Saturday, February 27, 2016

Now Accepting New Patients

I did my first surgery yesterday!

In the morning we went to church across the street from the hospital again, and then headed over for another full day of operating.  The very first case of the day for Dr. Ekbom and Dr. Wilson was a lipoma removal and they suggested I scrub in with them to observe and possibly help hold some instruments.  A lipoma is a benign tumor of fatty tissue, and the removal is a relatively easy and quick procedure.  Now, I've observed in the OR multiple times before, but have never once scrubbed in.  This was my very first time.  Dr. Ekbom took me over to the sinks, taught me how to wash, scrub, and rinse my arms and hands, and then he and Dr. Wilson taught me how to put on the gown and gloves.  The lipoma was on the woman's thigh, so we draped the sterile clothes over her legs, leaving a small opening where the lipoma was.  I was ready to observe! (Now keep in mind that health system laws and regulations are SO different here than in the U.S.) 

Never did I imagine I would actually perform surgery.  Real life surgery. On an actual human being. 

First thing I know, Dr. Wilson is handing me the scalpel.  Using his finger, he points and says, "So just make an insicion from this end of the lipoma to the other end of the lipoma."  Excuse me?? 

Quick glimpse into my mind:
"I think I'm hallucinating."
"Do they know I've never even held a scalpel before?"
"Wow, I'm so sweaty." 
"I'm glad this woman (who is awake for the procedure) doesn't speak English and doesn't know I've never done this before."
"Is this even legal?"

Well, friends, under the magnificent tutelage of Dr. Wilson and Dr. Ekbom, it happened.  I had Dr. Wilson make the first incision and I followed with the second incision.  As if I wasn't already nervous and excited enough, Dr. Ekbom then handed me the cautery, which is a tool that gently burns the tissue as it cuts in order to help minimize bleeding.  I cauterized away with help from the doctors, and before I knew it, the entire 10cm lipoma was removed.  What an experience, and one I will remember for the rest of my life!  Not many people can say they performed their first surgery at 20 years old in the Congo.  Huge shout out to Dr. Wilson and Dr. Ekbom for the remarkable guidance, teaching, and faith in me.  

After my maiden voyage as a surgeon, I went into the room my dad operates in.  There was a young girl in there, I think about 15 or 16 years old.  I remember this girl from the day in the clinic.  She came in with burns to her hands and lower arms, face, and head.  She is missing a large amount of hair on the top of her head where she was burned from (what I can remember) scalding water. Every day after that I saw her outside the hospital.  I think she was supposed to have her surgery the day before, but we didn't get to her.  I hadn't had any physical contact with this girl since the day in clinic, but every time she saw me, and every time I saw her waiting outside of the hospital, our faces lit up with smiles for each other. I started looking for her every time I walked outside of the OR building, and every time our eyes met we shared an excited smile and wave.  Anyways, when I saw her in the OR, and the nurse trying to get an IV in her, I could tell she was in pain.  I was walking out of the room, and heard her start to cry because of the pain.  I walked back into the room, took her other hand, and held it as she cried and as the nurse tried multiple times to get the IV in, putting it in, and taking it out.  I know too well that it can be miserable having someone dig around in your hand and arm trying to get an IV in, and it broke my heart to see her in so much pain.  I held and rubbed her hand, and wiped her tears.  I don't know if it made a difference to her, but I know if that was me, and I was young and alone,  I would have wanted someone to do the same for me.  

After she was asleep, she was prepped for surgery, and my dad began working on her right hand and arm.  The skin was very tight and damaged from the burn, and she didn't have great range of motion in her wrist.  My dad cut out a thin, long portion of the burn from the top, middle part of her hand, to roughly half way up her lower arm.  My dad was hoping to do a technique called a Z-plasty to close the opening, but the surrounding skin was too tight to bring together, so he skin grafted her arm using a section of skin from her groin.  At the end, a splint was made to keep her hand bent downward to help stretch the muscle that had become so tight.  I'm hoping we'll be able to see how she is doing on Monday, assuming that she isn't discharged before then. 

Today has been a day of much needed rest.  There is a Seventh Day Adventist church right outside Maji's gate, and I woke up this morning to glorious singing.  It was a beautiful morning.  Many of us spent time reading or doing devotions, and just sitting and talking.  At 1pm we drove down the road a little ways to Kivu Lodge, a beautiful resort, and had lunch there.  The dining areas look out over Lake Kivu and the gardens couldn't be more beautiful.  They're full of trees, bushes, and flowers of every color. We ate a delicious meal and talked, as Adele's newest album, 25, played in the background.  Am I really in Africa?


