First few days in Soddo

5-26-2013

Soddo

Wow, I did not truly expect time to fly like it has, but the past few days have sort of been a whirlwind. To pick up where I left off, I my short run ended up being about twice as far as I planned because I got lost. Fortunately, Laura was able to guide be back to the house with a few phone calls.

The Love’s prepared a wonderful supper for both myself and Dr. Wood, a giant in the field of breast surgery, former chair of surgery at Emory, and one of Tim’s mentors. It was a charming evening and it was a little saddening that I would be leavening in the morning.

Dr. Tim Love, the awesome host, before he left for work in the morning. He made be in it, toothbrush and all, so that he wouldn’t look so bad. 

Laura and Sam right before I left. 

The ride to Soddo was about 8 hours with a meal stop and running around to pick up the PAACS residents and a nurse who is returning from the States, Jodi. I napped a few times, having not slept well the night before, but was really amazed at the beauty of the land. The pictures below are from the drive go in order from leaving Addis. As you can see, things were pretty dry but progressively got wetter and greener as we got closer to Soddo. Like most pictures (that I take at least), they really do not do the landscape or the crowds justice. These crowds were the amazing thing to me. It was Friday, which evidently is market day, but it was still amazing to see just how many people lived in these rural areas. Even when were in areas that appeared very remote, there was always someone walking down the road.

There were lots of these half finished building projects around

Still in Addis 

 Yup, still in Addis. Kinda makes your work seem a little easier huhh?

Pretty darn dry, just outside of Addis

Heading into the jungle

Getting greener...

Going through a small town were greeted by a pack of donkey’s that pretty much owned the road. According to our driver, one of these is worth ~$225 which is about 6 month salary for most people so you really don’t want to hit one. You'll see another example of this later.  

All the Montanans and Van Booms in the crowd should recognize this field: Potatoes!!    

Here is that example of donkey power

Once we got to Soddo, I was instantly greeted by Hasaub who was estatic beyond all reason to receive his laptop. I am so glad that God used me to share the generosity of Denise and Roger!!

 I was shown my roommate, Martin (second on right), a general surgery resident from Norway (fyi, their residency is case based and the hours are 40-60 per week, but generally lasts 8-10 years after medical school). He was here with Olaf (hat) and Bjarte (left), who unfortunately just left today, but if you would to check out their website, they have some pretty sweet stuff about their work in Ethiopia http://www.tesfa-hope.org/ They are really great guys and I hope to work with them down the road. I will also be living with Dr. Warren Terry, a pediatric orthopedist from Canada who is here for a few weeks while Dr. Anderson is gone.

After a quick tour of the hospital, David (a pediatrician) and Jules (his wife) and their 6 kids invited us over for dinner (their blog http://www.ourgreatestjoy.com/). They made potato soup that would probably rival what the men of C8 made during college. Since I was pretty tired from the trip and not sleeping well the night before, I hit the hay pretty early.

Saturday, we had rounds at 7:15 and saw approximately 50 patients in 2 hours all with fractures in various states of infection or healing. As we were wiping through them, Dr. Terry would time to time look at a patient, get a look of concentration, and then ask if we need to take that particular patient to the OR. Evidently Saturday is only for elective cases, but we ended up adding 6 patients to the list for various wash-outs of wounds or more permanent treatment of wounds. Most patients should be pretty short surgeries and there would be me and two residents to assist him, but even still 6 cases is a fairly full day by any standards.

However, we were walking up to the OR Dr. Karnes, the gynecologist http://soddospecialdelivery.org/, ran into us and informed us that we would need to wait several hours because he needed the OR for an emergency hysterectomy on a woman with a molar pregnancy. These are rather difficult to explain, but basically the genetic material from the father creates a tumor rather than a baby and can cause serious bleeding or even death to the mother if not removed early as is commonly done in the States. This molar pregnancy was not identified until the tumor weighed 8-10 lbs and she was rather anemic. Fortunately, the uterus came out, tumor and all, without incident and minimal bleeding.

This took about 2 hours and then until 7:00 pm I was in the OR with Dr. Terry and the PAACS residents debriding open fractures and opening abscesses. I won’t describe all of them, mostly because they have sort of blurred together and it would take too long but one that stood out was this one very sweet girl with a completely swollen hand with a fever and other markers of infection who had seen a traditional healer without relief. I was informed that it was likely an infection of one of the deep spaces of the hand and that we would clear it out. I was able to read a little bit on these infections and evidenty since the hand is so plastic and can deform quite easy, it is difficult to identify exactly which of the 4 compartments it is in. Evidently the midpalmar space is most common and the spaces by the thumb and pinkie fingers also occur with regularity, but the back of the hand is very rare. The textbook even recommended only approaching the back of the hand through the front since it is so unlikely. Armed with this knowledge, we tackled this little girl’s hand. We made two good sized incisions on the front of the hand looking for the causative puss, but were only met with disappointment. As we beginning to doubt ourselves, we went to the back side of the hand as the last possible source of infection and sure enough, we found our bacteria. Fortunately, this infection had not been there very long and it appears that she won’t lose any function.

After our last case of a woman who got her foot run over by a car and will likely need an amputation, I was invited to join Dr. Hardin and his wife Karisa and their 5 kids for dinner (their blog: http://hardinfamilyblog.com/). Karisa showed me a novel way of making spaghetti in hot dish form and I was impressed.

After dinner, we went back to the ICU because we heard that there were some new patients to see. The first was a little boy that had a bad fracture with exposed bone (called an open fracture) who was treated at a government hospital about 4 days ago. We aren’t 100% sure what they did, but it looks like they simply put the bone back in, put in a few stitches, and then put a cast on. When we saw him that night, he was almost completely septic and needed to have the wound washed out and debrided of dead tissue. Fortunately, this wasn’t a very long surgery but the OR staff was not very pleased because it was already a long day.

The second patient was also supposed to be very quick. A tree fell on him that morning and he had an open fracture of his femur on the medial (inside) side of his thigh that needed to be washed out and temporarily stabilized before we could definitively fix him. Since this was supposed to be so quick, Ronnie, one of the PAACS residents, and I were just going to do it on our own. As Ronnie was washing out the wound, he was pimping me on the associated injuries with open femur fractures. I knew that you had to worry about injury to the femoral artery and nerve as well as the sciatic nerve, and infection of course. He informed me that the artery is typically associated with medial open fractures and the femoral nerve is more common with posterior fractures. Suddenly, the wound started filling with bright red blood for no obvious reason and it was obvious that during our manipulation we damaged the femoral artery. Ronnie was able to get his finger on the artery and stop the bleeding so we called Martin and Bjarte to come and see if we needed an arterial repair. It ended up that we only made a small nick in the side of the artery and they were able to repair it primarily without needing a vein graft. After they finished, Ronnie and I put a the patient’s leg in traction and were able to call it a night right at 1:00 AM

The next morning, I was pleasantly surprised to find out how seriously the missionaries here take their Sabbath. Most of the day was spent hanging out with the Norwegian friends before they left, having lunch with Dr. Terry and Ruth, a nurse brought here to help with the ICU, and checking out Soddo with Ruth. She has actually been in Ethiopia for over 20 years and was excellent at educating me to the culture and how to handle the children that are so fond of pestering foreigners.  At 4:00 we had a worship service in our house since there was an inconvenient downpour and after talking with Dr. Terry for a while, I was able to hit the sack without too much delay.

I hope that this account helps you get a picture of my first few days in Soddo and that you enjoyed the pictures!! Look forward to a tour of our house, the hospital, and the surrounding area to come!!

In Him,
David