writing about all of the things we smell and see and learn, recording the situations and experiences and people, I think it helps me digest the different world we’re immersed in here in arusha. i’ll say it again- I’m not sure what I was expecting when I came here, but im certain now there was nothing that could have prepared me for this adventure. I know a big part of me was trying not to have expectations, and because of this, everything seems to surprise, amaze, shock and baffle me. it’s been a lot to process over the last week (can you believe we’ve been here a week already?!). we’re finally getting comfortable with our setting, finding our way around, and knowing the best places to eat. today after the hospital we decided to venture out to withdraw money from the bank. standing in an outdoor line, about 30 people long (all locals), waiting for the atm, was enough to make anyone tachycardic. we’ve had so many people warn us about the precautions you should take when getting money from the bank. what made the situation worse was that a) I had a bad feeling. that kind of bad feeling that you look back on later, after something’s gone wrong, and say, I knew it didn’t feel right... and b) there were two men leaning against a post where you enter to use the atm, just loitering and looking suspicious. darn it anyway! they kept eyeing us and it was starting to annoy me, so when we were about two people from the front of the line I left thu and amy saving our place in line, I walked over and leaned up against the post next to the guys. I said jambo and one of the guys kind of nodded at me, looking very surprised that I had just walked over to stand by him. my intent was to let him know simply that I see him, and that im not afraid of him (that would be a lie, ha). as I stood there soaking up the sun and watching thu and amy wait, I would shift and move a little closer to him, and he’d shift away, ever so slightly, maintaining more space between us. he was uncomfortable, that much was clear, which was amusing considering the situation. I think it just threw him off, and he didn’t quite know how to handle it. when the guy in line in front of us left the atm he said it was out of money. what? we stood there for a moment weighing our next move as he went inside to tell the bank. moments passed, then simultaneously we were all like “let’s go, there are other banks”…. I think it was a sign. there were actually two atm’s at this bank, one wasn’t working, the other had no money inside. we were getting some serious signals telling us this was not a safe place to withdraw money. we walked away empty handed but a little relived. we will definitely bring along depaul, one of the canadians, next time. he’s been here before and knows the ropes. as great as arusha is, and as comfortable as I feel here already, we’d be kidding ourselves if we believe it’s a perfectly safe place. there are good people and there are bad people anywhere you go, as with all travel, we need to be smart.(we are being safe! mom, please dont worry :)
speaking of dangerous – motorcycles are dangerous. are you aware of this? I know what you’re thinking, something anti-motorcycle coming from my mouth?! It can’t be! but after today, my perspective on motorbikes might be a little changed... at least for motorbikes in arusha. brace yourself for a story. um, and this one definitely gets a disclaimer too. if anything else I’ve blogged about has bothered you, I’m telling you right now, stop here and wait for the next post. that said, if you’ve enjoyed the graphic nature of my blog, read on! oh, and you’re welcome :)
nothing says good morning like doing a pelvic exam on an HIV positive woman. can you say double glove? it breaks my heart because my mind automatically jumps to worst case scenario for how she contracted HIV, and unfortunately, my speculations are probably pretty close to correct. we had dr. ishmael with us, and we were trying to learn the swahili words for what we ask the women to do during the exam. lay back, stick out your tongue… or saying “I will now examine your stomach” or “I will now touch you down there” as they say here. this woman was very tolerant of our learning, and I think she appreciated that we were actually telling her what we planned to do before we did it. when the exam was over and she lay there on the bed I rubbed her back for a while as we talked with dr. ishmael about the plan for her. not only was she HIV + but she had a myoma in her stomach that they had originally interpreted as her being pregnant with twins. this is a culture very comfortable with touch, but at the same time you see so little consoling shown toward these laboring women. I think a kind touch, like rubbing a back, or keeping your hand gently on the woman’s leg, definitely wins rapport. honestly, just being female gives us an inherent connection with these woman, and you can’t help but want to comfort them.
