Sunday, July 14, 2019

Work Note

Sheer terror.  That is the only thing I can think of that describes the situation we were in.

Our new doctor Sarah had called me at 1am. Hey Danae, can you please come and help me for a uterine rupture?

Ok, Ill be right there.

So rare in America, uterine ruptures happen here in Chad all the time. Women labor for a long time at home. By the time they get to our hospital, their babies are dead. Surprisingly, they usually arent hemorrhaging badly. The baby typically is compressing the big vessels of the uterus, so the women somehow survive. We cut into the abdomen and repair or take out the uterus.  Its my bread and butter here, or so it seems.

But this is far from that situation. This was something worse.

I walk to the Operating Room (OR) to meet Sarah there. There is a woman on the table already, but Sarah comes racing around the corner with the gurney and another patient. I quickly realize that she was managing multiple patients at one time. She had a patient on the table awaiting Cesarean-section for failure to progress in her labor, but she hadnt gotten to her yet.

The patient on the gurney is the true emergency. I look around at whos going to help us. Five saucer-eyed nursing students stare back at me, clueless as to how bad the situation is.

They somehow switch patients to put the hemorrhaging woman on the OR table. Even doing this is a challenging task for our inexperienced team working tonight.

Has Philippe been called?” I ask.

No.

Sarah calls Philippe. I call Philippe. We need Philippe. We need anesthesia. We need a 16 gauge IV. In fact, we need two. Actually, we probably need three. All we have is a tiny catheter unable to drip fluid into our patient fast enough. Its never going to work.

I quickly assess the situation. The patient has a postpartum hemorrhage. Sarah told me a little of the history. The patient was induced, but then required a vacuum delivery, essentially pulling the baby out with a suction cup on the babys head, a very common and safe procedure. Sadly, but unrelated, the baby had died during labor prior to delivery. Sarah said shed felt inside after the delivery and could tell the patient had a ruptured uterus. She had hemorrhaged out like a bathtub faucet. I try to compress the uterus from below, but it isnt helpful.

Instinct sets in.

Must stop bleeding.

Foley please. Call the other nurses from the other services. We need a good IV! Call Staci to come help. We have nobody here to do anesthesia. Staci can give anesthesia.” Still nothing better for an IV.

A few more nurses show up from the other services. One clearly had been sleeping, rubbing his eyes. Its a major no-no, but I tell myself to address that later.

So many nursing students threatens my sterility, which Im usually absolutely rigid about, but at this point sterility doesnt matter.  I quickly scrub the patients abdomen in 30 seconds. Sarah and I do a half scrub.

Any moment, Philippe should walk through that door and place a good IV, and well be all set. I just have to stop the bleeding right now.

No Philippe, but Staci shows up.

The patient starts making gasping sounds.

I cut into her abdomen with zero anesthetic. She barely flinches. (Not a good sign.) I grab the uterus at its base, stopping the flow of blood into it, and thereby stopping the flow of blood out of it and out of her. Thats all I can do for now. Shes so close to death. It doesnt matter if I do a hysterectomy or not now. Ive stopped the bleeding with my hand, but if we cant get a better IV, we will lose her. I cant do it all at once. I just squeeze.

She has no blood pressure, no response, no sign of life. She needs epinephrine, the pharmaceutical equivalent to a horse hoof to the heart. We give some epi through the barely-functional IV.

Philippe shows up. He tries to get a better IV.  

But its all simply too late. Im trying to run the code, directing traffic to give chest compressions and breathe for the patient and give IV medications. I pass the uterus to Sarah to squeeze while I start chest compressions. Too late. All too late.

Give atropine IV. Give more epi.

Epi. Atropine.

Just keep pumping. She cant die. She labored at our hospital. Sheour patient.

My hands and arms grow tired. The sweat is dripping down my face. Thinking what else to do. We discuss placing a central line, an IV placed closer to the heart, but nobody is really comfortable doing that. I should have told Staci to do one. I should have tried one. Philippe can always get a line. But its too late.

