Friday, December 31, 2010

3am 12/31/10

3am 12/31/10 and the roosters are crowing in the new day as I make my way into my bunk. It is hard to distinguish the sound from the cries of the mother- cries that Hope and I were attempting to escape on the roof. Those wanton cries of untold and immeasurable grief ring in my ears now as I wish to find some rest, for an hour or two.

Today was a hard day. No lie. No bullshit. Just a hard, hard day. What started as ordinary – rounds, waiting for a case, wound checks, pharmacy runs – turned into intraoperative consults, ultrasounds, head lacs, poisonings, chest tubes, gastric lavages, codes, hugs from patients families, long distance ethics consults, no dinner, no beer, no more ventilators, another code and now, a mother crying and a child dead.

This is reality folks. And it sucks. Life and death walk hand in hand.

I have spoken of teams before and it is important to understand that everyone I am here in Haiti with is here with a full heart. It is another magical team of accomplished people far smarter than me, far more capable than me – but even when you play your a-team – you don’t always win. Sometimes, you don’t get to decide – you don’t get to control it – it is what it is and what it is ain’t always so frickin’ pretty.

Today we lost – and we lost big. There is nothing more to say, there is nothing more that would even begin to be appropriate. My teammates and I will carry today with heavy, heavy hearts and hear the echoes of a grieving mother in the crows of the roosters. For awhile, we will be haunted by the death in life but there will come a time when that balance will shift back to the equilibrium. What we carry in our hearts, what we honestly feel so deeply, lets us know we are where we are supposed to be, doing what we are supposed to be doing, living this life.  Even when it ain’t so frickin’ pretty.

Rain

Bike Shop Port-au-Prince
Street Vendors

It is raining tonight. Noisy, big-drop, rain in sheets. It is perfect.


Today was the third day of my trip to Haiti with Project Medishare. In this small hospital (4 bed ICU, 2 bed ER, 2 OR’s) the clinics are insanely crowded and “the gate” is always busy with people wanting to make their way into the emergency room. It is safe here. Clean. Dry. There is food. There is a bed . . . if you are sick enough.


Today I think I got it – I started the day a bit disgruntled, feeling useless and extraneous. I helped an oncologist with a paracentesis on a terminal cancer patient, picked a stone out of some adorable child’s ear, and then had to leave the compound – what more is there for a pediatric surgeon to do?? I had already “ruled out” appendicitis in my overnight observation patient and sent a man to the “cholera tent” who I was sure had cholera . . . I needed a better view of what I was doing. I got a much better view . . .
Warehouse


We left the compound to go to the warehouse and check out the supplies we might need for a few up-coming surgeries. But I left, mostly to leave. Haiti is a country of rubble. No one lives in the buildings anymore. They live in tents, neatly arranged along the major thoroughfares. Haiti has little industry save the street merchants, the electric company, and the beer brewery. The dogs in Haiti are not even skin and bones -they are flesh, hanging on wires like some sick stick figure drawing, roaming the streets, climbing the burning piles of garbage, hoping to find a scrap to eat. There are goats, everywhere, picking through the refuse, playfully jostling each other in the steaming desolation. We saw a pig moving towards a rare bit of shade to hide and wallow in a shallow pit of mud. Everywhere we looked, there was dust floating in the air, like some veil over the scene full of people, goats, dogs, pigs, rubble, mud, street vendors, life in Haiti.


On arrival to the warehouse we were let into a locked and guarded compound. Inside, we looked down aisles of dusty donations some useful but many expired, archaic products. The rubble of the street seemed to be sitting on the shelves, taunting me and my expectation of finding something different. After gathering a box of useful goods, we walked to the back of the warehouse where the damaged ventilators, tens of dialysis machines, broken hospital beds and cribs, laid useless, in a small nation, overpowered by refuse. We were there, in the epicenter of the garbage dump staring at a tragically symbolic representation of what has happened to these people who deserve so much more then our sloppy seconds.

It was frightening, and humbling - so much material waste. These people struggle to get by – living in a dollar store world that we have “given” them. They are ALWAYS impeccably dressed, ALWAYS incredibly tidy, ALWAYS sharing beautiful, gleaming smiles – yet they are forced to live in this dusty, rubble laden environment.