Back here at Maji there have been multiple wedding parties coming and going all day today. There are hardly any public accesses to the lake here, so on Saturdays Jo opens Maji for free for wedding parties to come take pictures.  There is one public beach kind of nearby, but nowhere near as nice as Maji.

The weather here has been warm, but very rainy.  I guess it isn't called the rainy season for nothing.  Almost everyday it has stormed, but the storms usually only last for a few minutes.  It's stormed twice so far today, once this morning and once while we were at lunch.  It downpours and thunders like crazy, but usually only lasts for about ten or fifteen minutes.  When it's not raining, it's usually overcast. We haven't seen a lot of the sun.  There was a beautiful sunset one night, so I'm hoping the sun will make a few more appearances before we leave.  We still have a week, so I still have hope for that!

One of the best parts of the trip so far has been learning from all the doctors--Congolese and American. The Congolese doctors are incredibly smart and dedicated to their jobs.  Dr. Luc is probably the best surgeon in all of Congo, and he is a fascinating man to watch and listen to.  He always has a smile and is absolutely brilliant.  He takes his job so seriously, with the desire to learn more everyday and provide the best medical care to his people.  Dr. Medard has been working a lot with my dad in the OR and again, has such an intense desire to learn.  He's always eager to ask questions and assistant the doctor he's working with.  Their passion to thrive and their passion for their people are inspiring.  

I also couldn't ask for a greater team of doctors to travel with and learn from.  Already in one week I can tell they will play such an influential part in my future.  I'm so thankful for the role models they have been to me.  Everyday I'm amazed by their performance and knowledge, but also by their love and dedication to God.  Dr. Ekbom is a hoot!  I've never known a better storyteller than him.  His sense of humor and positive view on life is so refreshing and fun.  He's a real breath of fresh air.  Dr. Wilson is also great.  He's so chill in and out of the OR and always willing to help teach me or explain to me what is happening during a procedure.  Dr. Erickson is incredibly knowledgeable about everything, but so kind and encouraging.  His stories of travel, involvement, and God never cease to amaze and inspire me.  My dad as well has always been a role model.  Every time I watch him operate I'm in awe of his precision and abilities.  It's been so fun to be able to be on this trip with him and learn from him as well.   I'm so thankful for and in awe of all the doctors here.  All these guys are serious life goals.  I will always remember the influences they have on me and their willingness to teach me and encourage me.  They've been so fun to be with and I'm so excited to have one more week here to grow and learn from them!

Thursday, February 25, 2016

Salle d'Opération

The first two days of surgery went so well!  We spent all day in the operating room--from 8am to 5pm. The HEAL Africa hospital has three operating rooms, so at any given moment there are usually two or three surgeries happening.  A large part of the American doctors' job is to help teach new skills and procedures to the surgeons here.  The motto is "See one. Do one. Teach one."  The Congolese doctors see our doctors do procedures, eventually learn to do the procedures themselves, and are then able to teach other doctors and/or residents how to do the procedures.

A lot of the cases we work on are unique, more complicated cases that have been saved for our arrival. Many of these patients came to the clinic weeks ago and were told to return when the American doctors come.  These are the patients we saw in clinic on Tuesday and if we can help them, they are told which day they should come to have their surgery.  Some people come from hours away, and some are from nearby.  They stay at the hospital overnight if they are from farther away until the day of their surgery.  On the specific day, everyone gathers at the hospital outside of the OR, and waits.  Patients are not scheduled to have surgery at a certain time during the day, so they all just sit outside and wait to be called.  This means sitting for hours, and hours, unsure of whether they will actually have surgery that day or not.  If they do not, they are bumped to the next day, and hopefully they will have their procedure done then.

Operating here is drastically different than in the U.S.  Pretend you're operating for 6+ hours a day in two layers of long sleeve clothing, a hat, and gloves, and pretend you're in a sauna.  That's pretty close to what it feels like.   The OR does have air conditioning, but it is rarely on because of all the power it takes.  I sweat enough just observing in my scrubs (and I can leave the OR whenever I want to get some fresh air), but I can't imagine how warm it must be all scrubbed up and operating, unable to leave the room for a few hours.  When the air is on (and even when it isn't) the power comes and goes.  During our very first case on Wednesday the power went off, leaving the surgeons to operate in complete darkness except for their single head light.  This happens multiple times a day, and no one thinks anything of it. The picture below is during our last case today when the power went off.

