Coffee, Drills, Sampson, and more

It's been a little while since my last post, so there's a lot to catch up on. I'll try to keep it short, for your sake and for mine.

I mentioned last time that we were going to a coffee plantation for a tour. It turned out to be a very good time. I'll spare you most of the details, but it was very cool to see such a huge plantation. If I remember right, it is almost a thousand acres, and right in the middle of it is a large hill with the plantation house at the top. It is a beautiful home with a huge main floor that is completely open and lined with windows. In the middle of the main floor is the stairways leading up and down to the bedrooms. The view of all the coffee fields and mountains in the background was really something. We tried to take pictures, but they really didn't do it justice. Here it is anyhow. Also in this picture are the drying fields (the tarp is wrapped up because it was drizzling) and part of the processing building/office.We also got to see how the coffee is processed, which is actually pretty interesting. Larry, the orthopod who owns the place, and his wife were very nice and are obviously enjoying their "retirement." They only spend a couple months a year here, but they are really doing a lot for the workers and the way the plantation is run. When they took over the place a couple years ago it was evidently not being run too efficiently and there was some degree of mismanagement that I'm not privy to. At any rate, they made it an attractive place to work by paying their employees more than they could get elsewhere, then proceeded to hold them to higher standards (no domestic violence, for example) and make lots of improvements. Part of the deal is also giving them a practical education. They also buy coffee from independent growers, aka the average village guy with a couple dozen trees in his backyard. This is evidently a bit lower quality, but they sell it as "tribal coffee" which has its own appeal I guess. It seems like a pretty cool thing they are doing. Oh, and apparently the coffee they grow is pretty good. They sell it to people all over the world, including Starbucks.

Also in the past week, we got a Jeep tour of a small part of the old Highlands Highway which connected the north and south coast (I think). It was a bumpy ride on a gravel road, but pretty enjoyable with some good scenery. Along the way we saw quite a few little thatched houses seemingly pretty isolated. In many of their gardens were miniature versions of the same houses. I assumed they were for pigs or chickens, but when I asked, I was told they were grave houses, or motmots. Some were more elaborate than others, which is related to how important the person was. Due to the bumpy ride, I didn't get any good pictures of these, but hopefully I'll have another chance.

Now for what you've all been waiting for: the freaky medical stuff you'd never see in the States. First, I'll give you a little warm up with stories that have no accompanying pictures. I started in the adult ward this past Monday, which has been a good experience. It is much different from peds, where I saw a bunch of diarrhea/dehydration, malnutrition, and pneumonia. The biggest difference is probably all the folks with tuberculosis (TB). Freaky Thing #1 - Hanging out with TB patients minus a mask and negative pressure isolation. It's a darn good thing my immune system works, because otherwise I'd be hacking up chunks of bloody lung right now. I guess that most of the docs here haven't even seroconverted yet (a positive PPD test meaning that your body has been infected/exposed and has mounted and immune response) which really suprises me. Okay, I can't think of anything else right now that is truly freaky, so we'll get right to the pictures.

First we have a nice xray of a young lady's (in her 30's) pelvis. Any takers on the problem? Even med student Ben picked up on the dislocated left femur and the piece of acetabulum (hip socket) that was definitely not where is should be. Apparently this lady was walking along a hill, began to slip, grabbed a tree branch, and the soil came loose bringing down the lady with the tree awkwardly on top of her. After seeing all the washouts that happen here, this story is pretty believable. Also, the husband would have had to be Hercules to inflict this damage himself. Listen to me, already jaded by the amount of domestic violence I see here.

This reminds me of non-pictoral Freaky Thing #2: domestic violence where you wouldn't expect it. The other day I was helping one of the docs cast a lady's arm which had been fractured. Nothing out of the ordinary. Then I started talking to the woman's husband who had known and worked for a missionary from the great state of Nebraska for many years! I was having a good conversation with this fellow when I casually asked him how she hurt her arm, expecting to hear she had fallen on something or been in a car accident. He sheepishly looked at me and said "Uh, it was a bit of a domestic issue." What?!? I didn't really know how to react to this, especially after such a nice conversation. After a bit of awkwardness, he asked me if domestic violence was a problem where I came from. I answered very matter-of-factly "Well, we have domestic violence in the States, but it is dealt with pretty harshly. We really don't tolerate it." This guy was going to have no repercussions at all, which is pretty awful if you ask me. The hospital does charge a domestic violence fee and a fighting fee (for chopchops), but that seems pretty minor. This may seem like it would negatively impact the woman later, but it is actually quite the contrary. Family structure is very important, and medical fees are often shared by the entire extended family. They are not happy about having to absorb extra fees, and will crack down on this activity (hopefully). So, back to the hip lady.