I returned to the compound with a perspective on “donation” that made me angry. How can you expect a wonderful people to rebuild a country on our left-overs?? Our rejects?? Our expired goods?? How can you ask a people to make a better life for themselves when you offer them only what you would not, could not use?? This is not giving. This is not generosity. This is dumping your trash in a giant landfill of need and hoping to feel better about yourself. Don’t. Haiti has enough to clean up already. Don’t send them your shit to clean up too. Send them the good stuff - the BEST stuff.


I was beaten by this idea. Beaten and feeling useless. In an attempt to make a small difference, I started cleaning up the ICU. The supply shelves needed some organzing and I just sorted and disposed of the trash. In the process, I found lemon mouth swabs and my ICU nurse was thrilled that his patient would finally get a respite from the taste of an ET and NG tube . . . small, oh so small, victories. I threw out half a bag of trash from just two shelves and then I had to stop. . . .



We were all sitting outside at dusk when Alex came to tell me there was a “surgical emergency” at the gate. A 30+ year old gentleman had excruciating abdominal pain and a new “bump” above his umbilicus. He had vomited a few times and come in . . . simple problem, simple fix, just what I needed. After evaluating our patient, I took the internal medicine doctor into the OR and we fixed the man’s incarcerated supra-umbilical hernia. Small victory, but on my stage, in my arena, and just what I needed to prove to myself that I was offering something here.


It is hard to imagine you can effect change by fixing a hernia, taking a rock out of a kids ear, cleaning up an ICU shelf or two . . . but perhaps, you can.

Sitting outside on the roof, after my case, I drank a Prestige with my teammates and laughed about the silly things we had been through that day. The rain came to wash the dust away. We ducked into the ICU to check on the patients and make sure the night shift was okay. And now, here I am, trying to capture 12/27/10 so it doesn’t slip away.

Thursday, December 30, 2010

Room 614

Room 614: Suz, Melissa, Laura, Jason

On Christmas Eve, I ended up with two great taxi drivers. They were both “talkers” and both had some strong opinions. Tony in Denver, and David in Miami made me laugh, asked some real questions and made me smile and were my Taxi Santas. After arriving late Christmas in Fort Lauderdale, David drove me over to Miami airport and I checked into the airport hotel for a few hours of sleep before my 730am flight.

When I arrived at the Miami airport there were messages on my cell from other project medishare volunteers who were eating at subway and sleeping in Terminal E . . . I texted them from room 614, told them to come up, and we spent Christmas Eve night together. Melissa, Laura, Jason, and I all crashed out, met each other for the first time, shared stories, and were together when Christmas 2010 rolled around. At 430 am we checked in for our flight to Haiti and met even more of the team. So the adventure began, Christmas Eve, in room 614.

Friday, December 24, 2010

Dr. Seuss Had it Right


When I was a kid, Christmas was Huge! It was all trees, ornaments, carols, cozy fires, hot chocolate, party dresses, white lights, Christmas specials, cheerios for reindeer, early morning cinnamon rolls, red pajamas, presents, Santa, wrapping paper, bells, stockings, food, family and all, on over-drive. Christmas, when I was a kid, was what I wish Christmas could be for everyone, everywhere, all the time.

Being “a grown-up” has changed the appearance of Christmas for me. I have spent more Christmases on call in the hospital and fewer holidays with my family. When I do get to see them this time of year, it is usually a quick and concentrated visit – no less special, just different. Christmas is subtle now, not so much on over-drive.

This year, Christmas means “a little bit more” than ever before. This year, I am taking Christmas on the road. Mom and I “skyped” present opening on Christmas Eve morning, and now, I am in a Miami airport hotel waiting to leave for Haiti. I will arrive on Christmas day for a week of work with a team I do not know, but for whom I already feel a great affection.

You see, in my heart, Christmas is exactly like it was when I was a kid. Christmas is warmth and love and generosity. It is hope, faith, laughter and joy. Christmas, no matter what it looks like, or where you spend it, is special for everyone, everywhere, all the time. We carry Christmas in our hearts.

Beau and I wish you a very Merry Christmas. We wish you love, warmth, joy, hope and laughter – just like when you were a kid.

Love Always, Suzy and Beau

Thursday, December 23, 2010

Packing . . .



