Sunday, March 8, 2015

The First Week

Hello all,

Sorry for the delay. I wanted to write on Thursday night but internet at the MSI (Malawi Surgical Initiative) house was wacky and I couldn't post.

Anyway, we arrived on Wednesday in the mid afternoon.  Wednesday morning at the Johannesburg airport was a little to exciting... When I checked in for the flight to Lilongwe (connecting through Blantyre, the former capital of Malawi further south) the flight company told me that I was not registered for the flight.  They tried various misspellings of my name but I could not be found on the flight register. Dr. Charles and I went over to an internet hotspot so I could recheck my email that had my flight confirmation in it and I realized that the travel agent had booked that one leg of my trip for 3/14 instead of 3/4. The Ethiopian Airlines people were very helpful and accommodating and I was able to change my flight to the day of for about 400 rand (40 USD).  Crisis averted. Moral of the story- check and double check your flights, each and every leg, before taking off.

Jared, one of the UNC surgery residents, picked us up at the airport.  He and his family are here for the year and he has been working on various UNC- Kamuzu Central Hospital (KCH) surgery projects involving the burn unit, trauma database, and others.  Here with him are his wife, Laura, and son, Lincoln.  Lincoln is 2 and is basically the life of the surgery house.  With his parents' permission, you'll see some cute pictures of him on here.  Jenny, who is also a UNC 4th year medical student, is here working as well for the next several weeks.  She's going into OB/GYN and is spending some time in the ORs at KCH as well as at Bwaila, the maternity hospital, and the Freedom From Fistula Foundation (for obstetric fistulas), which is also located at Bwaila.

Laura cooked us a great arrival dinner on Wednesday night and we went to bed.  It certainly took us some time to get used to the 7 hr time difference between here and the states. Luckily, that changed last night and after your US "spring forward" last night we're only 6 hours apart.

On Thursday, we woke up and the four of us (Dr. Charles, Jared, Jenny, me) rode over to KCH for morning report.  This is basically an hour or so in the morning where the interns and other surgical staff present the patients who came in overnight, usually either as traumas or emergency cases, any interesting cases, and any deaths.  This is relatively similar to something that would be done in the states, and it is always interesting. The poverty and scarcity of healthcare, especially in the rural communities, translate into people presenting to the hospital with very advanced diseases.  Some of the cases in morning report involve problems similar to what we have in the states - a broken bone from a motorcycle accident or appendicitis- but others are very different.  A person with chronic back pain presents to KCH and receives spinal x-rays and the preliminary diagnosis is TB in his vertebrae. Definitely not my first guess in the states.  Morning report is also a nice time for teaching, as the Attendings (doctors in charge, those who have finished training and are now teachers themselves) in the room also use some of the key points from the history, physical exam, test results, or operative findings as teaching points.  I always learn something.

Some pictures of KCH and our house here:
Jared and Dr. Charles outside of the Burn Unit, which was seriously upgraded last year with the gracious help of Johnson and Johnson.  There is even a separate burn operating theatre up on this floor now!


One of the buildings at KCH- the background has the bedtower which houses most of the medical and surgical adult patients.  There are open air walkways throughout the hospital.

out mode of transit

The road to KCH. Turn left (from the left lane).

Tidziwe center, where UNC Project Malawi offices and clinics are.  On the grounds of KCH.

UNC Malawi MSI house.

Lovely guard dog Zaza

Cottage behind the main house.

Even the sky is prettier in Malawi.

Zaza, the MSI house dog and my old friend.  You can see some pictures of her in the posts from 3 years ago.

Jared and Laura, our hosts.

It was a beautiful first week.  We operated on Thursday, which was our first day in the hospital.  Unfortunately, we had a very sick infant patient with a condition which was not survivable given his delayed presentation to the hospital and the operating theater. Seeing patients here can be frustrating as you wonder what systems can be improved to streamline and expedite care to acutely ill patients- with surgery several hours earlier this infant may have lived.

The remainder of OR schedule mirrored a busy general surgery service in the US- mastectomies, breast biopsies, hernia repairs, amputations, emergency bowel surgeries.  All of the surgeries here are open- meaning the area to be operated on is opened with a sizable incision, an operation is performed with the surgeon visualizing his/her field through that incision, the surgery is performed, and the incision is sewn up at the end.  This is in comparison to laparoscopic surgery which is incredibly common in the US (where multiple small incisions are made on the patient's body and long cameras and tools are placed through those incisions). Apparently there is a laparoscopic surgery tower here, which allows the video feed to show up on a monitor and allows gas to pump through one of the port sites which essentially blows up the abdomen (our word is insufflates), thus separating the abdominal wall from the abdominal contents so the surgeon can see.  However, there is no readily available gas for the machine and I don't think it plugs into the wall correctly so it's not in use.

On Friday afternoon we drove out to Lake Malawi for a weekend of fun.  More on that later...

Thanks for reading!

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