My dad works in one OR, taking care of the plastic surgery cases, and the other surgeons work between the two other ORs for the general surgery cases.  The doctors here are so passionate about their work and helping their people.  It's so wonderful to see their enthusiasm and desire to learn.  They can be quite ambitious regarding the number of cases they schedule for a days work, though.  My dad was scheduled for six cases on Wednesday, and we only completed three in the whole eight hours we were there.  Dr. Erickson, Dr. Ekbom, and Dr. Wilson were also unable to make it through their complete case list.  It can be so hard to judge the timing of certain procedures here due to many factors that are absent in the U.S:  some of these cases are procedures that are not routinely done in the U.S., more problems can be exposed after the surgery starts, there's a limited selection of instruments and radiology available, etc.  But, all the doctors work so hard and so meticulously to do the best they can with what's available, and the results are often wonderful!

So far, I've just been observing in the ORs.  I can walk back and both between the three ORs whenever I want to observe the different procedures.  On Wednesday, my dad operated on a little boy who burnt his hand in boiling oil, and his fingers were fused to his hand.  He separated the fingers, then did a skin graft to cover the exposed area using a section of skin from the boy's groin area.  As you can imagine, this is very tedious work to carefully separate the fingers and to graft a small piece of skin perfectly on to the raw area.  We saw the little boy today during rounds, and he has been doing well….besides the fact that we made him cry when he saw us.  I can only imagine that he's thinking, "Who are these funny looking people?".

On Wednesday I also saw some keloid removals on a man's chin, another skin graft for a large arm burn (wow, was this intense and time consuming and cool!), and a mastectomy on a woman with a large breast tumor.  Today, Thursday, all of the doctors were scheduled for a plethora of cases. My dad was scheduled for seven cases (like I said, quite ambitious) and he made it through three.  The first one was the removal of two infected keloids on a man's face.  This didn't take too long.  The second case, however, took about three and a half hours.  This was for a little boy who had previously had a bilateral cleft lip repaired, but also had a cleft palate that needed to be fixed.  His cleft palate was very wide.  He's about two years old already and has his front teeth, which added another challenge as those can get in the way and make it more difficult to see and repair the palate. I could try to explain how this was done, but I honestly have no idea how to explain the procedure.  It was crazy complex, but looked great at the end!  The final case was another child--a baby girl this time--with another hand burn, very similar to the baby boy from yesterday.  The tension was released, and the fingers separated and closed with a skin graft.  Her tendons in some fingers were so contracted that she will probably never have full extension of her fingers, but they are certainly functional now.  Unfortunately, we didn't get an "after" photo, but here is the "before" photo:

It was a long, sweaty day, but an amazing one, just like every other day so far!  We left the hospital around 5:30pm and headed back to Maji.  I don't think I've commented too much on the roads here, yet.  Most of the roads are dirt and lava rock and just covered in potholes.  Trying to have conversations while riding down the roads is hilarious because everyone is bouncing up and back and side to side.  There are more paved roads as of recently, though.  The president of the Congo is building (or bought? I can't remember which one.) a house on the same road as Maji, so a lot of the roads are being paved for him and for the upcoming election in the fall.  The busyness of the city and roads is astonishing!  It's literally just a free for all.  There are tons and tons of people just walking along the sides of the streets and crossing the streets where they please--including little children.  Cars pass in any available area no matter what side of the road it's on and motorcycle taxis zoom past and between any space they can get through.  I can't believe I haven't witnessed one accident yet.  On the sides of the roads are shops, restaurants, homes, etc.  People set out whatever they have to sell on the sides of the narrow streets. I haven't gotten any good pictures of the city, roads, and people yet, but will try to soon.

There are multiple big volcanoes around this area, but there is one massive one that we can see very well to and from the drive to the hospital. It is called Nyiragongo and is one of the most active volcanoes in the world! It is twelve miles from the city.  In 2002 when a group of doctors was here with HEAL Africa, including my dad, this volcano erupted and destroyed a huge amount of the city, including parts of the hospital.  The streets, buildings, cars, and houses were demolished by the lava flow, and some of the damage can still be seen.  When it is not too foggy or hazy out, Nyiragongo can be seen smoking from the top.  I'm trying to get a good picture one of these days on the ride to or from the hospital, but it is so hard because of all the buildings and rainy, hazy weather.

Tomorrow we will be back in the OR for another full day of surgeries. I may get to scrub in and help with some of the procedures! Updates to come!

Tuesday, February 23, 2016

Maji and The Clinic

We're now at Maji Matulivu ("still waters" in Swahili), the home of Dr. Jo Lusi where we stay during our time here in the Congo.  Jo has worked with HEAL Africa as a surgeon at the hospital for many, many years, and often times has multiple groups staying at his home.  And by home I really mean massive estate.  Jo's home is about fifteen minutes from the hospital--without traffic--and it is beautiful! It is the farthest thing from what you would think of when you think of living in the Congo.  It is a gated home and consists of Jo's house, multiple guest houses, and a large guest house all surrounded by beautiful gardens.  I feel like I'm at a resort.  It's lovely here.  It's right on a large lake called Lake Kivu that is so refreshing after a long day in the heat and humidity. We got here around dinner time on Monday, ate dinner, and were in bed at around 8:30pm.  I was so exhausted and thankfully slept straight through the night without any trouble! I think I'm the only one who did…it sounds like everyone else was up around 2am.