Though I have moved and travelled enough in my life to qualify as a professional, I can’t stand packing – or un-packing for that matter. With my nomadic life, it is safe to say that you can look in my closet, any time of year, and find one unpacked bag and one stack of things I am planning to take on my next trip. I had to unpack from both a Thanksgiving trip and an LA weekend in order to start packing for Haiti. Though experienced, I am no expert! Yet, I thought I would share a few tips that you might find useful if you are packing for a medical mission trip. In no particular order:

1. Patagonia. I love this company! Not only do they let me bring my dog into their Denver and Cardiff stores, but they make great, durable stuff that is guaranteed for life! The quality is so great that I have had a certain pink Patagonia pull-over since I was 16. (stop laughing! it is that old!) Yep, it might cost a bit more, but if you buy one of their travel bags and the airline ruins it, you can get it repaired or replaced,  free of charge – forever! I find buying this companies goods a pretty sound investment. I also recommend the book “Let my People Surf” by Yvon Chouinard. It describes Patagonia's philosophies on environmental responsibility and the value of an active, balanced, quality of life.

2. Find a place (your bed, or dining table) and lay everything out that you plan to bring with you – then remove stuff. Everyone always brings too much – try to be frugal with your packing.

3. Put all medications (ie. chloroquin, cipro, zithromax, imodium, pepto-bismol) in your carry-on.

4. Bring enough pairs of scrubs to cover everyday of your mission. Do not count on laundry services and you can always leave them in country if you don’t want to bring them back. Also bring reusable OR hats so you don’t have to use the expensive, environmentally toxic, disposable ones.

5. An old pair of clogs for the OR. Closed toe shoes only and again, something you can leave behind at the end of your trip.

6. Protein or granola bars – quick, easy energy when you miss meals. I like target brand peanut-butter/chocolate protein bars and nature valley granola bars. Instant coffee, emergen-C and powdered Gatorade are also critical. I recommend bringing a water bottle too. And a reusable spork in case there are no utensils.

7. Don’t forget an electricity converter and all of the chargers for whatever electronics you bring. I take my laptop for keeping track of patients, watching videos, getting on-line if we have access.

8. Stethoscope, protective eyeware, sterile gloves in your size, trauma shears . . . bring task specific supplies!

9. Flip flops for nasty showers

10. Toilet Paper you will be glad you threw this in your bag!

11. Facial Wipes I am a fan of Target cucumber exfoliating wipes . . . sometimes you don’t have the time or the energy and these just help!

12. Hand Sanitizer Do I need to explain?

13. Head Light! If you are working in an OR, lighting can be questionable. Camping headlamps are easy to use and provide great light in the OR. They can also be used as a flashlight in your living quarters.

14. Swiss Army Knife in your checked luggage. If you ever back-packed through Europe, you know how useful this little guy can be for wine and cheese. Don’t forget it when you go on a service trip!

15. Most trips have a recommended packing list – bug spray, mosquito netting, sleeping bag, towel … this stuff is trip/location specific but pay attention to this list! And don’t forget this stuff.

16. I always try to bring one “nice” outfit – I have a few easy travel dresses that don’t wrinkle and look OK if you need to be a bit more presentable. Headbands are a nice accessory for girls with long hair – they can distract from the lack of blow-drying and amount of time in a pony tail your hair has suffered on a mission trip.

17. I also bring some fun, inexpensive jewelry – plastic rings, funky earrings, bead necklaces, good luck bracelet – just because.

18. Photocopy of your passport in case of an emergency.

19. I have had many friends recommend that if you are traveling in a conflict zone, you carry US cash, in an envelope, in case of an emergency. Don’t be afraid to give this up!!!! Amount recommendations range from $20 to $100. I carry two envelopes one with $60 and one with $100 . . . cheap insurance policy as far as I am concerned.

20. Always carry a bathing suit in your carry-on. No lie, I do this. You can use it as an extra pair of underwear AND if your luggage is lost, it can be a difficult and expensive thing to buy in country.

21. Journal and pen. Try to write something every night – even if it is just jibberish, incomplete sentences, flighty thoughts. You will be happy you did this when you get home!

22. Don’t forget pictures of the ones you love – I keep mine on my iPod, Blackberry, and computer – and they have helped me get through more than a few tough days. 

Below, is my complete packing list for Haiti in case anyone wants specifics. I am sure I brought too much and forgot something important but that is just part of the challenge. I know that as long as I have my Chloroquin, a toothbrush, some emergency cash, my passport, and a Patagonia bikini – I will be alright. 

Thursday, December 9, 2010

Anna Home Photo Project 2011


Christmas is for children everywhere. In this season of giving, I am seeking support for a wonderful and talented group of children. 

