On to Tasmania

Hey there. I'm getting back to the blog-- sorry if it's been a while. I got back in the States without a problem on July 5th. Spent about a week packing up the rest of my stuff, moved it down to storage at my lil' bro's (thanks Jon/Kelly!), and went to FL to hang with the 'rents. Now, headed out to Tasmania. I'll be spending a year there at Launceston General Hospital as a "Senior Registrar," which is like a Senior Resident/Fellow equivalent position in the US. Because I'm not Board Certified, they wouldn't accept me as a "Consultant" (ie Attending/Specialist). It's kind of a silly quirk, especially considering I just learned that an affiliate of my old program is now advertising a position that pays two-and-a-half times what I'll be making in Australia!! Whatever-- it's the experience. That's what I'm telling my creditors...

So, in any event, feel free to stop by if you're visiting Austral-Asia any time in the next year... I've uploaded a few pictures of my theoretical apartment, which is just a few kilos walk (Yay metric system!) from the hospital. As a result of the cost and time lost in heading back and forth between the States and Aus, I think I'll postpone taking the Board Exam for a year. Apparently I can do this and still not have to start counting my CME activities for certification. We'll see. It'll be nice to have that money and vacation time to hang out in New Zealand, Japan, Thailand-- whereever-- if I can have it. It probably also makes sense in terms of not really having studied for the stupid thing...

Anyway, so let me know if you have suggestions about what needs to be seen/done in Aus, where I need to head to next, etc. I hope to keep updating the blog, but if I don't it's either because my life has gotten way too interesting or waaaay to boring... Cheers,

--aws

Monrovia 5-0, or how I became a Liberian Crime Statistic

I thought I'd include the above pictures in this, my last entry about Liberia. The left is a jello mold that was discovered by Rachel and myself while looking for a pan to cook lentils in. We found it, and she said, "Why would they make a jello mold of President Tolbert?" It is of course Harry Potter, but I understand the mistake, given the uncanny resemblance. So, Harry is pictured with three leaders of Liberia for comparison (I'd think Doe before I thought Tolbert...) for Rachel's benefit.

The right picture is of our competition-- the medicine man (or manor?) is apparently a big herbalist who can cure more sicknes ses. I'm not one to argue. But it does highlight the reliance on "country medicine"-- which is herbs, etc. that are eaten or applied to improve illness prior to coming to the JFK ("just for killing") hospital. So, by the time they get there, the question is raised as to whether the liver damage is from the original illness or the country medicine used to cure it...?

So anyway. The last 48 hours in-country were... interesting.

The last week there I had been asked to review some material for the Ministry of Health's supervisor training. It was actually a bit of a bigger project than I'd realized, but was able to complete some changes to their training manual in time for a brief talk on emergency care that Thursday morning (I mention this in the video of the medical side in the ER during my discussion with Deborah). It was suggested after that morning that I go do something fun in Monrovia, given that I'd spent a lot of time in the hospital while I was there. So I thought I'd go see one of the beaches that I'd been told should be relatively safe.
You see, some of the beaches in Monrovia, especially around the hospital, aren't all that secure and are known for their criminal activity. Kind of like alleys in the States, you really don't have any business being there, especially at night, especially alone. (Of course some private beaches that are patrolled are fine).
But, let's face it, I'd gotten kind of bored and was looking for something to do besides work. So, in the early afternoon of my penultimate day, I headed out to one of the beaches that was recommended as relatively safe. I wandered around the beach for a bit and was heading back when I was approached by a group of guys. There were about 6-8 of them, and they initially asked me a few questions in order to surround me. They started yelling and grabbing my arms, while two of them waved around broken bottles and one a pair of kitchen scissors (you know, the kind with the orange handles that your mom has laying around somewhere). They gave me a few cuts to make sure I wasn't going to try anything ("uhm, there are 7 of you-- I think you win today...") and took my wallet/money and my digital camera. Through the course of the encounter, it became pretty clear these guys weren't really all that dangerous, so I followed them a little bit and asked them to drop my wallet and id, which they did. It was kind of like in the Big Leibowski-- "Are these men going to hurt us, Walter?" "No, Donnie; these men are cowards."
After all that I called for the driver from the hospital to come get me. (My phone was in one of those "change" pockets that are sometimes in jeans or "travel pants" in the hip pockets..) So Mr. Moore, one of the drivers from the hospital, and one of the hospital's plain-clothes security guys (Frances I'm pretty sure) came. We eventually located the guys who took my money (they were still in the area apparently playing craps with a bunch of US bills. Yeah, not all that subtle).