We started CPR minutes after Philippe arrived, but she had already bled too much, too quickly, for too long. She needed blood. She needed blood fast.

After a long time, while shes still being coded, I go out to talk to the family. Her husband is there. I ask how many children they have. Three. I tell them how bad the situation is.

I go back inside. Its too late. Weve coded her for over an hour. We called it. Shes dead.

I give the news to the family.

We wheel her out to the pre-op room and switch patients. The next patient has to be done too. For moral support, I wait in the room as Sarah and Staci perform a C-section on the next patient.

Then I go outside to be with the family of the woman who died. The mother of the patient had been in the maternity ward and hadnt been told her daughter was actively dying. Now, shes actively grieving.

Its 5 am. Were all beat. We debrief some and then go home to sleep a couple of hours. Sheer exhaustion. Thats what happens after a stressful situation. Sheer depression.

The next day at work, I find out the patient had been waiting for a month at the hospital so she could have a safe delivery.  The baby died in labor, and the mother died after a vacuum delivery from a postpartum hemorrhage. A month living at the hospital to ensure she didnt die in labor at home. And she dies here instead.

Deeper depression sets in. We failed. I failed. After a month of being safe.

But theres still work to be done. Still need to round and see all the hospitalized patients. Operations on normal cases. Lots of consults. Sarah had gone home to get some rest because I told her she should take the day off. But shes too depressed to be at home, so she came back to work in the afternoon to help us with the consults. Shes amazing and smart and strong.

She presents a patient to me that had a fistula, an opening between her bladder and her vagina. The patient had lost her medical booklet, but Sarah had copied the operative note I had written in the computer three years earlier. She had been my patient. She had had a large 5 cm vesico-vaginal fistula that I had repaired, including a left ureter anastomosis to her bladder.

This next week is a fistula week at our hospital, but I hadnt made any announcements on the radio yet when this woman came in. So I was surprised that she was here to be operated on again. I was depressed already and now this woman came back who wasnt fixed by my major surgery on her.

She didnt speak any French, only Lele, a language far from Béré with only 26,000 native speakers, none of whom work at my hospital. I bring her into the OR so I can do a proper exam on her with good light. She doesnt smell like urine. Theres no urine leaking from her vagina, and theres none on her clothes. Maybe, just maybe, we misunderstood. I find a nursing student who speaks a neighboring language similar to hers, and we piece it together.

She isnt leaking urine. Shes been dry since I did two surgeries on her back in 2015. I told her to not work until her visit with me. Well, now three years on, shes back for her visit. She hasnt done any major work for three years. She was too nervous about the fistula breaking open. On her exam, everything feels soft and her urethra appears normal. She is cured.

She explains shes been arguing with her husband about whether she should be working or not and came back today to ask if she should. Should she start carrying things on her head and working in the fields this year?

Three years. Three years and she chose today to come back and ask this simple question! With tears in my eyes, I tell her today had been an extremely awful day, and I believe God had sent her for this very moment to tell me she had been cured. He had spoken to her heart so she could encourage me.

I ask her where she lives. She tells me she lives well past Kelo, a town 26 miles away. She got to Kelo and didnt have any more money to continue her journey, so she walked the 26 miles to our hospital just to ask if she should start working again three years after she was healed.

Right then and there, I give her money for her transport back. Actually I stole money from my amazing volunteer nurse, Sonam, so she could ride back to her home, plus a little extra. Which reminds me, I still need to pay Sonam back.

Saturday, June 15, 2019

The Farmer and the Cowman

“Oh, the Farmer and the Cowman should be friends...”

I don’t remember exactly how the whole song goes, but Rogers and Hammerstein knew about Tchad when they wrote Oklahoma!.

« Docteur, venez à l’hôpital. Il y’a guerre à Delbian et mon malade saigne trop ! »

10pm. Well, at least I still hadn’t gone to sleep. Might as well go see who’s bleeding in the ED. At this hour, in hot season... patients can deal with me in basketball shorts and a scrub top and flip flops. Whatevs. 