in the late morning the labor ward got a little boring (a rarity from what we hear), so naturally amy and I bolted for the surgery theater. a new patient was just being wheeled in on a metal bed (it pretty much looks like the tables our cadavers were on), and amy and I stood at the foot of the bed as they slid her over to the operating table. she was covered in blankets but her feet were sticking out, and we quickly noticed a huge metal rod through her heel. at first we both assumed the surgery was to remove this foreign object, but when they moved her to the next table, her blanket slipped off of her legs and we realized that she was here for a serious leg trauma. there was a massive bandage from ankle to knee on her right leg and when they lifted her leg from the foot to move it to the next table, it bend right in the center of the shin, as if there were no bone!! my eyes got wide imaging what was beneath that bandage and I leaned to amy and whispered through my mask “did you see that?! this is going to be good”… I mean that in the worst kind of way- good as in terrible- an injury so bad you wouldn’t wish it upon your enemy. we were not disappointed. as dr. lee cut away the dirty and blood soaked bandage the woman was already crying in agony. she lay wide awake on the table. layer after layer of bandage was removed: the anticipation was killing me! dr. lee finally got to the last layer. he gently lifted it off of her skin, unfortunately, her skin went with the bandage. yes, a thick, green, pus-covered layer of skin about a foot long and 7 inches wide leaves with the bandage, exposing the rotting bone and muscle of the anterior part of her leg.
it is moments like these when I always surprise myself. the logical part of my brain is telling me I should have some sort of a reaction. faint maybe? I should get goosebumps or feel nauseous at seeing something so unnatural. or at the very least my heart rate should increase… but no, nothing. instead, I stand there by amy’s side, taking it all in. it was an incredible injury! (again, I mean that in a very devastating sort of way), the most severe compound fracture I have ever seen. the soft muscles were parted by the huge tibia, jutting out and fractured so completely you could see the marrow… or at least where it should be, the bone was pretty much entirely dead. the story of this woman’s injury goes something like this: she got in a motorbike accident about a month ago. to repair the injury they closed the gaping wound and put her on bed rest with what they call skeletal traction. what this means is that they place a metal rod through the calcaneous (heel) and tie weight to it in order to keep the fractured ends from overlapping. this maintains the proper position for healing, or at least that’s the idea. unfortunately, this woman’s massive wound (I’m talking knee to ankle), got infected. she went to see dr lee, he removed the stitches, flushed out the dead tissue, and closed it again. but as I’ve mentioned before, the idea of sanitary and sterile here is relative, and it wasn’t long before her leg was infected again. necrotizing fasciitis or something of the like… this poor woman lay on the table, fully awake and alert and feeling everything! she could still wiggle her toes! which was amazing considering the state her leg was in. once the bandage was removed dr. lee just stood there staring. he kept sighing and shaking his head. he placed his hands on either side of her leg, hunched his shoulders over the injury and contemplated his options. every so often he would move one end of the broken bone, examine it, see how it aligned with the other fractured end. the woman would scream in agony. it was unbearable to watch. amy and I walked over the woman. I grabbed her hand and held it tight as i studied her injury, observing dr. lee deep in thought. each time he would touch or move something, her grip would tighten around my fingers. I felt so helpless. they finally decided to give her an anesthetic, some yellow liquid we didn’t recognize that dr. lee couldn’t explain to us. it knocked her out, which was a relief because by far the worst part of the whole thing was watching her suffer. they don’t intubate, just keep the head back and the mouth open… sort of. dr. lee began chipping away at the dead bone, looking for any sign of living tissue – nothing. he flushed the wound, redressed it, and she was taken back to the surgery ward. he has two options: 1) try to use a metal rod to stabilize the two ends (but risk terrible infection, which she’s already been fighting) or 2) amputation - something he needs her awake to consent for. such a young woman, it is very sad. watching suffering like that, someone in truly excruciating pain, it is so difficult. I hate feeling helpless but I suppose it is something you adapt to here, in a place where morphine and other pain killers are not readily available. such a wild injury, I took a photo, figured I needed the evidence to prove I’m not exaggerating. It really was that bad. tough things to deal with.
speaking of tough to deal with, the premature babies are kept in a room with black letters painted on the door that says FRESH BABIES in all capitals. we went with dr. ishmael to see what the preme unit was like. I’ve never seen babies that small in my whole life. even when I rotated in the NICU during college, nothing like these miniscule aliens. it’s remarkable! they move and grow and eventually, most will thrive and be normal children though they look nothing like humans at this point. arms no bigger than one of my fingers, it was almost more than I could wrap my mind around that something so small could survive. for a place that seems to have endless obstacles when it comes to patient care, they manage to keep these babies alive. I was impressed.
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