This September, I had a great adventure in Mongolia. While working in the hospital in Choibalsan, we had the opportunity to meet a group of children living in Anna Home. This small orphanage houses 25 children and has expanded to support teenagers as they make their way out of Anna Home, and into the great big world. 


The children at Anna Home were instantly enamored by our digital cameras. I let them run loose with a durable point and shoot I had brought along and when i got it back, I fell in love with their photos. They took AMAZING pictures, capturing their world with a unique view and innocent vision. 
Vincent Klein Breteler with the new camera!
When our team returned home, we sent money to a local volunteer, Vincent Klein Breteler, who was instrumental in buying a camera for the children and obtaining the pictures for this project. We have set up a cafepress shop (http://www.cafepress.com/AnnaHome) to sell products displaying the children's photographs. All proceeds from the sales at the cafe press site, will go directly to Anna Home www.allforchildren.info/index.php. Take a look (especially at the calendar). Thank you for your support of these bright and hopeful children.


more info at: http://suzyoder.blogspot.com/2010/09/anna-home.html

Friday, November 12, 2010

Gratitude


It has almost been a week since I returned from Belize. In a few days, the rest of the team will be back – after spending a week on the Belizean coast, diving, snorkeling, beachcombing . . . I hope they enjoyed the well-deserved vacation and come back excited about the possibility of doing this again sometime!

I owe some big “thank you’s” to team Belize. Bonnie Webber – Thank you for being patient, generous and supportive. Your contribution to our team was critical (no instruments, no surgery) Sorry you had to put up with my insomnia! Cynthia Kruger – Thanks for taking a leap with me. You did an amazing job! I hope you enjoyed the challenge – you certainly rose to it. Marilyn Vernon – Seriously, you can work in my OR any day! You were such a quick study. Thank you for your patience and hard work! Jane – Thanks for your laugh and your great work with our post-op challenges. You were sunshine! Anne Marie – Our hummingbird, or is that social butterfly? Thanks for getting to know each of our patients so well, and for always smiling. This was an amazing OR team that I would be proud to work with anywhere.

Back home I want to thank Shounta Candies for the support that got me on the plane with the tools I needed! You are the best! Saundra, Kristin, Steve; thanks again for letting me go do my thing. Team Choibalsan, thanks for reading my blog and cheering me on with each trip I take. Mom, Dad, Tuck – Thanks for always loving me, even when I wander.   Beau – thanks for being there when I get home and for loving me through my jetlag.

Next up – Haiti . . . 

Sunday, November 7, 2010

Legacy

Kelly Slater won his tenth world title yesterday. Pretty sure he knows what his legacy will be. I envy him – sitting there with this monumental, hard won accomplishment – looking out over the vast expanse of the rest of his life – knowing, that his legacy is set. Anything else, is icing at this point. Anything he does, save scandal or crime, can be a total failure, and he will be remembered forever as a tremendous champion.

Today we canoed through a cave in Belize – thought by archeologist to be a site of Mayan rituals and human sacrifices. When we got back to St. Ignacio, we walked through the Cahal Pech ruins – only a block from our hotel. It was peaceful on the cool stones in the jungle – quiet and shaded with beams of sunlight creating some interesting shadows. Perfect place to sit and reflect, high on top of the oversized steps. There we were, sitting on concrete evidence that these people have left an indelible mark on this planet – a legacy of unimaginable endurance.

So what do I leave as my legacy? I will not build a stone monument, or win even one world title in anything but I have to believe, that in some way, what I am doing, what we all are doing, will endure. I have to believe that one day, my children, my nieces and nephews, will know that I tried to have a lasting – if only small - impact on the lives that I have touched. I do not see my legacy on a grand scale, but more as a legacy of a life fully and well lived, a legacy of quiet integrity. That would be my monumental championship.






Saturday, November 6, 2010

Sleepless in Belize

It is 815 in the morning and I am sitting in a hammock, downing some Vega, looking out over St. Ignacio as she wakes up. I tried to sleep on the porch last night but it got too cold. And then I tried to just sleep . . .

We finished up at the hospital yesterday. 20 cases in 4 days. Our O.R. team of 6 women got a bit slap happy at the end. We really have become a strong team but we were really ready to be done. After inventorying and packing up the last of our supplies, we made it out for a ‘belizean snow’ at the bar and dinner at the fancy St Ignacio Resort Hotel. And then back to the hotel – where I couldn’t sleep.

