Dr. J- Rant Of The Day

I work with a rather, uh, charismatic doctor here. He likes going off on rants about various subjects from time to time, that range from the incompetence of some staff to the living conditions of Chinese workers in Gabon. His chosen subject the other day was the state of medicine in Gabon. Which is: not good. The government has been unable (or unwilling) to pay its bills to the hospitals for quite some time, and the result is that all of the hospitals have been on strike since January. (Not this one, it’s funded mostly by international foundations.) So the result of the strike is that sick people are not getting medical care, then when they’re gravely ill, they come here (to the HAS: Hôpital Albert Schweitzer), where often it’s too late (Dr. J-: "Do they think we're magicians?!"). The HAS has also been relatively overwhelmed with patients since the strike started: the maternity service has patients on mats on the floor, because they’re out of both beds and mattresses (“Patients are on the floor, four to a room! That is no way to treat people”). The medicine service sometimes keeps patients in maternity and surgery because there are no medicine beds left. It is frustrating that the government is unwilling to pay for medical care for its citizens, and it’s easy to place blame on any number of factors for the fact that people are suffering and dying of treatable diseases simply because there are no resources available to them, so his next statement caught me off guard: “And who is responsible for this?? We all are.”

Weekend pictures

We spent the day yesterday going to see a old mission in Sindara, about a 1.5-hour drive from here, picnicked at a "waterfall," (really, rapids), then stopped at a swimming hole on the way home (N.B. ASF Boston: I didn't swim).

Good thing we were in a 4x4.

View from inside the chapel at the Mission at Sindara.

Yes! Just like the real ones.

The swimming hole where we got attacked by the fouroux, tiny insects (so tiny you can barely tell they're not specs of dirt on your arm) that are not, to my great distress, deterred by any amount of DEET.

What is it exactly that you DO do?

(those able to identify this quote win a travel-sized bottle of DEET)

So…what do I actually do here? Ok, a brief rundown of the day, if you’re interested:
1. Get up, thrash out of mosquito netting
2. Wait for shower (four people who all start work at the same time share one bathroom)
3. Have cereal (fake cornflakes…that’s all we’ve been able to locate) and instant coffee out on the porch (heaven…I’m telling you)
4. Go to the medicine ward, or the Kopp, as it’s known, which is maybe a 5 minute walk from here, depending on how hot it is outside, to start rounds at 7:30. (Actually on Wednesdays and Fridays there’s a grand rounds type of meeting/presentation, where someone presents a topic or case to the staff, which starts at 7:30, so then rounds are after that.)
5. Round with the team, which consists of two doctors, 1-3 nurses, and me. There’s a little cart that we drag around that houses all the charts (really, cards the size of half a sheet of paper in plastic covers that have seen better days) and order sheets (for labs and x-rays and such) and a bottle of alcohol for hand washing and a trash bin and even a little vase of plastic pink and flowers. Next to every bed there’s a wooden board hanging on the wall with a spreadsheet that includes the patient’s vital signs (with the temperature graphed, so you can see its trend with a quick glance) and medications. It’s so simple. Patients get taken care of, medications get ordered and given, vital signs get taken and recorded, and there’s none of the triplicate record keeping that keeps rounds at home dragging on till 1pm.
6. Off to the Polyclinique, which is a giant waiting room with small exam rooms off of it. It is normally anywhere from 90-110 degrees in the waiting room, but, blissfully, the exam rooms have window air conditioners. See patients until noon or 1.
7. Have lunch from 12-1, then a break from 1-2:30
8. See patients from 2:30 to anywhere from 3:30 to 5:30, basically until they’re all seen. (Top reasons for coming seem to be: hypertension, AIDS, fever and headache and/or body aches [treated as malaria, even if the blood test for malaria is negative], and tuberculosis)
9. Go back to the Kopp, where it is now approximately 95 degrees after the day’s sunlight has run its course, and record all the lab values that came back during the day, as well as see any new patients who were admitted.
10. Either do yoga, or run, or sit in a tired and hot heap on the chair in my room directly under the fan.
11. Dinner is at 7 exactly. If you’re not done by 8 there’s a stern talking-to from the ladies who work in the dining hall (who are, I must add, all very nice).
12. Putter around until bed, either watching 30 Rock (a favorite pasttime around here), or going to the lab to use the internet, or going to the nearest town to have a beer, or removing large bugs from one’s room, or duct-taping the screens down, or hand-washing clothes, or…you get the idea…there’s always stuff to do.
13. Go to bed, rinse, repeat…

Some pictures

The view from the porch

My beautiful room

N.B.:  It takes literally an hour (or more) to upload one photo, so pictures are going to be few and far between...sorry. :( 

Things I've learned this week...