First bed, a 30-something very muscular man. Why won’t he greet me? Oh, the nurse didn’t notice the giant goose egg on his forehead. His eyes are meandering in different directions, each going in a direction irrespective of how the other tracks. Like a chameleon, I muse to myself. Pupils symmetric and reactive, so at least he has that going for him. ABCs solid. Well, kind of. That B part. Somebody get me a stethoscope. 

A nursing student brings me the disposable kind that hangs in contact precaution patient rooms in America, but remain our stalwarts here. Auscultation seems bit reduced left base. Percusses a bit dull left base. Tympanitic left apex. Heart fine. No respiratory distress. 

His chest has a hole just north of where his heart should be. It’s sutured up. Pretty solid suture job actually, for the health center. And another small hole just parasternal. Lower abdomen has another hole. Right hand has a massive slice across the base of the palm, sutured up. Pretty gaping spaces between a lousy suture job, and filled with dirt and filth. 

« David, qu’est-ce qui est passé ? »

And then I learn the story. This tribe was having their “Initiation” outside their village, 18km of horrible dirt road from here. Initiation is when the young men who want to know the secret spiritual ways of the ancestors are taken at a certain age outside the village for a few days to weeks where the older men teach the secrets of the ancient good and evil spirits. This is only for a select few and it is CIA-level secretive stuff where leaking of information is paramount to treason and punishable by death. To divulge would be to make public the secret curses and blessing of the witch doctors and put them out of business. 

During said initiation, the nomads came through, driving their cattle. Driving cattle across Tchad, as in the musical “Oklahoma”, comes at the expense of cattle trampling crops. When you’ve spent most of the year tilling and planting and weeding and watering and whatever else it is the Farmer does, and then all your efforts are squashed by a five-minute passage of a herd, and you are faced with the desperation of the prospect of traversing an entire year with no income and no food... you become unhappy. 

Conversely, when you are a Cowman and your entire livelihood depends on your cattle eating and moving from grazing pasture to grazing pasture and then to wherever they will be sold, and there are no roads, you must drive your cattle where they go, and that will invariably be crossing farmland at some point. And when you have a history of constantly being unwanted and shooed and impeded from living your ancient way of life... your fuse gets short. 

Well... somebody’s fuse got short. I’m not certain how it happened, but nomads interrupted the holy initiation and offense was taken. To counter the affront of the offended, the nomads bore their weapons and let fly. 

Wait, wait, wait. These are arrow holes?

« Oui. »

Are the arrowheads still inside?

Blank stare. Patient can’t answer us. Well... let’s assume they aren’t there. 

Ok, so two arrows to the chest, one arrow to the belly, a machete to the hand and something blunt to the head. Exhale. 

I go get the ultrasound to check for hemo/pneumothorax. It’s dead. Plug it in to charge. What? More patients? Ok. 

Next bed, elderly woman moaning. Nothing seems too amiss except her arms. Left arm, slice across forearm. Patient highly non-compliant with exam and I don’t feel like doing this tonight. Ring/pinky don’t move. Oh sheesh. Oh what? She broke that arm years ago and those don’t move? Ok. Moving on... other fingers seem to move. Sutures filthy and poorly done. Right arm. Horror. Practically circumferential slice around forearm. Base of palm sliced up badly. Hand crunches and patient screams anytime I touch it or move it. Yeah, something is broken in there. Stitches on forearm are intolerable. So I don’t tolerate them. Scissors. Cut. That’s better. Oh great. Isolated radius fracture just proximal to midshaft? Not common. And terrible to deal with. 

What? More patients? Grrr...

Next patient, old lady. Also histrionic. Well, if a lady with a big unsutured lac on her forehead and a slice from elbow to tuft of index finger down to bone for the length of it can possibly be considered histrionic. Those sutures are even dirtier. Take ‘em out. 

