05-AUG-B-13
FINAL FULL DAY AT
BEGINS IN OPERATING FURTHER CASES,
WITH A TRADITIOANL COFFFEE CEREMONY AT
HAZHAZ OR, MOVES ON TO PACKING UP FOR FINAL DINNER,
AND
ENROUTE TO FRANKFURT TO
THE END OF A LONG TWO-VENUE SAGA FOR
SUMMER-‘05
August 18, 2005
My day had begun early and was a standard operating day until mid-afternoon in which it became an adulation session with formal farewell celebrations at Hazhaz Hospital then a further very special evening at a private home converted now into a museum of crafts and art from Eritrea at which we were the honored guests, before we left early form the party to go directly to the Asmara Airport for the long haul flights back home. I will start out along the video path, give the “audio voice over” and then fill in the text of the final days’ (forty eight hours plus what I made up on the clock) experience.
POST-OP “ROUNDS” AND “VIDEO OPS”
OF GRATEFUL PATIENTS,
AND SPONTANEOUS “ON CAMERA” INTERVIEWS
FOR “PHYSICIANS FOR PEACE”
Steve Katz,
the Norfolk Pilot photographer freelancer who is filming and photographing this
mission and also the one in Mindanao in January for Physicians for Peace (PFP)
had made plans to interview me on camera for a couple of clips related to the
Board of PFP or for recruitment. Each
time these were to have been done before, something else came up so we planned
to do the interviews on camera for sure at
We then visited with Johannes who is all dressed to go home and promising to email us. He is a first year engineering student and now can continue his studies without the severe impairment he had when most of his gut was in his left chest. He is a crowd pleaser and very gratifying since he peaks English and had talked at length before and after his operation with the students, who had seen him immediately after the operation when he had both chest tube and nasogastric tube which were making him uncomfortable. Now, he is better than pre-op and going home, and could do so by bicycle the method of his sustaining his injury when he was struck by a speeding car from that same bike.
Dinah is one of the first patients we had seen, and she was the most impressed on the memory of the two young medical students from GWU since she had the same age, and she was so ill on our first meting that they were unaware that she spoke English. Now, with her mother beaming, she was gratefully embracing and posing with each and exchanging addresses and email addresses for future correspondence. We will try to get Tamoxifen for her, which is unavailable in the Eritrean market. She is the one with whom the students had most closely identified, and it was here chest wall skin graft after the wide local excision of the involved tissue in her inflammatory breast cancer that they had their first experience of suturing with a lot of help and guidance just before they repeated the very same process on a patient undergoing the same operation at a considerably more advanced age a few days later.
One woman who had had a cholecystectomy and another with a post-op goiter removal were effusive in their praise and continue to kiss my hand and follow me in gratitude, which this time was documented on video for PFP files. We said goodbye to each of them since they know we will be leaving tonight.
Then, with
a colorful collection of waiting patients at the OR Door for consultation, I
gave three spontaneous brief monologs for Steve’s requirements. He could not believe I could pull off the
zingers as sound bites in one take each, saying I was such a pro at it he could
hardly edit any of the things I had said and he would use each for some
different audiences he had in mind. The
different settings and the backdrops made the different off-the-top clips
useful for differing audiences, and he felt he had enough now to go over to
THE LAST CASES OF OUR SCORES OF
OPERATIONS
AT
OF THE GWUMC STUDENTS
We began
with the young man who had a kidney stone wedged at the inlet of his ureter
from the kidney’s collecting system. He
was braced up in the flank position with a kidney brace and we made a retroperitoneal
incision and exposed the kidney without entering the peritoneum.
This was a whole new approach to the anatomy that Sherry had been learning much
of last year at GWUMC. She said she had begun
the trip with a need for a vacation but has now never been so eager to get back
to school and learn what it is she needed to know to appreciate the vast
experience she had just accumulated so quickly.
The stone was grasped with a stone forceps in the “pyelolithotomy” we did—a question as to why I should be dong these when there is a Ghanaian Urologist form Howard over at Orrotto Hospital, but there is so much to go around, particularly in urinary stone disease that he does not feel at all possessive. Sherry was amazed to see the stone which we packed up as a souvenir for the patient. He was another happy camper who was continuously raising his arms high in salute to us.
As we were
doing his case, a one year old son of a woman who is an employee at the
Our last case was a woman who may give an instructive case in autonomy. She pleaded with us to have a tubal ligation since she had five children and had blown out the C-section scar which had been thrice repaired. It way a large symptomatic hernia that Dr. Haregu had been the last to repair in tow layers, so on this recurrence I had suggested that a synthetic mesh be employed. She had insisted that we do here tubal ligation and t hat would have been a simple operation to add, but here husband was not available to sign the permit, so we were not allowed to do that part of the operation much to her disappointment. Reproductive resources are never the property of the woman in and African society, any more than the fertility of the fields or rivers might be considered a private personal resource. In this case the society had decreed that she should not have her fertility interrupted despite her overabundance of children in her own opinion.