We drove back to the police station to pick some of them up and took them back to the beach. I was in this way part of my very first Liberian stake-out. Which quickly became my very first Liberian foot-chase, as the guys' lookout recognized one of the plain-clothes cops and sounded the alarm. Everyone scattered and myself and the driver in the van went around to try to cut off escape routes while the police and hospital security guys (as well as Mr. Moore, who-- as those of you who've met him might have guessed-- loved every minute of it) chased them through the little alleyways.
Eventually we rounded up about 5 guys (the 6-7 on the beach became 12 or so when we found them again) and took them to the main police station. I identified the ones I could and filled out a statement. During this, of course, they were in the room, tied together with the tails of their t-shirts. "White Man-- look at my face! It wasn't me!"
Got back to the hospital, and fortunately since I know a good ER doc got taken care of. The next day, I was told my camera had been found. Apparently there are only a few people in that area of Monrovia who can fence a digital camera, so both were followed and the one arrested. Obviously this effort wouldn't have been put into things if I weren't part of the hospital where the administration is so connected to the President, so I'm grateful for that. So in any event I survived the experience and did a little more work that last morning before packing out. An interesting aside, when I got to Brussels I checked the photos on my camera. They include the following picture of the guys who stole the camera from me. I guess they took a few shots of themselves for posterity... ;)

Video diary overload!

Hi there! Got the ol' camera back so thought I'd post a few of my close-to-last-day videos!
This first should be a quick look at the breezeway/classroom where we'd talk some to the Nurses in the morning. It's also a hall of the hospital that we'd use to walk to and from the main patient care area of the hospital and the dormitory.

This next one is a quick trip through the Trauma side of the ER. Nothing too exciting going on.


This is a quick look at the medical side, and a discussion with Deborah, one of the Head RNs

Here is a video of a trip up to the floors


Finally, this video shows a quick look at the medical wards and ICU, w/ Drs Toomey and Borbor




I tried to whip-pan (yeah, that's right-- it's an industry term) so that no one could be identified... Skills of an artist, or cinematographer. Trogdor. :)

Hysteria, Lazarus, and No mo' Flomos -- medical stuff

I had thought this text had uploaded, but I guess not... hmmm.

So some of the more interesting stories I'll try to list here.

One thing I was impressed by was the number of “hysterical reactions” or pseudoseizures that came in to the ER. I suppose I shouldn't be. I mean, I'm hesitant to diagnose depression in the Bronx (“Hey man, it's not your attitude/outlook or brain chemistry-- I agree with you, your life sucks.”) where at least you're not getting dysentery or malaria 3-4 times a year and your poverty does not preclude getting a ride thanks to public transportation. So why shouldn't there be a relatively high burden of psychiatric disease in a recently post-conflict poverty stricken nation? About once a day a girl/young woman would come in, not speaking, or unconscious, or staring. They'd usually get a dose of quinine before I was able to resuscitate them with an advanced ER procedure known as a “sternal rub.” (yes, think of it like a noogie-- except in the center of the chest. Really annoying and likely to cause you to come out of your psychologically induced coma). I can't argue with the quinine, though. Top diagnoses for acting screwy, depending on age, were cerebral malaria, HIV, hypertensive encephalopathy, and hypoglycemia.

So, they'll tell you in Liberia that the language is English. Not quite. Most people do speak a kind of “pigeon” English. I think it's equivalent to the way some Dominicans speak Spanish. Letters/sounds left off here or there, different idioms, etc. So it's not always easy. We actually started on a phrase book for the people after us. “Tryin' small small” means “getting somewhat better.” “Running stomach” means “diarrhea.” “O'Ga!” means “My Goodness, this is really painful.” And, interestingly, “Fell off” means “passed out” or “became unresponsive” or “felt weak.” (“Fell out” is sometimes used in the Bronx-- any others people know about?). So, when I came across this young man who “fell off” and has been “weak” since, I initially didn't think much of it. Get a malaria smear, give fluids, dextrose, etc. However, sometimes, “fell off” means something much more literal and in keeping with how I use the phrase. Sometimes, “fell off” means “this guy fell off the roof he was working on, landed on his head, and hasn't really been able to move his arms or legs since, so we brought him here in a wheelbarrow with his neck hanging over the back of it.” Overcoming this linguistic barrier I feel, was, in retrospect, key to his eventual care and disposition...
I decided to start calling him Lazarus. After ~ 6 weeks on the floors, getting intermittent physical therapy, he's able to stand on his own again (Partial cord syndromes, his diagnosis, have a good prognosis a few months out). He was so happy to see me when I went up on the wards that he got up and sat down several times to show me. He may not be playing soccer again anytime soon, but he's walking, so things could've been worse.