Fourth? Why not? 30-something man with two holes to the chest, huge lac on the forehead sutured and a hair less filthy, and a hole on the butt, also relatively unfilthy and sutured. I think I should start measuring filthiness of sutured wounds on a zero to ten scale. He seems stable enough. Good lung/heart sounds. 

I’m tired. I slept like two hours last night. 

« David ! Tu es où ? »

Ok, David, first dude, let’s pop out the stitches on his chest. See those bubbles coming out? He has a pneumothorax. Keep that open. If he starts breathing poorly, send a nursing student to my house and plunge a finger in that hole to open it up. Check his pupils hourly. If one blows, maybe we will drill a hole in his head. His belly is soft. I’m not opening him tonight. Not if he doesn’t wake up. Soak him in bleach. Especially that dirty hand lac all sutured up. I’m too lazy to redo it, we’re too far out from his injury to redo it, and the suture job is bad enough any pus he makes will immediately leak out the gaping holes in the suture line. 

Old lady #1... soak her arms in bleach. Left arm is also a bad enough suture job we will see pus if it forms. Right arm... just pack it open. Fasting after midnight... so like, now... and we will exfix her radius in the morning. Stitches on that hand really need to come out too if you don’t mind. Too dirty. And translate for her she will very possibly lose her entire right forearm. What? Her son just died? He was the first one killed? How many died? Five?!?!?! Ok, and tell her I’m sorry for being a jerk to her for not cooperating with my exam. 

Old lady #2... translate to her she will likely lose that index finger in an effort to save her hand. People adapt incredibly well to finger amputations. She will be fine. We can do a Rae. And that huge forehead will now just need to be secondary intention too. Sorry. Keep her NPO after midnight too. Just in case we decide to take the finger. But we can probably wait a day or two before we decide. There’s a small chance she can keep it. Oh, and soak that arm in bleach and wash her forehead too. 

Last patient... yeah whatever. I’m tired. He’s fine. Just give him the bleach bath. 

Tetanus for all. And give them as much ceftriaxone as their bloodstreams can handle. 

A quick shower and I’m asleep. For an hour. 

« Oui, David. C’est quoi ? »

« Le malade continue à saigner beaucoup ! »

« Qui ? Le même homme ? Il n’a pas saigné quand j’étais là. Juste un peu avec l’air. »

« Oui, lui même. »

« Ça va aller. Bonne nuit. » I’m too tired to care. 

3am next phone call. 

« Il faut venir. Il saigne trop. »

« J’arrive. »

Back up at the hospital. He’s fine. He’s bleeding, but not that much. I’m not gonna try to stop the bleeding, because the hole he’s bleeding from is what’s preventing his pneumo. Actually, he’s not bleeding. That’s all old stuff. And no more air is coming out. Gimme that stethoscope. Ummm... so his heart sounds are on the right side of his chest. They weren’t before. I go and get the now-charged ultrasound. Yup. That heart is on the right and there’s a lot of blood and air in there. Go to the OR. Get a chest tube, a scalpel, a suture on a straight needle and a curved clamp. 

Bedside. Geez, this guy has more muscles in his pec than I have in my body. I hope he doesn’t wake up. He’s gonna hurt me. Betadine scrub the clamp. Betadine the skin. Stab. Tunnel. Clamp. Puncture. Rip. Insert. Wow. Glad I wore flip flops. They don’t hold as much blood as shoes. I probably should have done this hours ago. That’s like liters of blood. It just keeps coming. Suture it in with the straight needle because it’s easier than getting pickups and needle holder. No suction. No impregnated gauze. Just unclamp it if he gets into trouble. Clamp the tube. Ultrasound again and confirm heart is back where it belongs now on the left side of his chest. Hemoglobin 13. Now 12 hours out from his trauma. No way that’s a real hemoglobin with this much blood. I’ve never had a tension hemothorax before. And no way I’m gonna crack a chest here at 4am for a 12-hour-old penetrating chest trauma with blood. It all looks dark red. He will be... ummm... fine. Yeah. Let’s go with that. He will be fine. Get a hemoglobin in two hours again please. Off to bed. 

