in my personal journal.  It's amazing where you find yourself if you can put yourself in the right mindstate; I'm working just as hard-probably harder-than I do back in the states, but there's a peace here that I haven't experienced in all of my training...

Good night.

"Success is getting what you want; happiness is wanting what you get."
-Dale Carnegie

Giant steps...everything irie...pull my finger!

Sorry for leaving everyone hanging yesterday-I've already heard it from a few of you; "where's your blog from yesterday?!" I'm ok mom!  I got home late Thursday night and couldn't stay up to blog-was too tired.  So now I guess I have to update you on the last 48 hours-here goes...

Me, my little girl Ma-Nowah, and her big sister!

Thursday was a good day; a great day actually!  My little girl took her first few steps!!  She has been such a pleasure to round on everyday and see her progress.  It really is one of the best parts of my day.  Even with the many frustrations that I've encountered, she alone makes this whole thing worth it.  She has won a special place with all the nurses-they love her!  It really is an honor to be able to touch people's lives like that.  It never gets old and each time feels like the first.  Many times back home I find that it's so easy to kinda forget that Hippocratic Oath that we all took upon graduating medical school; out here you're reminded of it on a daily basis..

As usual, the clinic didn't fail to disappoint yesterday.  Having been here now for 3 weeks I'm able to see many of my follow-up patients that I've met in the office (those I've injected, sent to therapy, even the 2 finger amputations!) and they're doing really well.  It's exciting to see.  There's this hallway that is lined with people on my way into the clinic that have been waiting for me to arrive.  It's pretty cool b/c sometimes I feel like bending down and slapping everyone's hands like I'm running out onto the basketball court!  It's fun to greet everyone in the hallway and then see them individually in the office.  I must admit though (man this mouse running around is distracting me...I digress) I do have some patients that frustrate me b/c either I can't do anything for them or am not sure what the best thing to do for them is.  I have this lady who has come in to see me twice now and has this mass growing from her skull.  It has this fluid weeping from it and looks infected.  I sent her for an xray and it seems that her skull is involved and being damaged.  I'd like to send her to Ghana to see a Neurosurgeon, but she can't afford it and I don't want to be in an awkward position if I take her to surgery myself to remove it and then leave her brain exposed.  I hear there's a surgeon here in Liberia at another hospital who may be able to help her.  Tried contacting him today.

Me and Justin our first weekend in Monrovia

My last interesting one I'll share with you is a little boy who had 2 weeks of ankle pain.  He was another one that came hobbling into the office unable to walk.  As soon as I saw his ankle I knew he had a septic joint.  His entire foot and lower leg was swollen and extremely hot and he couldn't move it at all.  I figured it'd be a perfect time to show the medical student how to aspirate an ankle joint...straight pus!!!  I sent the kid directly to the ER to get started on IV antibiotics and get placed into a splint. After clinic I went to the ER to make my rounds again and check on him.  He had gotten his antibiotics and was placed in a splint.  He had signed out AMA by morning.

Some new friends at Robert's Port!!

 Later Thursday evening I decided to go check out reggae night at Club 69!  Justin had told me about it and we planned to go when he was here, but we were so busy with everything else I didn't get a chance to check it out.  So I figured I'd see how Monrovia does it Jamaican style!  It was so much fun!  The music was great.  It was weird being in a club again-feels like I haven't been to a club in a long time.  It was nice too!  Kinda on par, if not better, than some of the NYC spots.  The only thing is-Liberians start partying waaaayy too late.  I got there at like 11pm and almost no one was there.  They don't go out until like 1 or 2am!!  I stayed out for a bit and ended up getting home at almost 2:45am.  It was worth it though!

Thad this one is for you and all the Vegas crew-"put dat PePe down!"

 When I came in today one of the nurses was like "oh, so you went to reggae night last night huh?!!"  Liberia is too small man!!  I only did 2 cases today: a secondary closure of this little baby's thigh wound that had a huge ulcer and then I did an elbow disarticulation for that guy with the infected open forearm fracture.  I'd never done that one before.  It's a pretty cool operation actually.  My other surgeries were cancelled b/c the patients didn't make the full payment, and another was cancelled by anesthesia b/c the patient didn't have any available blood for transfusion-the family had to be called in to donate.  In case you all are wondering, many of the surgeries run around 10,500 LD (Liberian Dollars), which translates into about $150.  That's alot of money here.  Initially I thought the anesthesia team was very conservative about cases and transfusions, but they've seen many patients die on the table b/c they don't have blood products available so they're really big on getting blood from family members and transfusing patients before surgery.  Problem is it's hard to get in touch with family and have them come in and pay to donate their own blood.  I don't argue.

Me and Lydia (one of the volunteer coordinators) at Groovie's.

