Last Things

Our trip has nearly come to an end.  We could not have asked for a better experience.  We saw so much in a short period of time, patients that presented as textbook perfect cases of diseases, some of which we have only read about.  We also developed some basic McGuyver skills, creatively fashioning solutions out of next to nothing.  We learned to be conservative in how we practice medicine, not by ordering a battery of tests to protect ourselves, but by using only what is necessary for diagnosis and treatment and nothing more.  We had to think more about our resource utilization, which made us think more about our physical exam, bedside ultrasound, and our differential diagnosis before we planned our work up and disposition.  We are better doctors because we had this opportunity.

While the medical experience was extremely rewarding, our experience would not have been the same without the people who helped us each and every day.  Our Ethiopian nursing staff in the ER made each shift a joy.  They tirelessly translated for us 'ferengis', proficiently navigating some difficult cultural and ethical situations and kindly but firmly redirecting patients who strayed from the questions we asked.  Sometimes we asked them to do something differently than they are accustomed to, or we wanted to do something that was brand new for them in the ER, and each time they were eager to learn and happy to help.  The GPs that we worked alongside were also invaluable resources -- we taught them a few things about airway management, central lines, ultrasound, and chronic diseases like AMI and stroke, but we learned so much from them in return-- they are experts in tropical diseases, they helped us broaden our differentials to take into consideration the disease processes that are common to this particular area, and they showed us daily how to make the best use of the system we had available.  They work extremely hard and they do not complain.  They were thankful for our help in the ER, but we were equally thankful for everything they did for us and for the work they do each and every day for these patients.

Finally, the Gabrysch family and all of the other missionaries at SCH were wonderful hosts.  Everyone was welcoming and generous, and it was nice to both live and work among them as part of their community for short time.  Jeremy especially was instrumental in making this a successful and rewarding trip.  He helped us immensely in the ER, we learned together as a team on some complicated cases, and more often than not if we called him to ask a question he dropped whatever else he was doing to come see the patient alongside us.  He even let us babysit his amazing kids for a few hours, but after keeping them up way past their bedtime playing games, I'm not sure we'll be invited to do that again!  Christina and Jeremy also let us crash their short vacation to Lake Langamo on the way to Addis before we all leave for the United States, which was relaxing and fun.  Plus, we got to spend some more time with the kids, both of whom are full of energy, very entertaining, and a joy to be around!

We will miss this place.  It will be quite a shock to be back at county in just a few days compared to our lives for the past month, but this was a welcome and refreshing interlude before the home stretch in our final year of residency.  Thank you again to everyone at home who made this possible for us, we love you all and we will see you soon!

New Airway Cart in the ER.  We finally completed this during our last shift!

Relaxing on the beach!

Fun in the car and kid-sitting shenanigans!

Top 10 Things You Should Probably NOT Do In Africa:

1) Drink from the rivers
2) Pet a warthog
3) Go on a safari...on foot
4) Swim in African lakes
5) Ride in a boat among hippos and crocodiles
6) Text, talk, or even think about blinking while driving
7) Walk around barefoot
8) Ride on top of any vehicle, especially an oxen lorry
9) Get into a tussle with livestock
10) Tell your husbands 'If you don't hear from us in 24 hours we were eaten by crocodiles'

We've only done a few of these...we'll let you guess which ones!

It's Cultural

The night before the Wegner family left for the Congo, we had the opportunity to experience an Ethiopian coffee ceremony in our guesthouse.  This ceremony which is done for visitors to Ethiopia, friends and also on special occasions/religious holidays involves the roasting of green coffee beans over hot coals with incense (frankincense, myrrh), followed by the grinding of the beans usually with a wooden mortar and pestle and heating of water with the grounds in a jebena over the same fire.  The coffee is served with snacks (most often popcorn here).  The coffee with thick, rich, and not at all bitter.  We sat on our back porch for the ceremony and talked shop with Stephen while Anna laughingly complained that she needed new friends until the sun started to sink in the sky.  It was a nice way to punctuate the end of their time here.

The following day, we were invited to speak at an English class for young Ethiopian students between grades 3 and 7.  We weren't sure what to expect, the only advice we received was "just talk about where you are from and show pictures if you have them."  We stepped into the small classroom on the hospital grounds and were greeted by a smiling group of clapping children, singing us a welcome song in English.  Their instructor, Paulos, asked each student to stand up and say their name, grade, and school and then ask us a question about ourselves in English.  We were asked our names, where we were from, about our siblings/husbands/families, and about our favorites (food, colors, activities, etc).  Then we showed the kids pictures on our phones of our family and our dogs.  Paulos asked if we had other pictures of animals and I happened to have photos of a duckling and of a moose on my phone.  The kids recognized the duck easily, but the moose was a tough one -- cow, horse, and buffalo were popular guesses, only one little boy in the middle of the room recognized it.  Turns out, the word "moos" in Amharic means banana.  We all learned something in English class!