The next morning, they are all fine-ish. Danae wants me to do the exfix. I assure her she’s every bit as good as I am. She does it with me in the room for moral support. I drill the pins in. We make do with oversized steinman pins cut in two. Very very very not ideal. And plaster to hold the pins in place. There’s a lot of traction on these radial fractures to rotate the bone all wonky, but it’s better than internal fixation here where everything gets infected and everything is too open for a cast. Danae rocks it. 

I go to visit the other patients. There’s a guy there in military fatigues to protect them. Drunk as a skunk. My guard doesn’t want to kick him out, so I take the military by the hand to the gate, hand him back his billy club and wish him well with a strong shove in the back, ignoring his vehement denials of his intoxication. Close the gate behind him. Kids aged 10, 7, 5 and 3 have been home solo for hours now. Time to go home and see what they’ve burned down. 

#anotherdayintchad

Update: X-ray confirmed danae got the radius perfectly aligned. And Danae saved the finger of the other lady. Everybody ended up doing well and going home with all body parts intact. 

Friday, May 31, 2019

Depuis

Depuis
‘Depuis, docteur !’
I cringe. It’s such a simple word. Depuis. It best translates as ‘since’. And I absolutely loathe the word. Hearing ‘depuis’ makes my fists clench.
Every time I hear it, it’s carrying a sentiment of malcontentedness. ‘Je suis malade depuis, docteur !’ Doctor, I’ve been sick since!
I couldn’t really makes sense of it at first, using it’s typical translation, but then quickly realized depuis simply means ‘for a long time’ here in Tchad. I used to try to clarify. Depuis an hour, a day, a week, a month, a year, a decade, since birth? Nope, just depuis. I doubt this is it’s proper usage in France, but it’s undoubtedly it’s most consistent employ in Tchad.
But there’s a particular instance that has grown over the years from being a simple nuisance to positively making my blood boil.
‘Je suis là depuis !’ I’ve been here since ! The implication is, I’ve been waiting for you a very long time and you clearly aren’t doing a good job at satisfying my needs. Perhaps I take it a bit more personally than I should.
And the most common instance is going home at night, walking out of the operating room with a wife who is exhausted. ‘Docteur, j’attends la chirurgie depuis !’ Doctor, I’ve been waiting for my surgery since!
My weary wife manages a smile and an apology and tries to get home to her children before they fall asleep. But they stop her with all their complaints. She tries to listen to their stories. She tries to make sure nobody is an emergency. She tries to be compassionate.
I’m tired. I don’t try anymore.
‘Mais vous êtes là depuis quand ?’ You’re here since when?
‘Depuis, docteur !’ Since, doctor!
‘Depuis quand précisément ?’ Since when, exactly?
‘Depuis le matin.’ Since this morning.
‘Et vous êtes venu à l’hôpital pourquoi ?’ And why are you at the hospital?
‘Pour la chirurgie !’ For surgery!
‘C’est claire. Mais quelle maladie précisément ?’ Clearly. But what surgery precisely? ‘Pour l’hernie.’ For my hernia.
‘Et vous aviez l’hernie depuis quand ?’ And how long have you had this hernia? ‘Depuis des années !’ For years!
 I look in the computer. He literally just paid for his surgery an hour ago.
‘So lemme get this straight... you’ve had a hernia for years and you just arrived to the hospital this morning and just paid for your surgery this evening and you feel my wife should operate on you today?’
‘Oui.’
‘It’s 8pm.’
‘Oui.’
‘But you don’t think the surgeon should be able to go home until she operates on the problem you’ve had for years and just paid for this evening?’
‘Oui.’
‘So what time should she be able to go home?’
‘Maybe midnight.’ These are very real conversations I’ve had with patients.
And I want to scream. I want to grab these patients by the neck and shake them, but I’ve been told that’s not really culturally-appropriate in this particular corner of Chad.
And instead of my voice screaming, my brain screams.
‘Do you know my wife has been in the hospital depuis 5am, when she got called up for a Cesarean?’
‘Do you know my wife operates over 1000 cases per year, more than anybody else in the country?’
‘Do you know my wife hasn’t eaten depuis yesterday, since she’s effectively given up on breakfast since her first pregnancy ten years ago?’
‘Do you know my wife hasn’t peed depuis yesterday?’
‘Do you know my wife probably hasn’t had anything to drink depuis yesterday, unless she
remembered to stick her head under the faucet?’
‘Do you know my wife hasn’t seen her children depuis yesterday morning, since she got home last night after they were asleep and she left this morning while they were still dreaming?’
‘Do you know we’ve been in Tchad now depuis over eight years, being on call 24/7?’ ‘Do you know we haven’t been paid a local salary depuis ten months?’
‘Do you know we haven’t seen our extended family depuis?’
‘Do you know we haven’t been able to work in a *real* hospital depuis because we’ve been here trying our best to help over a hundred thousand patients in the last eight years?’

