Recharged and ready June 7, 2015

As usual, the flights were long and crowded.  Getting more and more crowded, it seems, and not just the flights, but the airports as well.  Throngs of humanity, all with their duty-free, masses of bags and stuff.  Garbage bins overflowing on the floor.  Out of forms because too many visitors.  Bathroom lines out the door.  Nowhere to put things on the plane; overhead bins crammed full and no real leg-room.

We passed through Abu Dhabi on the way here, a shopping mecca surrounded by land that is all one color - sand.  Even the roofs and roads all blend together. 

Flying in over Kathmandu in the dark revealed few lights and many open fires until we were right over the city, and even then it had very low illumination for a city of this size.  The air quality was hazy; almost fog.  My bag never showed up, so now I am in the vortex of bag-recovery mode.  I will be fine, but brought almost a bag full of things for the OR.  We will see what happens with that over the next few days.

It was dark on the way into the hotel, but we could see that most of the roads are cleaned up.  Most of the rubble and debris are swept and piled into stacks alongside the road.  "There was a house, and now is bricks," commented our driver.  We certainly will see more of that today on our way south to the hospital.

We are at a hotel familiar to me from my last visit, and all is comfortable and friendly.  I had to deal with the desk clerk about my bag and he asked what was my "good name".  Very sweet.  Great breakfast, those of us who need to be here are here.

This morning we are going with Dr. Shankar to a Ministry and get registered as medical workers.  We get to see the bureaucracy at work - or not - and then off to Kirtipur for our first day.

We are all showered, rested, and ready to go.

Nepal June 2015

Return trip to Nepal for me, but in different times.  In April and again in May of this year, Nepal, a small and very poor mountain country of 27 million, suffered serious earthquakes and multiple aftershocks that has left their crumbling infrastructure tentative or in rubble, with mostly newer and more solid sturctures standing.  Many villages have been wiped out, ancient stupas ruined, and subsequent rains have caused slides and rendered many areas inaccessible.  Efforts with helicopters to aid locals have been difficult with some disasters of their own.
http://www.telegraph.co.uk/news/worldnews/asia/nepal/11565120/Nepal-earthquake-Eerie-footage-shows-flock-of-birds-fleeing-crumbling-building.html

Being from California, earthquakes are not new to me, having experienced several in LA during my youth and some severe ones here in the earthquake country, Humboldt County.  But the structures here are built under strict codes and we often just duck in a doorway or under a piece of sturdy furniture.  In Nepal, they instinctively run outdoors because many buildings are at risk of collapse:
https://www.youtube.com/watch?v=MjyWHfvLSIY

The monsoon season starts in June, and will bring problems of its own with so many without shelter and so much debris on the ground.  Transportation for the ill, children trying to return to school, and clean-up efforts will all be impeded.  Standing water and mud are problematic in many ways and can only be a deterrent to a return to normal life.
https://www.youtube.com/watch?v=bfRQGdp9ZUs

So why Resurge, why now?  Resurge is not normally a medical relief group, providing instead for elective service to the poor in areas without access to the needed surgical skills and related medical care.  It has been many years that Resurge has had a relationship with Dr. Shankar Rai and his new burn center in Kirtipur, near Kathmandu, providing education teams, funds, materials, and workers to assist him in his efforts to bring plastic surgery to Nepal and its poor.  It makes sense that he turned to Resurge for help when the quakes hit and he found his new, small hospital innundated with Nepalis needing help with injuries, including many burns.  There have been 1085 health care facilities damaged, 402 of these totally devastated.

Resurge was able to deploy a team almost as soon as Dr. Rai asked.  I am in a following team hoping to help continue the services he is providing, teach some of the local anesthesiologists about care for some of the specialized surgeries that will be happening, and provide relief where we can for the many workers who are themselves stressed, worried, and fatigued.  Having seen them all at work in the past - how hard and for so little pay - I do this with great pleasure and appreciation.

I am bringing my water purifier, a length of rope, poncho, matches, candles, tools, rain boots, and mosquito net - almost seems like a camping trip.  But also will be medical equipment, scrubs, sterile gloves, and some drugs.  This last week at home I am arranging for pet care (thank you Chuck, and mom + dad!), taking care of any debts and details, and hopefully leaving everything worry free until long after I get back.  A long trip is quite a motivator!

Mwanza, August 25, 2014

Spent all day at the hospital meeting people and seeing the facility, patients, and the ward.  900 bed hospital, mostly at capacity, which means beds full.  What you don't get from that is that each bed probably has more than one patient in it, with family around on floor.

August 24

Up early in Nairobi for flight departure.   Cessie had quite a time arguing with the front dest.  We had been promised a $30 fee for transportation to the airport (10 minute ride), for which they then wanted to charge us $110.  The number kept changing, and I think they were hoping the clock would run out and we would just pay.  Cessie held her ground, and although a cute American young woman, she feistied them with her fluent Swahili and got them down.  What a fighter!

Health form reflects concerns for Ebola.