The meaning of names is important to Ethiopians and being asked what your name means after an introduction to someone is not uncommon.  We had to do a little research when we got here because neither of us really knew the origin of our names -- Kelsey means "ship's victory" and Auna means "grace."  Ferengi names can be hard for Ethiopians to pronounce, so when Jeremy first introduced us to people here, he tried to help by comparing our names to Amharic words -- Auna is similar to the word for "and" and has sounds common to Amharic.  Kelsey is closest to the word "kalsi" which means "socks."  Awesome.

Probably our favorite cultural discovery here is the Ethiopian gasp.  It wasn't obvious immediately, but as we became more accustomed to listening to our patients speaking Amharic and interacting with Ethiopian consultants, we started to really notice the gasp.  It is a noise that indicates agreement, kind of like our "uh huh" in conversation, but it is startling, especially in an emergency room!  Every time we heard a gasp, we'd look around for a femur fracture,  profuse bleeding, impending death but we would find...NOTHING!  Just a happy, agreeable patient before us.  This blog post really sums up exactly how the gasp strikes you when you first hear it: https://aloneinastrangetown.wordpress.com/2012/11/14/the-ethiopian-gasp/.  Please forgive us if you notice us gasping when we get back...it also seems to be contagious. Gasp!

English Class

Coffee Ceremony

Another week in Soddo

The sky is slowly turning from dark black to light grey.  You can start to see the outlines o the palms and avocado trees rocking in the wind.  They are strong, they've done this dance many times before.  It  is windy nearly every night. The sounds of gates, windows, and other lose pieces of hardware banging sporadically through the night sound much scarier in the dark.  The doors of the house moan and creak in the wind storm. It reminds me of a beach house - loud but resilient.

The family we share our guest house with is leaving today.  It's going to be strange to have the house so quiet. There are three kids in the family who can most often be found in avocado trees and sitting on top of swing sets (not anywhere near the actual swings).  We asked their daughter how she got on top of the swing set once and she replied, "it's easy, it's just like when you're climbing up walls." We will miss their company.

This week has been filled with more of the same in the ER, but as we sat in our living room last night swapping case stories with a couple (ortho resident and FP doctor) who arrived this week, we realized we are so absurdly excited about the patients we have seen here. We showed them pictures and described things we have read about but never seen before. We talked about the highs of our triumphs and the lows of our failures.  Although working in a county hospital makes you somewhat accustomed to witnessing the suffering of the world, it still hurts to see patients in pain or dying, especially from things that seem so easy to treat at home.  But, like most ER docs, we keep working in hopes that our next patient will have a better outcome.

The highlight of our week was a very critical patient who we were able to resuscitate enough to get him to the OR. We had to place a central line and start him on vasopressors in the ER. The nurses haven't done this before, so it was up to us to mix our own dopamine drip (the only pressor available that day). There aren't IV pumps available to adjust the rate of infusion either, which means we also had to calculate a rate....in drops per minute.  We mixed our concentration of dopamine into 1 liter of normal saline and then converted the dose we wanted our patient to get from mL/min to drops/min so the nurses could count approximately the amount of pressor the patient was getting per minute. Who says doctors can't do math?!  So far he is doing well post operatively.

The sky is bright now. Coffee is ready. Time to head off for another day.

P.S.  Some of our patient stories are intentionally vague.  Every single day here we have patients with shocking physical findings, great radiology studies, or interesting stories or we get to do procedures we've never done before, but we are trying to save some of the details to share with our UTSW residency friends at home...can't give away the answers too soon!

Weekend Edition

We were off for the weekend as far as ER work goes, but did work on some side projects (stocking an airway cart, updating the pharmacy formulary list, etc) and celebrated a second Thanksgiving on Saturday with a real American turkey.  For the past two weeks, we have been making mental notes of all of the ways working in Soddo is similar to and very different from working in a county hospital.  So, here is our top 10 list!

Top 10 Ways Soddo is County
1) Throngs of people waiting, everywhere...in the hallway, waiting room, outside, on the lawn, etc
2) We talk to patients in a chair, then examine them in a bed
3) Everyone has at least one non-specific complaint that is potentially a sign of bad pathology
4) Some patients just want to be radiated, even when it is not clinically indicated
5) In theory, we can use ketamine
6) Translators are a precious resource
7) We prescribe medications based on whether our patients can afford it
8) The nurses know what to do in emergencies, and they act immediately
9) The to-be-seen list is never zero
10) It is fun, rewarding, and exhausting

Top 10 Ways Soddo IS NOT County
1) Everyone takes a lunch break, including patients
2) People rarely complain of pain, and ibuprofen works
3) Hypoxic patients walk to x-ray, not to a booth
4) Fractures are treated immediately
5) GCS < 8 does not mean intubate
6) Anything that ends in -itis might be tuberculosis
7) People pay for their medical care (and stay in the hospital until they can pay, instead of being discharged)
8) Hand sanitizer and PPE are precious resources
9) Long ER dwell times, but patients wait at home and return for results the next morning
10) Clinics can actually see patients on the same day they are referred

Weekend relaxation below...