 ‘Do you know patients have come from all surrounding countries for surgery because they’ve heard of our excellence and there’s a waitlist of 30 patients for surgery? Do you have any reason for me why your years-old hernia should take priority over the others?’
The patient senses my brain screaming and tries to make his case more evident.
‘Mais docteur. Je souffre !’ But doctor, I’m suffering!
‘Your hernia is not strangulated or incarcerated. Why are you suffering? Is your suffering any more than it’s been for years? See that guy over there with the *fill in the blank drastically more painful surgical illness* awaiting surgery? Are you suffering more than he is?’
‘Mais docteur. Je viens de loin !’ But doctor, I come from far! Oh don’t get me started on ‘loin’.
‘Farther than me?’
‘Well, no.’
‘So you really want a surgeon who’s been operating for fifteen hours solid, who hasn’t eaten in 24 hours or taken so much as a pee break, to be operating on your chronic problem?’
‘Oui.’
‘Ok, then your ability to think rationally is seriously impaired and I’m ending this conversation
and walking past you to my house. Demain.’ Tomorrow. ‘Demain ?’ Tomorrow?
‘Inshallah.’ If God wills it.
And with that I go home, holding my tired wife’s amazingly-talented hand in mine. That hand which has healed thousands upon thousands. That hand which intuitively knows where to cut, what to tie, what to... do surgeryish kinda stuff.
And while walking home in fatigued silence, my brain reflects on these impatient Tchadians. And how maybe they aren’t just impatient Tchadians, but impatient humans. And maybe, just maybe, I’m still human too.
‘God, we’ve been here depuis! When will you call us somewhere else?’
‘God, we’ve been waiting for our replacements depuis!’
‘God, we haven’t been paid depuis! What will we do?’
‘God, I’ve been trying to homeschool my kids depuis! Can’t you grant me a few days without hourly knocks on the door throwing off our schedule?’
‘God, our hospital has been disastrous depuis, despite our very best! When will You come and sort out all our nursing and administrative and legal issues?’
‘God, the local authorities have been harassing me depuis! When will they learn I’m only here to help?’

‘God, everybody has been saying we are here for the money depuis! Won’t you come and show them the truth?’
‘God... depuis. I’m just tired. Where’s the respite you promised me?’
As if God takes vacation. As if God forgets. As if God gets tired. As if God has no plan for us. As if my depuis, measured in weeks and months and years, is His depuis, He who is infinite. We’ve put Him to the test over and over again. And He answers. In His own time. In His own way. Showing us He’s been behind things all along. In control. It’s no longer our worry.
We’re still tired. We’re still frustrated. We’re still burned out. But maybe just a hair less so. Because in my frustrations and fatigues of the day, I was reminded... My God has loved me depuis.