Today we are going canoeing through some caves and then down the street to check out some Mayan ruins. Looking forward to day of recreation, a night swim, and the trip back home. As I look out over this city, with the sun shining down, I hope that sunshine finds those who need it the most. Winding down from this adventure in Belize – maybe tonight, I will sleep. 

Thursday, November 4, 2010

Patience and Grace

Today was a good day. If you were here, on the surgery team at La Loma Luz Hospital in St. Ignacio, Belize; you may disagree with that statement. Please let me be so bold as to explain.

We had scheduled five cases today – two quick, easy kids and three lap choles. After yesterday’s marathon, we were prepared for just about anything but wanted a bit of an easier day. But today, today was nothing like yesterday. Today we met a whole new set of unforeseen challenges. Today we were tested. Today was our proving ground. As a team, we weathered a halothane hang-over and a power outage with patience, faith and grace. I am proud to say that this team showed each other the utmost respect while taking care of our patients and facing these challenges. We were patient with the process and each other; had faith in each others expertise and knowledge; and were graceful enough to move through these trying times with level heads. I am proud to be a part of this team and proud to see that I can find inside of me the strength to endure and to help move a team through difficulty. I have never thought I had much patience or grace but today, I found what I had and put it to use. Today was a good day.


Wednesday, November 3, 2010

Flying

Belizean sunset view from the front of the hospital
This is the first time I have been the “lead” (read “only”) surgeon on a medical mission trip. Initially, the idea was exciting, then intimidating, and then I think I just gave into it – the next step, figuring out how to fly without a net.

Today was our second day of operating. Every case had an added degree of difficulty – funny liver anatomy, acute inflammation, large gallstones, difficult airways, short cystic ducts. I got stressed during our second case when the anatomy was obscured by inflammation and I made the comment that I sometimes make when I am doing a difficult case “I’m not happy.” The minute I said it, Cynthia, or anesthesiologist piped in with “if you’re not happy, we’re not happy.” Subtly she reminded me that this team is counting on me to set the tone, be the leader, and make this a good situation for everyone. I shut up and got back to work – damn gallbladder has got to come out.

It was a long day. We operated until 830. Staring at 11pm right now and we have only just eaten dinner and gotten to our rooms. But we did it  - managed to take out five gallbladders of the nastiest variety and fix a little kids funny looking belly button. Everyone worked incredibly hard today and we are all pretty tired. But we are here . . . we are doing this. We are each others net. We are flying.

Sunday, October 31, 2010

Night Swimming


A big yellow school bus picked us up at the Belize City airport. Wilhelm, our driver, took a fifteen-minute detour to show us a mostly boarded up downtown – they have just started putting the pieces together after Hurricane Richard. When we hit the west highway on our way to St. Ignacio, I left my window open and let the humid air race on in. Thick and warm, I welcomed the tropics, and I think, she welcomed me.

We drove up the hill to our resort – which instantly reminded me of some nicer surf accommodations, minus the ocean. We have cabanas with private decks, hammocks, WiFi . . . I am sitting outside now, listening to the town below – music in a distant bar, dogs in the valley, geckos chirping on the patio, city lights below and the warm, thick air holding me tight.

We have a good team. Bonnie Webber, my roommate and scrub nurse, has been working with the global health initiative for years. She has been to every site but Vietnam and will bring such a wealth of experience to our enthusiastic team. I am fortunate to have met her – and know that she will be one of those forever friends.

We ate a great dinner at the hotel restaurant and everyone has called it a night. I just jumped in the pool for a quick night swim under a spectacular starry sky. Wrapped in a towel on the dark pool deck, I watched the fog roll into the valley below. Here, I will call it a day and look forward to the promising sunrise and the gift of a day full of new friends and good work. 

Saturday, October 30, 2010

It's a Small World after All


As I head off to Belize, my thoughts are with the people in Indonesia and Haiti who are in immediate need of medical assistance. Please remember them as you celebrate the holidays with your family and friends and think about donating time, talent, or money to help out these devastated countries. Project Medishare http://www.projectmedishare.org/ or J/P HRO http://jphro.org/ are doing amazing things in Haiti. Last Mile http://www.lastmileoperations.org/ is providing rapid aid in Indonesia. 

Belize



Apparently November 1-7 is “Global Surgery Week” on Twitter. Though I have never heard of such a thing, I find it somewhat fitting that I am headed off to Belize early tomorrow morning. I will be working with Centura Health’s Global Health Initiative (http://www.centuraglobalhealth.org/) doing general and some pediatric surgery. Unlike Mongolia, this is less of a “teaching” trip and more of a “doing” trip. We have 22 surgeries currently scheduled and I anticipate we will add a few more as the week progresses.

