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 or J/P HRO are doing amazing things in Haiti. Last Mile is providing rapid aid in Indonesia. 


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 ( 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. ( 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