I always enjoyed Michael Jackson as much as the next person (Rock with You, Don't Stop Till You Get Enough, and Billie Jean are overplayed, The Way You Make Me Feel and Smooth Criminal underplayed), but certainly didn't get all bent out of shape when he died. (It was ridiculous, BBC and Al Jazeera- London desk were covering news, while “the Situation Room” was on Michael Jackson all-day all the time for what seemed like a week. Yay America and your declining world relevance!) Liberia, like most of the world, however, felt differently. There were two days there when everyone felt a little sadder, was a little quieter (not easy, in Liberia) in mourning for the King of Pop. In particular, one young man came in to the ER the day after the announcement. Seems that upon hearing of the death of the King, he let out his best “Dangerous”-era “O!/Hoh!” and dislocated his jaw. So, after I finished laughing at him, myself and the medical student grabbed and yanked. Not so successful, and well past the end of my shift, so I gave him some muscle relaxants and figured I'd try again in the am. Apparently, he'd relocated during the night and was able to be discharged by the overnight team. I guess it wasn't a bad dislocation. Not a Bad, Bad, really really Bad, one anyway.

I feel I should break up the text here with a picture I only got at the end of my stay, as it was from the OR. Often surgery is the diagnostic modality of choice here, so there is a certain significance to claiming that an abdomen is "surgical," especially for kids. In any event, they had thought this tyke had a typhoid fever perforation, but on opening the peritoneum, turns out it wasn't the case. Here you can see the surgeon taking out the worms (ascaris) from the small hole in the small intestine before repairing the hole and putting the kid on antibiotics and anti-helminths. Enjoy!

Early on in my stay, I was given the Liberian name “Flomo.” For almost 5 weeks, I tried to get people to tell me why I was given this name. Louie was called something that apparently means “owner of a town,” and as far as I could tell, both Marcia and Rachel were called “Kebbe,” which is a name from Lofa county. Lofa is one of the biggest counties and quite a few people who moved to monrovia after/during the war for protection are from there. It is common knowledge among hospital staff and I assume Liberians in general that Lofa women have the biggest backsides. I'm not sure how this is appropriate, because if either Marcia or Rachel attempted to tie their children to their backs with their Lappas, the way most Liberian women do, their kids would slide off to the ground. Sorry if I'm telling you something about yourselves that you didn't know Drs., but it's true.
In any event, I too, it was decided, needed a name indicating I was from Lofa County. (and yes, the children would slide off my skinny Irish ass as well, though I don't think that entered into the decision making process). So, I was called “Flomo.” The name had shown up a few times as either a first or a family name, so I was a little familiar with it, even though I was told it didn't have a “meaning” per se. But, over the course of my time there, I noticed something-- Flomos died. Like, a lot. Chances are, if you were named Flomo (first or last) and you made it to the JFK ER, you were not getting out. I mentioned this a few times to the nurses, and thought maybe a different name would be better. They all loved it. To the point where they would say in the morning “Hey, it's Dr. Flomo! Do you think he'll leave today?” One time I felt particularly uncomfortable when a nurse in triage (full of people, mind you, any number of whom could've been named “Flomo” to varying degrees), explained to another nurse that “Dr Shannon doesn't like to be called Flomo because Flomos always die.” Ha ha-- not so funny if you are overhearing this conversation and just registered your uncle, Flomo Flomo from Lofa county. And if you were Flomo and triaged to bed 19, just frickin' forget about it. Bed 19 was not kind to Flomos. Or to anyone else, for that matter. Come to think of it, Beds 19, 10, 8, 6 and 5 were just not good beds to be in. So, I instituted a “No Mo' Flomo” policy in the ER, which the nurses also loved. I would not be called “Flomo” on days I wasn't feeling well, and all Flomos under my care had to have rock-stable vital signs before I would see them-- even if this meant lying to me.

--aws

Radio Silence- pictures of ME!

I apologize for being negligent on the blogging front. TRUST me, though. Some interesting things have been happening, and I've had an action packed last week and few days. Suffice to say, I hope the scar lasts so I can pretend I'm a bad-ass... I'll post a few things in the next few days. BUT, I'm on my way home to from Brussels now, and will be back in contact shortly. A few teasers... Myself and Dr. Fowler enjoying the official hospital Jollof (or Jollah-- I saw it spelled a few different ways) rice in the cafeteria, and Joseph, Dr. Borbor and the ward nurses checking out a sonogram on one of our ICU patients. Hmmm, with the Brussels internet, maybe I'll risk posting a video before the plane leaves... Oh, no, can't-- long story as to why not, involving the Liberian National Police, my undercover operation, and the aforementioned scar. Oh, apparently the flight is oversold and they're looking for people to stay in Brussels tonight... This is God testing me after the events of the past 3 days-- Lord, no worries. I have learned that discretion is the better part of valor...
--andrew