My surgery practice has privileges at many Denver area hospitals. One of those, Littleton Adventist, is a Centura facility. I learned of the Global Health Initiative through a mailing that went to all Centura physicians. After contacting the medical director, Greg Hodgson, I committed to Belize. When the anesthesiologist for the trip fell through, my friend Cynthia Kruger was kind enough to step in and join the trip. It will be her first medical mission and hopefully, we will sell her on doing more!

In the interest of full disclosure, this trip has cost me $800 up front. We also had to work on getting supplies and some equipment. MAP is a program through Ethicon Surgical that supplied us with suture material and mesh for hernia repairs. (http://www.map.org/site/PageServer?pagename=what_Ethicon) Other equipment was a bit more difficult to come by. I have left my dog (ie. my first born!) as collateral for a few items borrowed from some kind friends (who shall remain nameless in order to protect the innocent and encourage further generosity) We have scrounged together enough supplies to get the job done next week, and hopefully leave some things for the next group to use.

I am excited for tomorrow – but for now, one more sleep in my comfortable bed. 

Wednesday, October 27, 2010

Coming Home


(Written the night I returned from Mongolia)

My bed has never felt so comfortable. . . getting home from Mongolia was not easy. Our flight out of Choibalsan was delayed from 650pm until 7am the following day necessitating another night in a hotel in Choibalsan. 6 people, one room, lots of extra roll-away beds and not much sleeping. Awake at 430 am we arrived in Ulanbataar to find out that our flight to Beijing was now delayed from 11am until 8pm . . . that became 11pm . . . eventually 1145pm . . . you get the point. We spent the day shopping and seeing some sites in UB. We also had another great lunch at Hazaar Indian Restauraunt and got to catch up with our medical translator – enkhe. But then we spent too much time in the airport only to arrive in Beijing around 2am where we had to wait in lines/have our passport looked at atleast 5 times, all before getting to a smelly transit hotel. We finally got to sleep at 5am. 4pm in Beijing, we left for SF and when I finally got a glimpse of the Northern California coast line out of my window seat, well I smiled a tired little smile. After beaming at the immigration guy and letting him know how happy I was to be home, I walked outside and smelled some fresh air before getting on my last leg – southwest to Denver. The taxi driver asked why I had a down jacket on – Denver is having an Indian summer – and I told him I had just gotten back from Mongolia. His response: “that’s in the middle of nowhere!” Thankfully, Beau had been dropped off at home and was there waiting for me when I walked in the door.

And now, it is quiet. Too quiet. Somewhat lonely. I miss team Choibalsan and our grand adventure. But my bed is comfortable, really, really comfortable.

"You are Important Surgeon Now"

I leave Sunday for Belize and another adventure, but before I go, I need to wrap up the Mongolia story. I have put it away for awhile - worked at my 'real' job, and enjoyed being home with Beau. I hear from my new friends often, will be planning a trip to Utah to ski this season, and regularly recall the lessons I learned in Mongolia.


Dr. Ray Price left Mongolia on Wednesday of the second week. I was not aware that the same day, our medical translator would be leaving. When i voiced my un-ease, Ray was quick to point out "don't worry, you have Harold." I looked at him in shock, "but Harold doesn't speak Mongolian!" (see 'Leave 'em Laughing' to really understand!)


Despite Ray's departure on Wednesday afternoon, we finished our cases early and the Mongolian surgeons brought beers into the OR to celebrate an early day. As we drank our celebratory beverages, I showed them pictures of my family and surf trips on my computer.
Hmmm . . . beers in the O.R.?
The next day we were determined to get 4 cases done by 4pm (4x4). We encouraged quick room turnovers and attempted to move through the day efficiently. Our translator pointed out, as I was running around between cases, that I was "important surgeon now." It made me laugh, and it made me work harder.  In the end, we finished by 5pm and the last lap chole performed by Ganbolor and Oyuunbold took 49 minutes! They had been such good students!!
After the LAST lap chole!
The last lap chole team! Ganbolor, Suz, Allison, Oyuunbold
That evening, we went out back of the hospital and flew a small travel kite i had brought along. That kite has flown in Fiji, California and now Mongolia. We watched a gorgeous sunset, moon rise and started to think about heading home. 

