Meteor? Moon Rock? Fossilized anemone?

It has been a little while without updates. Since the last update, I have left Gabon, spent 2 months in Kenya, 1 week in Sudan and finally arrived in Angola in midMarch. I have hit the ground running here in Angola. I started work at the hospital the day after I arrived, went apartment hunting and found an apartment to live in the first 2 weeks I was here, have flown out to rural hospitals for 4 different weekends for marathon operating days, have inherited a weekly health radio show since all the other doctors are out of the country, have been on call for the last month and a half, hosted visiting doctors and medical students, have been running the hospital for the last month and a half with another 3 weeks to go. In between all that, I'm slowly starting to get settled in and as I get settled in, more updates will be coming.

I did have to share one photo from this last weekend trip to Kalukembe. Kalukembe is a big rural hospital that is run by nurses. Once a month, a surgeon flies out from my hospital to do 2 and a 1/2 days of operating and seeing consults. We arrive at about 10am and go straight to the operating room, operate until 8pm and then see consults from 9pm till 11 or 12. The next day starts at 7:30 with devotions with the nursing students and then rounds and then operating until 8pm, and consults until I can't see straight--usually around midnight. Saturday morning is operating from 8am until the plane picks us up at 5:30--usually you're racing through your last exploratory laparotomy, have just managed to remove the large tumor or mass, and then run out the door to catch your plane. I love my trips to Kalukembe. :)

The picture was an extra surpise. I was operating on a gentleman to remove his prostate and found this stone in his bladder. In real life it's about 5cm, but I'm pretty sure he's going to be feeling alot better without that thing in his bladder.

Plate of Misfit Cookies

Does anyone else end up with strange, deformed cut-out cookies when they make Christmas cookies? Somehow there's always a gingerbread man that looks more like an amoeba, or an angel that loses its head (I just frosted her head onto her skirt), or a "Birdman", or a snake or an-umbrella-shaped-who-know-what-it-actually-is cookie. They all get sent to the plate of misfit cookies, never destined for a platter for company or a giftbox. Despite their misshapen imperfections, they were still very, very tasty.

Floating down a River

Last Saturday I had a lovely break from the usual routine. Several of us took innertubes and went tubing down the river that runs by the hospital. Three and a half hours floating and swimming down a river, only rarely were there signs or sounds of civilization. The jungle crowded the banks of the river the whole way to the next bridge which was our landing zone. It was wonderful. It did rain the entire time we were on the river, actually it kind of poured, but it was a blast! :)

"No-See-Ums"

Overall, thanks to two cats in the house, I don't notice the bugs too much. The bugs mostly stay outside except for the occasional ant or little cockroach or this bug in the picture that keeps trying to get in the house. I've thrown him out twice so far. It's at night that you realize how much the cats help--the rain forest all around comes alive with sounds--chirps and whistles and buzzes and rustles. Or after a rain when you can watch the bugs pour out of the ground almost like turning on a spigot.

Then there are the bugs you don't ever see--the "No-See-Ums". The ones that leave a million bites on your arms without you ever knowing they'd been there. I've actually made it a month without any bites so I didn't really believe in the stories about the "No-See-Ums". Then I spent an hour at a church in a small village. At the end of the service, I looked down at my arms and it looked like I'd developed leprosy or a bad case of the measles. I never saw a single bug or felt a single bite.

Hand Trauma Week--Surgical Cases

Sorry to the nonmedical folk reading this, there's a little bit of blood--no guts though. So this week has been hand trauma week. One case was a machete wound to the wrist. The other was a close range shotgun wound to the hand. I'm still working to try to save the index finger and part of the thumb for the patient who accidentally shot his hand. I don't think he'll have any sensation left in his index finger, but he really wants to keep it. I'm going to have to do a tendon graft to reconnect the tendons in that finger. The patient with the machete wound severed both arteries, both nerves and all the tendons on the palm side of his wrist. The photo shows my repair of the arteries. Tomorrow he'll be back in the operating room for repair of the nerves and then tendons.

How you know you are a general surgeon in Africa
#10 Your first case of the day is a prostatectomy
#9 Your second case is a hysterectomy
#8 Your third case is an open reduction & pinning of a wrist fracture
#7 Your fourth case is a tonsillectomy
#6 Your fifth case is a VP shunt
#5 You do the difficult OB ultrasounds because you’re the best radiologist
#4 You scrub out to donate your own blood to your patient because he’s bleeding
#3 An intra-abdominal ectopic viable pregnancy isn’t that exciting--you get one every couple years
#2 You scrub with dish soap and river water
#1 You are your own scrub nurse, at times circulating nurse and at times anesthetist.

Arrived at Bongolo

I've arrived! I left on the 15th from Philadelphia, had a short layover in Frankfurt and then flew to Libreville, Gabon. Thankfully, the plane touched down and I got my luggage before the power went out in the entire city. :) The power came on in time for dinner and to turn on the air-conditioning to get some sleep. The next day I caught an hour flight down to Huimba and then it was a 2 hour drive to Bongolo Hospital.

The area around the hospital is beautiful. There's a waterfall just below the hospital compound and the house I'm living in has a great view of the river.

I'll start work on Monday.