One other special thing would happen during this case. The Chinese doctor who is a looker on, who had done nothing while we were here but show up for a brief time with a colleague from china and when asked invariably blew the simple taking of a picture with an autofocus point and shoot camera, had asked if he could scrub in and do an operation with the professor. He was gong to do this operation and it was immediately apparent to Sherry who had only seen tow previous surgeons at work—me and Dr. Haregu, that there was a huge difference in the way we handle tissue and the rather spastic approach he used and his rough and clumsy means of getting what he wanted done—which seemed largely an ego thing. He had a lot of heavy help form me, including the placement of the graft and the pushing the needle through the layers to be closed around it, but he felt pleased as punch that he had “done it” and insisted on multiple pictures to be taken with me as his colleague professor here in Asmara. I can only imagine the stories of his long and hard and excellent work once he returns to China about his tutelage at the feet of a master American Professor of Surgery and how that will be parlayed into a prime position in two more yeasts of his loafing around as an occasional drop-in observer or hanger on!
While we were completing the last case, there was a shuffling outside where we typically get dressed into our scrubs suits behind a cabinet that contains some surgical instruments and disposables. They had moved all the furnishings around and the woman I call “Mama” who is dressed in the shawl and white robes of the traditional Eritrean woman was hard at work in each of the steps of the ritual. She had earlier been cutting long muslin folded sheets into gauze sponges so that we had our own multiple gauze packs, not exactly the same as our machine made and counted packs that make it a requirement in some hospitals to throw away the unused sponges and lap pads that are left over at the end of the case, since you could never rely upon or trust the intelligence of a nurse to count the sponges correctly and thereby hangs a lot of liability if one or more of them go missing. It is for that reason that I have abundant sponges and laptops since the whole of the process in one world redundant and wasteful, and in the other world it is needy and labor intensive. We see examples of each here, since the supplies I have brought along are a result of the redundant wastage and irrational policies of a materials-intensive society, with the spill over benefiting the labor intensive societies I work with regularly.
We did her ventral hernia repair, putting a piece of Marlex mesh in the defect, and folding it “pants over vest.” With the mesh sandwiched in between, I would think she might hold that repair as she did not for the first several tries at it. But, it did not resolve here fundamental problem which she had sought us to fix, here excessive fertility which she would like to control—bnt it is not hers for the controlling. This is the sort of cultural sand social milieu which is not easy for the first worlder to understand—but it is the overwhelming reality which turns up the other factors with which we work. The very state of Emitter is a struggling underdog, and as such it will not listen to the advice of the developed world, and will develop its own rules, including those which sound a lot like a police state.
THE PERSONAL AND TRADITIONAL
CEREMONY OF GRATEFUL PATIENTS
AND STAFF AT
FOR ME AND SHERRY ON OUR LEAVING
As we were finishing up, the Mama who had been cutting sponges for us had been busy with a fan in one hand sweeping air at the charcoal brazier. This was for the purpose of roasting –not chestnuts over an open fire—but the coffee beans which are essentially burned at the black bottomed pan over the fire. She had previously “popped millet” which like puffed wheat or rice, or popped corn, was the kind of carbohydrate which was available in the original Africa before the Columbian exchange There wren few calories of the carb variety available in the underpopulated continent before the Europeans arrived carrying with them a whole bunch of the things you think of as classically African—mangoes, citrus, palms, bananas, corn, wheat rice and potatoes or yams—all of which are new world products which had been imported with the colonist’s from Europe, first from the Portuguese. So, we are having the “miniature popped corn” which is the millet when exploded, and the beans that are roasted are a traditional ceremonial ritual of hospitality. The roasted beans are passed around in the burning pan to have you waft the aroma at the recipient so he ors he can appreciate what is to come later—like a Starbucks in that the ritual precedes any product.
The whole ritual is geared to the guests’ appreciation since after the first sip one is supposed to say "Tahum!" If not, (“delicious!”) the hostess must discard the whole process and begin again. The roasted beans are then put in a mortar and pestle and pounded up to a fine grind, then placed in a ceramic “Erlenmeyer-type” flask on the charcoal brazier, and the bubbling over and vaporizing of the water of the coffee essentially concentrates it into an exresso. Horsehair from the tail of a horse is put into thee neck of the flask to filter it as it is poured in the succession of small handless cups, and then it is served on a tray to the guest. It is hot and thick, but they thicken it with several spoonfuls of sugar. I had the “Tahum” experience as the first in the line.