Not much wind, but if you run fast enough, it flies!
Big Sky and a little kite
Our next day was full of rounds, one last lecture, and the distribution of certificates to all who had participated in the training program. We took more pictures (surprise) and gave Dr. Ganbat framed pictures of the whole team (these were later put in their cabinet of books - quite and honorary position). One more case and we were done . . . 
Giggles at the certificate ceremony
Dr. Ganbot and the group photos
We went back to Anna Home to see the kids one last time, and then off, to the adventure that was to be our long journey home. Bittersweet, we finished our work in Choibalsan with new friends, and a wealth of knowledge and experience. I think it is safe to say we all found a place in our hearts for Mongolia and the inspirational people we met on this trip. 
Allison and her best friend at Anna Home

Surgery Camp

Written Tuesday of our last week in Mongolia:

Ray “the buddha” Price is leaving us tomorrow. I think we are all finding it hard to believe we will be returning to “real life” in a matter of days. When we first arrived in Choibalsan, Dr. Rust made a joke about how we had become such a tight family, and how this all felt a bit like camp . . . I chimed in with a wise ass – “yeah, surgery camp” but it is true, we have become like some twisted summer camp/surgery camp hybrid. So here we are, the night before Ray is leaving – all of us piled onto two queen beds smashed together, watching Indian Jones and the Raider of the Lost Ark . . . we have five cases tomorrow but here we are, staying up all night, watching a movie at surgery camp. Life is good. Life is good.

Tuesday, October 12, 2010

Leave 'em Laughing



It has been a long time since I laughed that much. Maybe with the nieces and nephews, maybe out with friends . . . but this was two weeks straight. Yes, we were doing serious work, teaching, doing surgery, taking care of patients. The hours were long but the days were hysterical. Maybe it was how we dealt with being so out of our element. I tend to think we were just enjoying the challenges, and enjoying the little things so much, that they made us laugh. 

We laughed at the Mongolian airline brochure that announced “safety is not an option” prominently in their message to passengers. We thought about that after safely landing and then jumping into an old Russian ambulance for the road trip to the hospital. In that van, on that pot-hole laden road we bounced around laughing that perhaps safety really is not an option in Mongolia.

There were countless silly moments revolving around this foreign diet. The first day we all sat down to a formal lunch with the hospital big wigs. I tried not to look at the food, just forced myself to take a small bite of what at quick glance, looked like thinly sliced roast beef.  After two relatively non-offensive bites Ray chimes in to ask our hosts “so, this is beef tongue, right?” It was then that you heard three forks drop simultaneously and all the girls shot wide-eyed glances at each other. Then I looked . . . obviously tongue. 
Beef Tongue
Gaby celebrated here birthday in Choibalsan and invited Cody to make it an extra special day - “cody, you can jump out of my birthday cake; I mean my mutton stew” Then there was the always giggle inducing “how are your mutton balls?” Our lunchtime mantra started on the second day when Allison asked “could this be mutton?” That didn’t end until she non-chalantly announced “I am taking a break from mutton” and we all jumped on that bandwagon.
"Mutton Balls"
Then there were Cheese Curds - No matter how many times we got burned, someone would always forget and grab what looked like a crunchy, yummy snack. The laughter would ensue as we would watch the forgetful one contort their face and politely work their way through swallowing the sour, gummy textured "treat."
Cheese Curds

We laughed at the condom dispenser in the lobby of our hotel – literally, the first thing you would see walking in – even before the reception desk. We laughed at the guys posing in Allison’s head bands. We laughed as we did Yoga in the OR. We laughed when Allison got on Cody’s shoulders to peer into the window of the lecture room. We laughed at everyone wanting to pose for pictures with Cody because he is just so darn tall. We laughed at cows grazing in the hospital courtyard. It all just made us shake our heads and chuckle.
What have we here?
Boys in Headbands

OR Yoga
Umm, some of us are lecturing in there!
That would be cattle. In the hospital yard. 
We laughed at each other trying to speak Mongolian. Harold’s language butchering was probably the best – though he was going for a much higher level of difficulty than the rest of us who were only trying to learn to count.  While trying to say “help, I am lost” Harold sent a full OR into tears, literally, people had to leave the room they were laughing and crying so hard. Appears what he had actually said was “Cut me open. I just delivered a baby” . . . our Mongolian friends could not stop laughing.
Learning Mongolian

There was Okoo, droning on, and on when I had given a very brief instruction to my Mongolian mentee. When I finally interrupted her to ask exactly what she was telling him to do, she said “I was just thinking. . . “ Mind you, I was giving SURGICAL instructions to the guy holding the sharp instruments and Okoo has no surgical training at all. Though I politely asked her to “stop thinking” and just translate, I thought it was hysterical and could not stop giggling  . . . .
Loco Okoo :)
We laughed so darn much – but I know, I know, you probably had to be there. 