1. There is an entire country off the coast of Gabon.  It’s called São Tomé and Príncipe, and it’s the second-smalled country in Africa (after the Seychelles).  It’s an archipelago of 12 or so islands, the two largest being São Tomé and Príncipe.  According to my guidebook (the only one ever published on Gabon, as far as I can tell), the islands were formed from volcanoes, and were unsettled when the Portuguese came in 1470.  All the islands comprise 386 square miles and have about 165,000 people, and they speak Portuguese.  

2. There are a lot of Chinese people in Gabon.  According to an article from the nytimes, Gabon is running out of oil, and to compensate for its lost income it’s allowing Chinese logging companies into protected forest.  Not good.  But anyway, the hospital has anywhere from 3-6 Chinese men out of 26 beds, all with malaria, none speaking any French.  There’s a lot of charades going on on rounding. 

3. There are many things I like so far about Africa, but hand-washing, line-drying, and then ironing all my clothes (botflies get killed by the heat) isn’t one of them.  I think I’m going to take my chances and put most of my clothes in the hospital’s industrial-sized washers (with notoriously hot water).

AH! A bug just fell down my shirt.  Ok, zen with the bugs, zen with the bugs, zen with the bugs…  

Buggin' out

So I've been sitting here for about 45 minutes, trying to be ok with the ants.  Because it's Sunday, the research lab where we use the wireless is locked, which is how I find myself sitting on the back walkway using the computer, and trying to be ok with the ants.  They are everywhere.  They're not the little annoying ones that walk in organized lines by the billion (I can't even describe this, it's so amazing, I'll try to take a picture), they're the bigger black ones.  They keep trying to invade my space.  I keep shooing them away with (HAR) my shoe.  If they get too close I brush them off the balcony to the grass below.  I haven't killed one yet, though I think one or two haven't made it off the balcony injury-free.  There are too many to try to kill them all anyway, and I think killing animals on the grounds of the Schweitzer hospital is kind frowned upon by Schweitzer himself wherever he is.  You know, Reverence for Life and all that.  Then I decided to scoot up a bit and give them a little path behind me, so they could still hug the wall and get from one side of me to another (I was leaning against the wall), and I think we've worked out a mutually beneficial situation.  I don't have to spend half my time brushing ants away, and they can still go about getting breakfast, or going to ant church, or whatever it is they do on Sunday morning.  Letting them mill about so close to me is doing nothing for my near-constant feeling that bugs are crawling on me though.  Then I think I'm just paranoid or crazy, but then end up with zillions of bug bites all over (and in clothing-covered places).   I have even found spiders biting me.  Spiders.    I should just stop trying to fight the bugs.  There are way more of them anyway, and they can't kill me.  I'm going to try to be more zen about them, and just live and let live.  I'm probably scarier to them they they are to me, right?  I'll just keep putting hydrocortisone on giant itchy red spots and tuck my mosquito netting in real tight at night.  

Week 1: And so it begins

Thus begins our rotations here in Lambaréné.  I am doing adult medicine, and the other American medical student (also a white girl named Elizabeth, to maximize confusion) is doing pediatrics.  This week so far I’ve been in the inpatient wards in the morning (rounding on 26 patients in as many minutes) and the clinic in the late morning and afternoon (today: 2:30 to 4:30, hardly the schedule we're used to keeping at home, though it is oppressively hot, effectively limiting how many hours one can actually work during the day).  On my current to-do list: 1. Learn French, 2. Learn medicine, 3. Learn to understand Gabonese French, 4. Learn names of medicines in French (Esidrex?? Never heard of it.  Oh, wait, it’s hydrochlorothiazide?  Riiiight, I have heard of that).  The doctor I was working with actually left to go get something yesterday and said, “Ok, you can see this next patient while I’m gone,” and I was like, ummmmmm thanksbutnothanks.   It takes me 10 minutes just to read the notes from their previous visit, because they’re all in illegible French with abbreviations I can’t figure out.  Oy.  Adventure!  (Ça va aller...at least I hope.) :)  

