05-AUG-B-3
ARRIVAL IN HIGH ELEVATION
IN
“UNDER RECONSTRUCTION” USING MY “NAFKA”
AND SETTLING IN FOR TWO WEEKS OF ANOTHER KIND
OF ADVENTURE WITH MY TEAM
August 7, 2005
When we
left Jeddah and almost all passengers on the plane who were arriving in Saudi
Arabia for their Umrah in a religious pilgrimage to Mecca, the doors were open
letting in the desert dry heat of 43* C.
We took off for the one hour hop with a very much lighter Airbus 330 to
cross the
The people
meeting us at baggage reclaim were wearing jackets. We traded in US fifty dollar bills for 300
“Nafka” making the exchange rate for $1.00 US= 15 Nafka. We trundled through the dark city “under
renovation” passing the Eritrean national Festival whose last day is tomorrow,
and checked in at the
FIRST DAY’S SCREENING CLINC IN PICKING
BIG AND COMPLEX CASES TO OPERATE THIS
WEEK
I began the clinical activity by going to the hospital compound and seeing two dozen patients that had been set up for me to see, and booking half of them for operations. There was little about it that was trivial since the diseases were long in waiting and advanced in the terms of their pathology. I saw a dozen goiters, many of which were recurrent or hyperthyroid. Some of these ere under treatment and could be safely done as Grave’s Disease and would be scattered through the coming week. A number were simple hypothyroid goiters and a couple of patients had nodules. I talked some out of operation and others were booked. I saw a young woman with a six months size gravid uterus which was a complex mass, most likely uterine fibroids for a chief complaint of infertility. She was advised that I would be willing to operate on heir but she should know that her infertility might not be resolved but would become permanent if we had to take out here uterus. She understood that and wanted it to be removed, since having a six months gravid uterus pressing on her bladder continuously was getting to her. I saw a couple of breast cancers, one a tragic young women with a nipple discharge of bloody fluid for three years, now with a messy infiltrative inflammatory carcinoma which had eroded the skin and broken down the area all around it, which would need a skin graft as part of a clean up mastectomy. This patient got to my student Sherri since she was the same age and their futures seem remarkably different.
Another was a woman with a right breast mass, which was much more like the kind of breast cancer I could see anywhere else, but we had here go for a needle aspiration following which we would book here urgently or electively for biopsy. A young man had a large sarcoma of the leg which will need an extensive bloody excision. A very big problem presented with a man who had achalasia of the esophagus, who has been losing weight and cannot swallow, regurgitating undigested food, and a swallow showed a very dilated distal esophagus just before a unrelaxed stenotic are. He needs a Haller myotomy and perhaps a Thal patch—a big thoracic procedure which will be the first tine I have seen or encountered anything like this in three decades. But there is no one else I can refer him to, so he is on the schedule for a thoracotomy. I also saw a woman who had cholecystitis that had resolved and had a sonogram that showed gall stones. So, we will do here cholecystectomy. We received her abundant thanks along with the salute, “May you live forever.” Maybe not but the thought is what counts.
So, already
we have a full day’s operating list of several cases each day for the entire
time we will be here, and I know we will have to push others into this already
full schedule. So, we will be busy. I came back after meeting the rest of the
team at the sorting out of the equipment we had brought and learned that many
are form the Diaspora of the Eritreans unaccountably clustered in
“BAYAS” IN THE RAIN,
AS I WALK AROUND THE CLOSED MARKET AND
SEE THE
ASSORTMENT OF CHURCHES AND MOSQUES
We were
taking a walk under a darkening sky as the clouds rolled in over us. The central city streets are as safe as
anywhere to be walking in
Finally a young
girl was located who ran to us with a bucket full of the “Bayas” and with a
knife, cut both ends off and peeled the skin for us to eat the Bayas, with a
charge that came to us on the basis of how many skins were left on the street
after we had dined. It was sweet, but
with a gritty collection of seeds in the soft sweet pulp. We were distracted at the time by being
pushed back against the side of a building near the market by a downpour that
hit abruptly. Fortunately, I had the
light jacket that I had packed up in the bag I had brought that had been in the
extra bag checked in from Derwood with the surgical supplies I had carried here
by leaving them with Amy who checked them in.
I am going to be going to a special dinner tonight, with an interval
rained out opportunity to see the last day of the Festival, which we may stop
to see after the dinner. It was once begun
as a way to raise money for the war effort, and with peace and independence on
May 24 1993, there was great enthusiasm for prosperity. These hopes were dashed with resumption of
the fighting in 1998, and things have been somewhat stymied since then by
economic drain of ten percent of the Eritrean population staked out along the
border with Ethiopia to defend against incursion and occasional sniping and
cross border disputes. The other border
is with
But,