Thursday, February 14, 2019

27 Dresses

27 Dresses
Twenty-seven dresses. Okay, well, it’s really 28 dresses, but I really love the 27 Dresses movie. So I went with that.
Plus, I’m secretly hoping that someone will turn me in for copywriting problems. They will contact the lead actress of 27 Dresses, Katherine Heigl, and she’ll give me a huge donation of 27 dresses. I mean, what is she gonna do with those dresses anyways?
I swear, what girl doesn’t LOVE that movie? Weddings. Romance. First world problems.
But I’m here in the third world. And I have 28 women who have been operated on during our fistula week at Bere Adventist hospital. Plus two more that I did this week, and more and more that are coming with the news of our fistula surgeries.
If you’ve read our blog, I’ve explained to you what a vesico-vaginal fistula is. If you’re new to us, a vesico-vaginal fistula (VVF) is a hole between the bladder and the vagina. It is most often caused by prolonged labor, something common here in the third world simply due to the difficult logistics of getting to the hospital for advanced delivery care when home births don’t work. In those cases, the baby usually dies during labor and the mother barely escapes with her life. In first world countries, a VVF is very rare and most often caused by surgery or cancer.
I have been operating on VVFs for seven years now, but usually only do about 10-20 per year. I had some harder cases that were not healing due to their urethral involvement. I was able to find the fistula expert in the country and invite him to our hospital. Normally he works out in Abeche, a 2-3 day drive from here.
Hoping I would get at least ten cases to do together, I made a few announcements on the radio. I had already had six patients waiting, so I needed just four more.
To my surprise, there are more VVFs here than I thought! We ended up doing 28 cases in one week, many of them quite complex! It was a busy week. And all of the other non-urgent cases had to wait until the following week since we only have one operating room to work in! (Although some amazing people are organizing a container of supplies for us to have THREE operating rooms functional by December! If you have access to a massive warehouse of medical equipment, let me know!)
Dr. Valentin was very easy to work with and I learned a lot of techniques to apply to my vaginal repairs. He works with a few NGOs, and one of them donated some money to help with the cases. I was able to get $70 per patient to help with medicine and food (even food for their family members!) for their 3-4 weeks stay. So it was a great help. The hospital still had to eat the cost of the consult, hospitalization, supplies, labs, surgery, etc, but it was rewarding work!
Each story is touching. There are several older women who have been leaking urine for over 20 years! They had never been operated on. They didn’t know that someone could fix them! One lady came in with a pretty simple fistula. But get this. Her daughter now has the same problem. Both of them operated on in the same day! A mother-daughter special. Both healing well.
Another lady gives a heart wrenching story of having a rope in her hand ready to hang herself. She just couldn’t do it, but she was strongly considering it several years ago. Now she is on her way to recovery.
These women live tough lives. They leak urine. Therefore, they smell like urine. They sleep in wet, smelly clothes. Everywhere they sit is wet when they get up. They can’t get a normal job because they smell. Most of their husbands leave them. They can’t have more kids usually. Their life is a mess.
And now they have a second chance. A second chance at life. A second chance to be clean. And I want them to go home in a new dress.
So I’m in need of 28 dresses. Katherine’s dresses would do just fine. But they would probably cost about 200-300 dollars each I’m guessing. My dresses would only cost $20.
I would like to thank Dr. Valentin for coming to help me with these cases. We are planning another fistula week in May together.
I would also like to take this time to thank Mission Regan for donating many ureteral catheters/ stents (keeps the tube between the kidney and bladder open when the surgery is right next door). I was looking everywhere for these, and was about ready to buy them at $200-300 each when I was put in contact with Mission Regan. Sometimes the ureteral openings are very close to the edge of the fistula, so you have to put a ureteral catheter in to know the location and to keep the urine off of the closure postoperatively. Other times you have to reconnect the ureter to the bladder abdominally. Without these stents it would be impossible. Thank you Mission Regan!!!
Let’s just assume that Katherine is going to read this and donate all of her dresses to me! But in case she doesn’t, there is a donation button on AHI’s website. Just write in: “Bere Fistula Fund” to help with this special project. The donation from the NGO is special, but it doesn’t cover any of the OR materials, and certainly none of the dresses.
And a girl’s gotta have a new dress for this special occasion of being DRY! Out with the old stenchy clothes, and in with a new DRESS!