Flowers had been placed on the table and we also had the delivery of a special cake heavily frosted which said “Thank You” to us on the top, and I was supposed to ceremonially cut the cake. I brandished the knife with a lot of comments about whether they would trust me with it after seeing me wielding it for two weeks, with people lowing body parts when I am so armed. When I cut the cake, they all began ululating, a frequent response to the events around special celebrations—weddings and funerals chief among them.
With millet, popcorn and the cake and four different servings of successive generations of coffee, we concluded the ceremony, with the traditional
Eritrean dance which is a shuffle in a circle, with males then bumping shoulders with a spasmodic little seizure
DEPARTING
CENTRAL HOTEL, OUR GROUP’S FORMAL
FAREWELL,
AND LEAVING
We then got into the ambulance to get back to the Central hotel, where I was going to do my final packing out, and Sherry was gong to try to shop with whatever Nakfa she had left. I heard a familiar Spanish language from the front of the ambulance, and learned the nurses who were hitching a ride were all Cuban. The drop off was said with the last of the goodbyes, after we had made one more round of the post-op patients who wished us all Godspeed.
I got the room key to the Room 437 which I had already checked out of and paid out the incidentals on Amy’s and Sherry’s rooms which were largely their laundry and dinner charges were assigned to my bill. I found that the room was vacant with a new towel so I sneaked over and took a shower knowing it would be thirty six hours more before such facilities would be available to me. I also stashed the big box of “Bellas” that had been packed for us. We had admired and appreciated the cactus fruit that they had served us so that meant they were obligated to give us a bunch of them. There is no way we would b e able to get into US through the agricultural inspection with such fruit so I left it with Steve Katz who is staying through the weekend, along with the three bottles of “Plastic water” I had secured for me.
We loaded
the bags on the bus, and all went to the special home of one of the Eritrean
physicians which was said to be unique as a source of Eritrean art and also a
school to perpetuate the patterns of weaving and straw and ceramic arts. I toured around with out host. He was the one who had told me that the term
“Eritrean” is Greek, for the “Red Sea” which was once called the “
We also had
Multiple toasts were drunk in
appreciation of the volunteers’ service, and we were thanked again and again on
the part of the Eritrean people for our busy service here and the paying of the
funds from our own resources. We then
had the last of a series of group photos, and the group of us leaving for the
airport took off directly, but the later group going on Eritrean Air at 1:00 Am
went with Haile back to their hotel at
the Crystal to get their bags,. We said farewell
to the colleagues and our hosts and entered the maddening melee at the airport
where the “financial police “ had to be sure that our customs forms matched our
currency declarations. This took up more
time than the other “formalities” and the one thing that the need for my extra
Nakfa turned out to be irrelevant was the $20.00 Airport use tax which ad to be
paid in the last of my small
After the melee we barely got to
our plane in time for the boarding, and I disposed of my last Nakfa in buying a
few tee shirts. We boarded for the one
hour hop to the port city to the sacred sites of the two holy mosques—Jeddah
between
THE LONG FLIGHTS BACK
”OUT OF
“OUT OF
AND BACK TOWARD HOME
I tried to
type a bit into this log along the way, but was in the dark on the way to
Jeddah, then was smothered by a large Saudi man and his abundant family, all in
flowing robes and head covers who had sprawled all over the row along form the
return from Jeddah to Frankfurt, so I tired to sleep. I once tried to access the “Sky Net” but there
were no servers along the
I was one
of the first in the line, and could watch the near “strip searches” on each
person going through. At each stop I had
to take apart my carry on bag into which I had emptied my pockets for the
things I might need on the flight. After
the hour and a half that this process took, I arrived to learn that they had
changed the gate and terminal for the Washington Dulles flight out. I had to go
out form the Secured area and change terminal by the Skyline and then go
through the whole intensive process again for more than an hour each. Fortunately I had enough time, and met up
with Sherry who also threaded the maze, whereas the mother daughter combination
of Sally (family practice form Franklin Square in
I had hoped
again to work on the laptop with all its vaunted capacity for the fourteen hour
battery extended life, and I have no complaints about its capacity there, but
it froze up into immobility on the spellchecker, so I had to repeat that after
shutting it down twice. I decided not to set up a new account on this “Sky Net
Server” as I went over
It has been
a long and continuous remote exotic experience through Europe to Asia and
Africa, with a couple of the kinds of things that I may do best—in an intensive
learning process through which I helped quite a few others and especially a few
student protégés in GWU and Eritrea and quite a few more patients, each one
more unusual and spectacular in their pathology and even more effusive in their
gratitude and appreciative thanks expressed to us in the hospitality we had
lavished upon us in this new nation in the Horn of Africa. I hope I may have introduced you to