Saturday, October 9, 2010

Work with what you've got

Modern Art? . . . 
. . . nope, foot massager!

My previous post attempted to give you an idea of the operating rooms in Choibalsan. Throughout the hospital we were confronted with ingenious ideas that served to make up for an obvious lack of resources. We found sharps container made out of old water bottles, ICU transportation provided by patients own family, and a re-used materials foot massager that could have passed as modern art. Another lesson in creative thinking! 

Sharps Container

ICU transport - family carries you down 5 flights

Thursday, September 30, 2010

Playing an "Away" Game


Door to OR#1

Operating in a different operating room is like competing on the visiting teams field. You’ve got to make a quick assessment of the lay of the land and then play your game.  Things in the Mongolian OR’s were quirky but in general, I was pleasantly surprised by the resources we had available. When things weren't up to par, we had our own biotechnician, Danny, who made things work, like our very own personal "roadie." 

There were three general surgery operating rooms in the hospital. OR #1 was the largest with two big windows and two big OR lights. Unfortunately, when we arrived, there was only one functioning light bulb between those two large panels. Before our first cases, they found functioning bulbs for one light but one big light remained dark for our entire visit. The big windows helped in the daytime as the regular room lights were also missing bulbs. We relied on a back-up generator one day in Choibalsan and saw no interruption in power to the anesthesia machine, lights, or laparoscopic equipment in the room. We had a complete laparoscopic tower though the regulator on the CO2 tank was faulty and created a constant cricket-like chirp for two whole days of operating. Suction was also available but shared between the three general surgery operating rooms, the surgery ward, and the ICU. OR#1 accommodated a c-arm for intra-operative x-ray. This machine was 10-15 years old and required some work after our first series of cholangiograms provided a near white out image with the faintest hint of the biliary tree. Once it was adjusted, we had interpretable images.
No Bulbs in those lights. Eventually, we got the small one working.
Danny is checking out the lap tower. 
The anesthesia machine in OR#1
Big light, no bulbs.
The second general surgery room was smaller than my closet (I have a BIG closet but this room was still small) It fit the bed, anesthesia machine, bovie, and was filled when we brought in a laparoscopic tower and a back table of instruments. Lighting was again an issue and this room really only had one window. There was a small pass through to OR #1 which made it a good vantage point to spy into the action in the other room
Tight quarters in OR#2
The third room was about as big as OR #1, located on the opposite side of the hospital and was reserved for emergencies or infected cases. The anesthesia machine in OR#3 was not the most reliable.

Striking contrast to my new “home field” in Denver – with the state of the art Storz HD flat panels, fully integrated teleconferencing, video, audio, LED lights, even an integrated iPod dock . . . we are fortunate. But the stadium doesn’t make the team. Sometimes, I think we forget that. 
RMHC OR#1

Tuesday, September 21, 2010

Anna Home



Sunday afternoon while Ray took Gaby to the airport, the team met up with Maarten (a dutch physician who volunteers in Mongolia, working with hospital administration) to go to Anna Home. 


Street children are a problem in Mongolia where abandonment is the most common reason children are left on their own. In the big cities (and small cities) of Mongolia, homeless children live underground where the steam pipes provide some heat. In Choibalsan, a karate instructor and generous soul - Boldsaikhan - began taking these children into his home. When he met Maarten in 2006, they worked together to found Anna Home; an NGO orphanage in Choibalsan. Currently 24 children live and thrive off of the street, in a safe and clean home. They have citizenship, healthcare, and go to school. They have a garden, chicken coop, soccer goals, computers, a fresh water well, and a loving home. 


We arrived at the orphanage and were met with smiles and enthusiasm. My camera got whisked away until i rescued it in the garden. I gave the kids my point and shoot for the remainder of our visit and this is the story they told . . . ALL of the pictures on this post are theirs. Even that sunflower - which is probably my favorite picture from the whole trip. 








please check out the Anna Home website if you want to learn more. http://www.allforchildren.info/index.php
PS. I am sending them a digital camera when i get home - if anyone wants to chip in, we can send a few.