I was a bit tired after surgery so I made my way back to the dorm to take a nap.  After a short time my phone starts to blow up!  It wasn't a number I recognized so I figured I'd return the call later, but everytime I ignored the call, the phone would ring again!  Long story short, turns out to be this VIP lady who was given my number by someone else and had a finger fracture 2 days ago. She asks if I could come check her finger and make sure it was straight...sure I'll be right there...
When I get to the ER this lady has all the nurses and another one of the doctors tending to her finger.  Mind you this is in the middle of the trauma ER-you already know the type of patients that are in there.  I needed to pull on her finger a bit to straighten it out, but there was this whole fiasco of getting some pain meds before I did it.  As you can imagine, the thing that got me was all these proceedings for such a small thing (relatively small I admit) when others wait for days for care in the ER.  I've noticed that things here can be just as, if not more, political than back in the states.  I'm not going to get on a soapbox right now-it's late already.


Me, Dr. Muvu, and some of the OR staff.

 For lunch today I got a call from one of the friends I met when I arrived to see if I'd like to go get some good Liberian food after my surgeries.  I tried some Liberian collard greens with various meats. Delicious!  Everyone has been sooooo gracious to me.  Looking out for me and making sure that I'm ok.  They are making my stay so pleasant.  Everyone keeps telling me to just relax and that I'm family now.  It really is a good feeling.  I can't get over it.  The drivers take me wherever I need to go and everything.  They're even going to try and arrange for me to get to travel and visit Ghana for a weekend!  I got invited to go to this club called Groovie's tonight.  The woman whose house I went to on Wednesday owns it.  She also sings there.  It's a pretty classy place with a more mature crowd.  When we got there we had reserved seating and my meal and drinks (pineapple juice for those who know me) were paid for.  There was a live band that played good music and many people were dancing.  At a certain point in the evening Ade (the owner) stops the music and gets everyone's attention along with Lydia and another doctor here in Liberia and introduces me in front of all the people in the club!  I wasn't expecting that one!  I didn't know what to say.  Good thing they didn't ask for a speech!  Soon as I sat down I got a message on my cell phone asking if I was at Groovie's!!  Liberia is too small!!

Should be another good weekend. Will keep you posted.  Have a good weekend everyone!

SHOUT OUT TO MY NEPHEW TYLER AND MY BEST FRIEND MARC-HAPPY BIRTHDAY!!! LOVE YOU!!

"Humility is not thinking less of yourself, it's thinking of yourself less."
-Rick Warren

New friends...

Unfortunately my patient with tetanus didn't make it.  He died this morning.  It's tough man-not the fact that he died, but it's the way that he died that gets to me.  This was an otherwise young and healthy kid who could very well and should very well be alive right now.  All because he didn't get a tetanus shot.  The nurse said he was writhing all night and was very uncomfortable.  I don't want to dwell on it, but I just pray that he's in a better place now where he doesn't have to worry about all that stuff...

The OR today was exceptionally hot!!  Usually there is an air conditioner that runs, but today for whatever reason it just wasn't cutting it!  I was drenched in there!  Fortunately the first case today went rather quickly, but the second one took longer so it was like a sauna in there by the time we got finished.  It was a cool case though (iliac crest bone grafting and plating of a tibial nonunion with fibular osteotomy for those who care...).  Remember how I said there's an ebb and flow to the surgical cases here??  Friday is going to be on and poppin'!!  I have 6 cases booked as of now!  It may be a long day...

This afternoon I met some new friends through one of the volunteer coordinators and was invited to their home for dinner.  The house was gorgeous.  Some of these homes are so unassuming-you'll be driving through dirt roads lined with trash and then all of a sudden you come up to a gated concrete wall and once you pass through it there's this amazing home; it's an interesting dynamic.  They were very welcoming and actually knew Justin very well.  They had a cook and server and all that stuff-it felt a bit awkward at first to be honest, but I just rolled with the flow.  I'm sure I'll be seeing them again-they invited me back to hang out anytime.  

I'm going to cut this one short because I just got in and am pretty tired.  No pictures tonite-don't have time to wait for them to load. 

Good night.

"Discipline is just choosing between what you want now and what you want most."

-Unknown Author

 

 

Just when you think you've seen it all...



One of my first pictures in Liberia

 One of the most interesting things about this job is that you never know what you're going to get when you walk through the door every morning.  As I made my way through the Trauma ER this morning on rounds I noticed this patient who was lying on a stretcher in a dark recessed area not moving much, but moaning alot.  I went over to assess him and get the story, but he couldn't really articulate that well b/c he was in so much pain and had a nasogastric tube down his throat.  He was sweating profusely and he had a splint on his arm which was soiled with blood.  Turned out that he had an RTA (review your Liberian acronyms...) and sustained a really bad open fracture of his forearm and an associated elbow dislocation.  His injury was one week ago and he initially had come in to the ER for treatment, but left before he was registered-not sure if it was another financial issue or not.  Anyway, the guy ended up coming back to the hospital with worsened pain and over the course of the evening was complaining of an inability to swallow as well as neck pain.  When I looked closer I noticed that his neck was hyperextended and he never could bring his neck down to communicate with me b/c he was in so much spasm.  The guy had tetanus!!  I've never seen that before!  It rarely gets to that point in states.  It was crazy-it was like he was getting more and more spastic right before my eyes!  The staff in the ER told me that it is quite common here and they actually jumped on top of it rather quickly overnight with appropriate management.  He's currently in the intensive care unit and seemed to be stabilizing later this afternoon.  Wild...