After my astute observation, Josh and one of the visiting surgeons, Kevin Kerrigan (who is a really cool guy and retired Navy), helped to set the hip. Unfortunately, it was very unstable due to the acetabular fracture, so we had to put it in traction. Now, for those of you who have never seen it before, orthopedic traction involves putting a pin through a bone and attaching a simple device that basically pulls constantly via a given weight on the end of a string. Anyway, I've seen this done once in medical school. I was helping Kevin set up for it, thinking I'd just stabilize the leg like I'd done before. Imagine my suprise and delight when he handed me the syringe with the local anesthetic in it and said "okay, now just make a nice wheel where you're going to start, and another one where you'll be coming out." Freaking awesome!, but also Freaky Thing #3, medical student performing orthopedic surgeon's job. Here's a picture of me with a hand crank drill going through the lady's tibial tuberosity (right below her knee). Notice the stupid grin on my face. Also, this would be done with a multi thousand dollar power drill back home. In fact, on the one I'd seen before, there was a hand crank in the kit, but the orthopod performing the procedure just laughed and made some reference to it being "Stone Age." Well, welcome to Bedrock!

Freaky thing #4: a little girl's clavicle sticking out of her skin, then sitting in a trash can. Originally I was going to post these pictures as well, but it is just taking too long to load all of these, so I'll just have to describe it to you. Basically, this little girl had gotten an infection either in her clavicle or right above it in her skin that was never properly treated. As a result, the skin over her clavicle had eroded, along with part of her clavicle closer to her shoulder, and about half of it was just sitting exposed to air. I'm talking about a little girl with a bone sticking out of her chest. Definitely freaky. Dr Susan took care of her while Josh, Dr Jim, and I were taking care of a chop chop. When we finished, I looked over to see Susan dropping the dead and exposed half of the clavicle into the trash can. Pretty crazy.

I'm really enjoying all the things we are getting to do here. It's really improving my procedural skills, which definitely need some work. As Dr Jim says, I'm a little ambisinistrous, or equally poor with both hands! He is joking (mostly). My physical exam skills are also getting quite a bit better, as we have less imaging to rely on, and I'm much more responsible for patient care. Today I felt two of the biggest livers I've ever seen. Both have liver cancer (most likely from hepatitis B) and will not live too much longer. Both would also be on transplant lists in the States. One dude's liver took up almost half of his abdomen and could be seen even before it was felt. It is definitely good to know what abnormal is, and I'm seeing way more of that here than I ever would have back home.

Caleb is doing well, though there is not quite as much for him to do here. He has been playing non-stop with his trains and track that we packed for him, and we're worried that he is getting a little obsessed! He relives many of the Bible stories and even some events of the day through those trains. One day he said "Don't worry James, I like God, I will be with you, I will protect you, said Gordon." That made me laugh, and made me a little proud. It's good to know that all the Bible stories we tell him and read to him are soaking in. You can never start too early.

One more piece of news. Earlier I wrote about the hydopower here on the station. Well, today I met Thomas, the super hero that goes down to fix it when it's "buggadup." He was in the hospital because we have been running on generator power since a big rain storm last night cause some problems with debris in the hydro generator. Dressed appropriately in huge yellow golashes, he was standing in front of our big circuit box talking about how we should be switching back over to hydro power, but we weren't. All of a sudden there was a really loud noise, all the lights went off, the breakers all tripped, and then the lights came back on. Thomas jumped just like the rest of us! We all started laughing and he said, "Well, I guess I fixed it!" He is a really nice, funny native guy who loves to speak English, which he is pretty good at. I actually met him once before, but then I didn't know the extent of his super powers.

Now, in an effort to end things on a happy note, here is a picture of me with Sampson. He's a kid with transposition of the great vessels, meaning his aorta and pulmonary(lung) artery come out of the wrong heart chambers. He would have died in utero, but he also has another heart defect (ventricular septal defect) that makes the blood in the two ventricles mix. Here, there is nothing to do for him, so unless they can somehow find a way to get him to Australia and get a cardiothoracic surgeon to operate for free, he will likely not live a long life, and will certainly be very limited in what he does. You may be able to see his blue lips from the very low percentage of oxygen in his blood. Normal O2 sats for you or I would be in the high 90's, but little Sampson lives in the 50's and 60's. On the up side, and the only reason his condition isn't Freaky Thing #5, is that I saw a lady in the States with the exact same heart defect. Normally, those kids are operated on as soon as possible, but this lady was over 50 years old and had evidently not had good medical care as a child or else was a poor candidate for surgery. In spite of this, she lived a relatively normal life. She was blue, had some characteristic physical findings, and was on a ton of meds, but she was alive. Sampson does not have the benefits of an easy life or state of the art medications, so the chances of him living to his 50's is almost zilch. However, it gives me at least a little hope for him.

Well, I said this would be short, but here I am writing a novel. In my defence, these pictures load so slowly and I just write while I'm waiting for them to load. I just remembered I have another story and picture which actually belong to Josh, but I'll save that for later. Now it is after midnight on Friday morning and time for me to get some sleep. I'm on call this Saturday and Sunday, so we'll see if I can rustle up any more stories.