Flight to Mwanza; foggy so no views from the plane.  Captain Phillips movie of choice.  Hmmm.

Ride from airport and first views of local dress.

Caught napping in the lobby, Dr. Chris Connor catches up on sleep.

Mwanza is called Rock City because of the many rocks around Lake Victoria.
http://wolfganghthome.wordpress.com/2012/05/19/mwanza-tanzanias-almost-undiscovered-city-on-lake-victoria/

Maribou storks are everywhere.

Selling fish from Lake Victoria, usually Tilapia or Nile Perch.  She told Cessie to go home and bring her some American clothes.  Everyone things I am Cessie's mom.  I am honored!
http://www.independent.co.ug/news/news-analysis/7899-lake-victoria-losing-its-fish

Cessie is working hard to overcome her creep factor for these large Maribou storks by embracing her inner bird and taking photos.  These birds wander around the town freely and eat garbage and fish trimmings, so the locals call them "Health Ministers".

It's all in the presentation.

Ride in bajaj, a three wheeler.  Great way to get around.

Our three Maasai friends.  We all hung out at the street corner while Cessie got a sim card for her phone.

They were selling sandals they had made, but I found their own shoes most interesting.  Made from tires, this was how they protected their feet from the concrete street surfaces.

We took them to get pizza, and watched them eat their first cheese.  They all made a face that said "ick".  Nomadics who herd cattle and use the milk, they don't have the opportunity to store and age cheese, so not in their diet.  I wasn't eating any pizza, so we had an "ick" bonding moment.  Chris bought 3 rungus and they all posed with them.  When Samwell, the gentleman in all blue, would stand up and reach for pizza, I could see his bare torso and large hunting knife on his waist band.  Very interesting young men.

I said some kind words to this dog, and he made himself a member of the pack.

Our last adventure was to walk to an Indian place for food, which we could never find, so we went to the hotel restaurant to eat and were surprised at the yummy food there.  Then to bed to rest for our day of work tomorrow.

August 22-23, 2014

Arcata to SFO to Amsterdam to Nairobi to hotel.  It is now 11:30 at night, a day and a half later, we get some sleep, and then off tomorrow for Mwanza.  So far the internet has been spotty so not sure I will be able to upload photos, or even text until I am back to the bigger cities.  I will try; otherwise save the updates and photos for next week.

KLM was amazing - room to sit, hot towels, plenty of meals and drinks, etc.  Not a bad way to spend all day.

Love that loamy, earthy, vegetation, smokey and steamy feel and smell of Africa, although it is not as strong here right now as Mali.  Just had some rain though; they are heading into the rainy season.

All 3 of our team members made it, so we are ready.  Five a.m. wake-up call, and then back to the airport.

As usual, Resurge delivers.  Two very interesting team mates:  Chris Connor is a plastic surgeon from Houston who has also been a cardiac surgeon.  He brings a lot of energy and seems to know a lot about so many things.  Cessie is a young new worker at Resurge who was in the Peace Corps in Tanzania and lived in a central village near where we are traveling.  She then did 3 years in Dar es Salaam with CDC.  Her knowledge of the language, local traditions and culture will be extremely valuable.  It is quite amusing to watch people when they hear her rattle off in their own language.  They are quite shocked.

Tanzania - team site assessment visit, August 2014

Resurge International is a non-profit medical group that provides education and surgical assistance to people with disfiguring defects or injuries who are unable to obtain needed repairs.  Often people in this situation are unable to work, viewed as evil by their community, not able to pay for help, or the resources are simply not available.  More about Resurge here:  http://resurge.org/home/home.cfm

Tanzania is a country in East Africa, consisting of the Mainland and the island of Zanzibar, just south of Kenya on the Indian Ocean.  The population is about 48 million - 75% of whom are rural - with a life expectancy of about 60 years.  More than 5% of children die under the age of five years.  The median age is 17, and on average a family has 5 children.  Basic issues we take for granted, such as nutrition, immunizations, and medical check ups are not always available.  It is a battle to stay alive.

Most of the medical needs are unmet.  There are about 800 physicians in Tanzania (lowest physician;population ratio in the world), no reconstructive surgeons in Tanzania, and only about 10 general surgeons and other specialty trained physcians who try to do some of this reconstructive work. That is roughly one per 5 million people! About 1/2 of what exists is funded by Tanzania, and 1/2 comes from international efforts.  One example, the Global Health Initiative, has been instrumental in prioritizing, orchestrating, and quantifying the health challenges in Tanzania.  Communication is always key to avoid duplication and maximize outcomes.

Friday morning the travel begins.




 WORLD MAP SCALED BY NUMBER OF PHYSICIANS WORKING AND POPULATION (Lancet, 2004)

Kathmandu 10/05/2013

Turning toward thoughts of home.  Kathmandu to Hong Kong, a 4 hour flight, then an 8 hour layover (delay), and then 12 1/2 hours to SFO.  Going to be about 30 hours by the time I get to Arcata.

Looking forward to seeing family, my son on his birthday, and the doggie-doos.

Almost like it never happened, except not.