In the morning, we ate breakfast and then headed to the church assembly area for HEAL Africa for church at 7am.  Church here is so lively! I love it! You feel like going up front and dancing? Great! There is no holding back with these people in action or voice during their time of worship and it is a beautiful thing to see.  Definitely different then the typical church in America. They sang for us in English, too!

After church, we headed across the street to the hospital and took a tour of all the buildings.  Apparently it has grown dramatically in the past few years.  It is honestly so much bigger than I was expecting.  They have pediatrics, orthopedics, ER, public health, radiology, a surgery center, etc.  It's a very busy place!

After the tour, we all joined two of the Congolese surgeons in the clinic to meet with patients and determine whether they would need surgery done or not.  The two general surgeons and the vascular surgeon with our group went with one of the surgeons, and my dad and I went with another surgeon to see more of the plastic surgery cases. Wow was it ever interesting!  We saw many, many people with keloids, which are thick areas of tissue that form usually at the site of a scar or injury.  For example, many men came in with a keloid reaching from one ear, under the chin, and back up to the other ear that they got from shaving.  Another man had keloids form at the sights of gunshot wounds.  One woman came in with almost golf ball sized keloids hanging off her ears that formed from piercing her ears.  Keloids were probably the most popular thing we saw today.  Another interesting case we saw was a man we came in with a bandage on his bottom lip.  Apparently, this guy had been in a fight with someone and the other guy bit his bottom lip right off. What?! You could see the teeth marks and everything.  There were also multiple patients with burns.  One man's shirt had caught on fire and his left arm completely burnt from the shoulder almost to the wrist.  His arm is stuck in a bent position, so he will be having a skin graft done to release the elbow and shoulder joints.  Another young girl, probably my age or a few years younger came in with burns on her hands, arms, and face, and lost most of her hair on the top and sides of her head, apparently from boiling water.  We also saw multiple lipomas, some cleft pallets, and cleft lips, which are my dad's favorite cases.

I love it here.  It's difficult to see the poverty, but the people are so wonderful! The African culture is beautiful.  The people here usually speak their tribal language and then French as well, neither of which I speak, so that has been a little hard.  Some people will talk to us, saying any English words they know, but very few know a good amount of English.  The doctors are all relatively good at English, however, and are easy to understand, but I so wish I could communicate with the kids and parents.

Today was a lot to take in, but so incredibly interesting.  I already feel like I'm learning so much.  Tomorrow (Wednesday) we will be in the OR for most of the day, getting started on some of these cases, and I will hopefully be able to write again tomorrow night or the next day.

Hopefully, more pictures to come soon! 

Sunday, February 21, 2016

Arrived in Rwanda!

What a long but exciting 24 hours! This is the first time I've had good wifi connection since we left so here's a short update on our travels so far:

Our first flight left Chicago around 9:15pm and 10 hours later we landed in Istanbul, Turkey.  Many of us tried to sleep most of the time, but as you probably know, sleeping on planes is not the most comfortable.  After landing in Istanbul, we had roughly two hours before our next flight, spent mostly sleeping and talking.  At around 5:45pm Istanbul time, our next flight departed for Kigali, Rwanda.  My favorite part of the flight was looking out the window during dinner as we flew over the city lights of Cairo, Egypt.  That's such a cool thought to me!  We're thousands of feet over Cairo, Egypt! Eating dinner! Wow. We landed in Kigali around 11:30pm and it took a good hour and a half to get through customs and collect our luggage.  Thankfully, all the luggage made it through.  

We took three taxis from the Kigali Airport to the cutest hotel called Inside Afrika where we spent the remainder of the night before leaving today for the Congo, and where I am sitting now as I write this.  Let me tell you: Driving in Rwanda is not like driving in the U.S.  It's like a free for all on the roads, and for some reason makes more sense to drive right down the middle of two lanes than it does to stay in one lane…I don't know why.  But, we made it safely!  I have to say, I was a little concerned about what a hotel in Rwanda would be like, but I love it here!  It's very protected, clean, and there's even a pool.  It sits on the side of a large hill, and looks out into the valley below.  It's gorgeous, but of course a picture doesn't do it justice.  It was such a relief to take a shower this morning as well after so many hours of traveling.  

We're now eating breakfast at the hotel and getting ready to head out for the three hour drive to Goma, DRC.  I'll try and upload some pictures of the journey later today or tomorrow depending on the wifi situation.  

Bye for now!