Wednesday, July 13, 2011

Rabbit, Rabbit (July 1, 2011)

I am tragically behind on this blog. Busy schedules, sleep deprivation, spotty internet, the usual excuses. We leave Mongolia today! I will hit the highlights on the blog in the next few weeks as I sort through this  experience from my balcony overlooking the Platte. For today, I give you the highlights of July 1st ... Bjoern joined our team and brought re-enforcements (medical supplies, toilet paper, horse sausage, cheese and german candy called apple shachft); JQ left us; we did 4 lap choles in COLOR and actually got some teaching done; and the night deteriorated into a mini-bar clearing party in my hotel room. But what you really want to hear about is the weekend .... stay tuned! and Happy Birthday Uncle Friday!!!  


Scott, Alli, and two post-op appy patients

Thursday I got to operate on a 13 year old boy with an inguinal hernia. The orthopedic hand surgeon assisted, and like all the other pediatric cases I have done here, the patient had a spinal anesthetic. So strange to be able to smile at your patient over the curtain as you are dissecting the hernia sac off of his spermatic cord … I’m just saying. 

The first night we were in Arvaikeer I assisted an open appendectomy on a five year old. Again under spinal, this child did not cry or squirm or protest as we worked. These children DO NOT get sedatives … just a spinal anesthetic. Can you imagine an American five year old holding still without some sedation?? These children are stoic.

I don’t get to do a lot of pediatric surgery on these trips, but when I do, I tend to marvel at the universal grace of my patients. The pediatric post-ops were all boarded in the same room directly across from the operating suite. We spent down time playing with them in the hallways and taking goofy pictures. They recharged us, made us laugh and helped us through our slow days.

I’ve said it before, and I will repeat if forever – kids are kids, wherever you travel – and they are magical, and beautiful, and joy – pure joy. 

5 year old appy patient - post-op

Ortho surgeon and hernia patient - pre-op

Scott and Jaja

I love what I do!!

Monday, July 11, 2011

Mongol/Basque Queens

This year the Swanson Foundation partnered with SAGES Go Global ( on our trip to Arvairkheer. In pursuit of the common goal of teaching laparoscopic surgery in developing countries, SAGES offers the Swanson Foundation an increased network of surgeons  and stronger industry connections. In addition, SAGES Go Global has organized an evaluation system used to assess the effectiveness of our teaching methods. The benefits of this relationship are obvious to both parties; but for the team this year, the biggest benefit was our time spent with JQ.

While in Mongolia, I read the book The Secret History of the Mongol Queens by Jack Weatherford. It was a fascinating insight into the powerful, bright daughters of Genghis Khan and their descendants. The daughters took control when the sons could not. The daughters found ways to learn from historic mistakes, and rebuild an empire that the sons had allowed to self-destruct into chaotic, internal conflict. It was a great, true historic tale of strong, capable women.

And then, we had our Basque queen, Jacqueline. Our fearless, capable leader helped us get lectures going, kept us fed and watered, and brought the fun along with her surveys. She insisted on taking the reigns – literally (when we went “camel riding” she made her escort leave her alone on the camel.) Thursday night we had to say goodbye as JQ headed back to the US. After our trip to the ger (see previous blog) we ended up at the local wedding palace for a team dinner, gift presentation, Mongolian flute performance, vodka toasts, and a surprise dance party (complete with flashing lights, limbo and jump rope). Surreal, yes; but all just part of a normal day in this Mongolian adventure.

It is always an honor to meet a fun, smart, capable new friend. JQ, from west side Mongolia, to west side USA – we love you!! We miss you!!
Cody and his Mongolian wife
Orthopedic Hand Surgeon playing the Mongolian Flute
Cashmere for our Queen
Allison and Tuvsho - Limbo!

JQ and a young member of the West Siiiide Posse :)

Wednesday, July 6, 2011

“And all I wanted was the simple things, a simple kind of life.”–Gwen Stefani

By our third day of operating, we managed to rig one “color” monitor. Subtle shades of pink and pale green added enough variation in our visualization and we were able to make slow progress with our teaching. We finished three cases and had plans to see JQ off with a trip to the countryside and a dinner with the hospital staff.

I have witnessed nothing as simple as the life of the Mongolian people. Today we visited a ger. Driving in an old Russian van over dirt roads we joked about the practicalities of having an address and the comedy of attempting to give friends directions to your house, but when we arrived, the silence, serenity and vastness of the landscape made sense. Silence, and space, beauty and peace – sweet peace.

The landscape is tree-less pasture as far as one can see. There are rolling hills, and mountains, in soothing shades of green and purples. The sky is vast and expressive. Clouds shift in the wind, slowly. The silence is hypnotizing and the simplicity is beautiful.

These people raise sheep, goats, horses. They make yogurt, and cheese, and fermented goats milk alcohol. Dung fires heat their small homes and cook their meals. The wear heavy “deels” covering their whole body and tied at the waist with a thick wrap. Simple.

As we watched the family milk their sheep, we began to hear distant bleating. The tethered ewes became restless and started returning the calls. Slowly, the volume increased and the energy seemed to change. There was an urgency. We watched as a herder on horse back lead the lambs toward us. The ewes were untied and the cacophony came to a crescendo as the lambs ran to their mothers to feed. No wasted movements, all fluid and grace. Such a simple moment, so amazing to witness with all its sound and motion.

“a simple kind of life …

Tuesday, July 5, 2011

Monday, July 4, 2011

The Blair Witch Project: Arvairkheer

“I am so scared …”
June 28th, 2011. Our start this year was fraught with some interesting challenges. Flickering images on a 15 inch monitor were interrupted with crackling electric surges. Five minutes of crisp, clear picture would suddenly disappear. After trouble shooting the camera, the light box, the camera box, and all the cords in between nothing seemed to work. Blank screens stared back at us as we wondered how we were going to get over this hurdle …

We started asking questions, raiding closets, and digging up old pieces of electronics. Idle, early generation laparoscopic equipment began to appear. Antique camera boxes, old cameras, we pieced together random parts donated by various organizations and patched together our mismatched solution. And there, in the operating room that is smaller than my closet, we performed laparoscopy … in black and white. Blair Witch lap choles – that’s the way we roll.

Blood/bile?? Not sure. Black and White. It was a surreal, retro experience that pushed our surgical skills and intuition to the limits. We made it work.

After completing our laparoscopic cholecystectomies for the day we were approached by an Australian aid worker we had met at our hotel. His translator had abdominal pain and everyone was convinced it was appendicitis … could we help her out? We moved our mismatched laparoscopic tower and set up for a lap appy.

And in the end, we walked home well past dark through the dusty, rock laden streets, wearing headlights – another Blair Witch moment to this Blair Witch day.  “I am so scared …”

Scrubbing with Allison