Back view of the hospital on my way to work

  People in the community are beginning to recognize me more and more.  On my way to work today and as I make my way up and down the hosptial halls I can hear people calling my name and greeting me as I pass.  It's actually a nice feeling.  Some of the peoples' names I don't remember so I just hit them up with the usual "how is it?!" to which they always seem to reply "alright doc" or "thank God."

Clinic was a mad house today.  I swear it's getting more and more busy as word continues to spread that I'm here.  It seems sometimes like word has already made it down to South Africa! LOL! It's all good though-I'm seeing so much pathology.  There's so much variety too-some of which I don't have to means to treat unfortunately.  The next stop is Ghana, and if they can't get treatment there, then some even have means to get to the states.  Can you imaging having to travel to another continent just to get healthcare?!!!  Feeling blessed yet??  As always, you know I have a story or two to share with you from the clinic.  I did another finger amputation today after a guy came in following a severe crush injury to his finger.  It was about as bad as the other one I did last week.  My clinic room is very small and the ventilation isn't very good, so when someone comes in with an infection or something of the sort, it becomes quite memorable.  When I saw the bandage on his hand I immediately started writing up the prescription for him to go to the pharmacy and pickup supplies for an amputation (I have very limited supplies in the office, so if someone needs a minor procedure I have to give them a prescription to pickup the supplies from the pharmacy-even gauze, iodine, needles, lidocaine, bandages, etc..).   

Another shot taken from the Liberian-Japanese Maternity Hospital

I had another guy come in after a fall 2 weeks ago out in the bush.  He was down for 3 days with an open fracture of his forearm before someone came to his aid.  As soon as this guy walked in the room, the medical assistant Massa broke out the aerosol spray!  It's actually pretty funny when he does that-he has no shame!  If something comes in funky, Massa is like quick draw Mcgraw with the spray!! This guys entire forearm and hand was all necrotic and malodorous.  It's hard to believe that people will allow their condition to get to this point.  I'm still trying to get a pulse into culture tenets that are embedded in these patient's lives.  In New York it seems like everyone runs to the hospital for every little boo-boo, but here the ER is a last resort.  I knew immediately that he had been to "country doc" b/c his bandages had this blue dye on it-I've noticed that the herbalist uses this ointment or bluish iodine type solution that he puts on everyone.  I swear I've got to meet one of these guys...
Anyway, I sent this guy to the ER and admission to the Orthopaedic Service.  He's going to need an amputation unfortunately-but of course he's going to have to pay first...



Making the OR schedule for the following day

  The day ended with a bang.  After clinic I walk into the trauma bay to scope things out and then walks in the dean of the medical school along with the head of general surgery with another one of the surgeons.  The chief medical officer just so happened to be in the ER at the time too.  Long story short, the Dean-who is also a doctor-was trying to move a patient into the Trauma ER and was told that there was no room b/c no beds were available.  Remember how I told you patients just sit around in the ER b/c they haven't paid their bills so they end up like prisoners and are unable to be discharged-but as they're staying in the hospital waiting for someone to bring money to pay the bill, they're accruing more charges!  What ends up happening is that you have a stable patient waiting to be discharged holding up beds for really sick patients that need them!  The Dean ran blindfolded smack into this problem and asked what the deal was with all of this.  There was a big hoopla in the middle of the ER with all of the most influential people in the hospital who have the ability to try and do something about the system.  I watched as everyone kinda said their piece and even put in my 2 cents only being here for 2 weeks already.  Supposedly some "meetings are going to be held" as a result of all of this-I'll let you know how it turns out...politics man. 

I was rather tired at the end of the day.  The last kid I saw was an 11yo boy who was hit by a car and has bilateral femur fractures.  I had a long talk with the family about the options of surgery vs. nonoperative management.  I'm going to take him to surgery on Friday.


Gettin' tore off in the barber hut...notice how he's the one smiling!

 The family system is very important in the culture here.  Many times it's not the patient who is making a decision to undergo surgery or treatment, it's the family.  They are all very supportive of one another-it's nice to see.  While some are in the hospital for months at a time and have been shunned by everyone, many of the patients have great family support.  Visiting hours can look like a block party sometimes-HEEEYYYYYYY!!!! LOL!  It makes for some lengthy conversations when you get caught up in a patient's room though...usually I just try and pick out one person and make sure they understand everything then they can pass it along to everyone else.                                                                                     

The Market in Red Light-an area in Monrovia

I'm just trucking along taking it day by day.  You guys keep me in your prayers-especially with all these dang mosquitos!!  Goodnite.

"There is no road too long to the man who advances deliberately and without undue haste; there are no honors too distant to the man who prepares himself for them with patience."
-Jean De La Bruyere