It is hard to believe, but it's been 5 months since I left for Ethiopia. After getting back to the States, I had to quote Robert Frost "miles to go before I sleep." Since getting back, I have taken my board exam (Step 2 CK), vacationed with family up north and friends in the Grand Tetons, done rotations at Burlington VT and Greenville SC, and now started up a pediatric rotation at St Paul Children's. These adventures have given me the opportunity to see many old friends and meet several new ones, but the change took some getting used to.
Transitioning back to the US was not too difficult as I had a number of things on my plate to keep me busy. The biggest differences were the changes in food, ie not eating injera for every meal, being able to blend into a crowd once again, and actually understanding the conversations that were occurring around me. Also, the ease of doing day to day work and travel continue to amaze me. Rather than having to visit 3-5 different shops to fill my grocery list and eventually realizing that there are several items that I will simply have to do without, I can simply visit "Price Chopper" (South Burlington's main grocery store). The bigger transition has been getting used to healthcare in the US. The multiple moving parts and copious documentation that is involved in patient care here has taken some time to get used to. Also, the very different patient population and mechanism of injuries has been a change. For example, rather than typically seeing hip fractures in young people who have been hit by cars while walking down the street, now I am seeing hip fractures in elderly osteoporotic patients who fell down at home. Or rather than seeing kids with draining sinus tracts, I see asthma attacks or the stomach flu.
These changes have served to strengthen my resolve to continue with long term missions and hopefully I can remember them 7-10 years down the road when I can actually return to the international mission field long term. I figure that the best way to remember this passion is to try to remember the patients, so I would like to introduce you to a few of our patients. BTW, there will be some blood and guts type of pictures, but in a lesson I learned from Dr. Gray, Goldy will give you a warning so if you have a weak stomach, you can dip out.
This guy I only met briefly in clinic, but he is a great example of the kind of work that Dr. Anderson is doing and I hope to do one day.
Several months ago this guy was hit by a car and basically mangled his foot causing about 3-4 inches of bone to die. Fortunately, his foot still had blood flow and the nerves were intact and although they tried to talk him out of it, he wanted to try and save his leg. This would mean the placement of an external fixator frame on the outside of his leg and slowly pulling the bone from the top of his leg to his foot.
This is after the initial placement of the external fixator. Notice the lack of shin bone that Dr. Anderson is pointing out.
Transitioning back to the US was not too difficult as I had a number of things on my plate to keep me busy. The biggest differences were the changes in food, ie not eating injera for every meal, being able to blend into a crowd once again, and actually understanding the conversations that were occurring around me. Also, the ease of doing day to day work and travel continue to amaze me. Rather than having to visit 3-5 different shops to fill my grocery list and eventually realizing that there are several items that I will simply have to do without, I can simply visit "Price Chopper" (South Burlington's main grocery store). The bigger transition has been getting used to healthcare in the US. The multiple moving parts and copious documentation that is involved in patient care here has taken some time to get used to. Also, the very different patient population and mechanism of injuries has been a change. For example, rather than typically seeing hip fractures in young people who have been hit by cars while walking down the street, now I am seeing hip fractures in elderly osteoporotic patients who fell down at home. Or rather than seeing kids with draining sinus tracts, I see asthma attacks or the stomach flu.
These changes have served to strengthen my resolve to continue with long term missions and hopefully I can remember them 7-10 years down the road when I can actually return to the international mission field long term. I figure that the best way to remember this passion is to try to remember the patients, so I would like to introduce you to a few of our patients. BTW, there will be some blood and guts type of pictures, but in a lesson I learned from Dr. Gray, Goldy will give you a warning so if you have a weak stomach, you can dip out.
This guy I only met briefly in clinic, but he is a great example of the kind of work that Dr. Anderson is doing and I hope to do one day.
This is his X ray when I saw him. Although it looks like the bone is missing at the top, there is very subtle calcifications that show up as white puffy clouds on the xray. He will need another surgery to bring the bottom ends together and had a long road to recovery, but his leg is functional and he avoided an amputation
This dude traveled all the way from Somalia (likely several days) to get treatment.
Sorry for the blurry picture, but this is as much as he can straighten his knee (about 80 degrees).
The solution was to place a pin at the base of his shin and put him on traction to literally pull it straight. As you can see, it worked and this was literally overnight. He will still have a fair amount of physical therapy to do, but should be able to walk again.
This guy came into clinic and clearly shows why polio is such a devastating disease. He had polio as a child and now his legs are basically stuck in this position.
In order to "walk," he uses these blocks and crawls on his knee
Although Dr. Anderson was able to offer him some surgeries to release his tight muscles so that he could hopefully at least straighten his legs and walk (albeit awkwardly), we were able to get him a hand-powered tricycle so he would at least be able to stop crawling in the dirt.
Yup, here's Dr. Goldy encouraging the squeamish to advance with care. For those weak of stomach, I hope that these patients helps give a flavor for the kind of injuries that are seen in these world situations and will give you a passion or a curiosity for missions.
I honestly can't remember how this guy broke his leg, but he did a few years ago and it managed to heal, although not exactly straight as you can see below.
A few months before he came into see us, his leg began bothering him so he went to the local "healer" who recommended a regimen of treatments that included branding the skin with a hot piece of metal. Leaving the characteristic scars that you can see here. However, this did not solve the underlying osteomyelitis that ultimately needed surgery.
Since he had such a robust immune response, we were able to simply cut out a small window of bone (a cortical window) and wash out the dead debris.
Sorry but I don't have a picture of this guy, but basically one of the bones in his forearm (his radius) had a long term infection.
We opened up his forearm and removed the dead bone that you can see below. Fortunately, he also had a very strong reaction to the infection and we did not have to help him regrow the bone.
I'm going to warn even the bravest, these next few pictures are rather graphic.
This man came in after breaking his leg a month ago when he was rebuilding his barn after an arsonist burned it down. Since he literally didn't have a dime to his name, he went to a local "healer" who wrapped it up really tight and sent him out.
When he took off the bandages, his leg looked like this. ^^^^ It was very fluctuant suggesting fluid underneath. Initially we were afraid to do any sort of surgery since his hemoglobin was 6.0 (normal is 12-15), but when Dr. Anderson saw him on rounds, he made the below intervention.
With a small nick of a scapel, we were greeted by roughly a gallon of surprisingly nonodorous puss. He needed multiple additional surgeries to remove all of the infection and several blood transfusion including some from the hospital staff, but when I left he was looking like he would make a full recovery.
I do have many other patients that I could talk about, but blogger.com is starting to get mad at me saying that my post is too big. I hope that this gives some insight into healthcare in the developing world and will give you a passion to help the people there in anyway that you can.
Have a happy Monday!!
In Him,
David
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