I’m already a little bummed out (for lack of a more eloquent phrase) by the sick people.  Not that sick people in the US don’t bum me out, because they do, but I’ve already seen a few people this week who are sick.  Like, I look at them and wonder how it is they’re even still alive.  I saw literally the most cachectic girl I have ever seen in my life yesterday.  She was 22 and weighed maybe 65 pounds.  Good lord.  AIDS is a scary thing.  She'd been sick for a year but hadn't come to the hospital until now.  I just think of millions of dollars being spent in the US chasing incidentalomas (translation for non-medical people: incidentalomas are little shadows and blips that are discovered incidentally on CT's and MRI's done for other things, and usually turn out to be absolutely nothing) and it makes me crazy.  

Ok, off to bed.  Under my recently re-strung mosquito netting.  Now hopefully it won't fall on my face in the middle of the night, causing me to brush it off my face in a panic cause my half-asleep brain is concerned it's an ant colony, or a hungry mosquito family, or a bat.  Or a spider the size of a yorkshire terrier that we calmly (ahem) removed from my roommate's room the other day.  (Picture to follow)

La Petite Union Européenne

This is a very interesting place, for reasons I didn’t expect.  Dinner every night is a veritable melting pot of nations.  Some of the faces around the table: A couple from the Ukraine (internist and surgeon), a nurse from Switzerland (the German-speaking part), a man from Switzerland (the French-speaking part), a nurse from Spain (who retired from a career as a lawyer and then became a nurse), two Gabonese students, and a doctor from France (who is on sabbatical from a 20-year career as an internist in the French Antilles and drove here from France).  On the way back from dinner the other night in town, we were piled into the back of a big van, and we picked up a German student on the way, and suddenly everyone in the back (except the Americans) started speaking German.  (As Other Elizabeth said, “This conversation has taken a turn for the German.”)  And I kind of enjoy conversing with someone when neither of your first languages is the one you’re speaking in.  There’s no self-consciousness about grammar or pronunciation when the person you’re talking to probably won’t notice anyway.  

First attempt at a video...

Ok, ok...I know it doesn't play. This appears to be a youtube problem (a widespread one). I'll figure it out later. It's too hot to think right now.

Finally in Lambaréné

Well, the day has arrived. After, oh, 10 or so years of wanting to go to Africa, here I am! I am a little oppressed by the heat to fully enjoy the moment, but I am pretty excited. (Oh god, I just checked and weather.com says it's only 89 degrees outside. Could this possibly be true? I would have bet it was 95.) Luckily, there's no lack of modern conveniences here, including a small library with air conditioning and wireless internet. So...so far it's kind of like home, except for the bats in the walls. Anyway, it's pretty exciting to say you're on a new continent; that doesn't happen often in life.

So, this is not a place you'd pop over to for the week. To get here: a 6-hour flight from Boston to Paris (which landed at 12am Boston time, which was 6am Paris time, and I was very confused by the loss of the night. I mean, you can wake me up at 11pm and serve me coffee and orange juice for breakfast, but that doesn't make my body believe that it's really morning), then a 5-hour wait in the airport (with totally uncomfortable chairs not conducive to napping), then another 6-hour flight to Libreville, Gabon. Then waiting in lines in the airport, then a stay overnight in an airport hotel (it was 6pm by now), then a 4.5-hour drive from Libreville to Lambarene (see car below) the next day. Which included one exciting stop: the equator! We stopped at the sign (also see below) and I stepped across it, my first time entering the southern hemisphere. Yay! Then we finally arrived in Lambarene around 1pm. See photo of the welcoming committee below. Yesterday was a holiday, so there was a party going on, but we were too exhausted to go, we just unpacked and napped. And tried to figure out things like: how to hang mosquito netting, where the toilet seat went, how to prevent the bats from getting into the bathroom, why the towels are the size of hand towels, where to find dinner, etc. It was all very taxing on my jet-lagged and tired brain.

When I have more energy and my computer has more battery life, I will post more. I know you're all on the edge of your collective seat. :)

Stopping on the way to Lambarene

Really white girl on the equator

Part of the welcoming committee at the hospital

(A pelican, the hospital mascot)

(Why don't US hospitals have mascots? Discuss.)