On the inside looking out

Mark describes the MSF compound he is moving into. Staff movements are restricted to the compound for their safety which means that evenings can seem long and actvities are needed to keep the mind occupied.  

It’s a very nice prison, but a prison just the same. The guards are protecting the inmates from the public instead of vice versa, but none of us has any illusions about strolling outside (even in the compound surrounding the hospital). MSF has very strict rules to keep Expats safe and out of trouble. Ignoring these rules can get you sent home, for your own good and for that of the team (not to mention for our patients – the reason we are here in the first place).

At present, my back prevents me from walking more that 100 metres anyway, but it’s the spirit of the thing! Unfortunately, I arrived in Aden in the middle of the night, drove from the airport in the pitch dark and arrived at the hospital compound long before dawn. On my way home, I catch the same plane returning to Istanbul, leaving around 5 am, so I won’t be taking in the sights on that leg of my journey either.

We have a variety of activities to keep our minds occupied and to keep us from dwelling on restrictions. The best is a long, hard day of work, where you are so bagged as the sun goes down all you can think of is a meal, a drink and sleep. However when it is calm, like now, it takes a lot of imagination to keep busy and distracted.

We have only been working in the operating room until noon most days. I have prepared and delivered a number of “lectures” for National staff (including the physicians, nurses and Anesthesia team). These have been very well received, as usual (I have always performed well in front of an audience). I have half a dozen more talks organized (loaded onto my iPad before leaving Calgary).

Wifi in Aden © Mark Kostash

We have Wifi (most of the time) which is often slow and petulant, but occasionally surprises me (such as when I accidentally downloaded a large presentation off my home computer “DropBox” account and the 28 Megabyte file reached my iPad in about three minutes. All the Expats have a personal device of some sort; laptop, iPhone, iPad, iPod – but I think I’m the only one with one of each. I brought my old iPhone along to use as a notebook (jotting down ideas for my newsletter; work to do for the mission; things to pack next time), as well as to have constant access to my calendar. I really do need to keep track of my appointments, lectures and meetings, not to mention what night I volunteered to cook dinner. I was hoping I could also IM home from it, but although it will sync and update my apps, it doesn’t like the internet/wireless settings so texting home is out of the question. As a consolation, I also loaded my favourite music playlist which even some of my younger compatriots seem to enjoy.

As on my mission to Pakistan, we have a gym in the living compound. We share it with the National staff, some of whom have rooms adjacent to us for the nights they are on-call. A poster has been created for the female expats to hang on the door, preventing any uncomfortable situations resulting from male Nationals walking in on skimpy, sweaty Lycra (or whatever they wear – I haven’t caught the ladies in there either. Yet.)

HR/Admin dart board © Mark Kostash

We also have a dart board with a variety of high-quality darts courtesy of our HR/Admin who just arrived “home” from vacation leave this morning. Add to this the Olympic sized ping-pong table (currently doubling as a purse/backpack staging area for trips down to the hospital or meeting rooms). We have a smoking lounge and a smoking lounge [sic]. After all, this is MSF France we’re talking about. To give them credit, the smokers do make an effort at courtesy, smoking only by the open windows (although that could be just to catch a glimpse of blue sky and trees).

Whenever possible, we meet on the hospital roof, which is one big open-air patio. I have set up a chair to catch the late afternoon sun, and when I don’t have duties in the operating room, I have been known to read my Kindle or write in my journal and work on my Vitamin D levels.

Journaling © Mark Kostash

And yet, my under-taxed, over-imaginative mind still finds time to jump to some truly ridiculous conclusions. Take for example, the day I was cleaning up in anticipation of our usual 6 pm dinner gathering. I stepped out of the shower, dried off and dressed only to find the upstairs completely deserted. I checked out the offices – doors open, lights off, not a soul in site. Ditto the gym. And the rooftop patio. And the operating theatres. At ten past I decided there must be a meeting and I just missed the memo (or more likely, the memo missed me). But the Meeting Rooms on both floors were deserted. It was at this point that jet-lag, insomnia and chronic pain sneaked up on me and I was convinced it had happened. They were all kidnapped. I was alone with a new telephone that didn’t have any numbers programmed into its memory and now I there was no-one left to call, anyway. If I had been given more time to brood, I’m certain I would have started to be angry; “Hey! Why didn’t you take me?! What am I, chopped liver?!” Fortunately it was just about that time I received a text message inviting me to join the National team in the Inpat Mafrash Room (National staff lounge, TV room). Most of the Expats met me there. Mystery solved.

The actual operating room work has been very light. One theatre is fully equipped with an anesthesia ventilator, a laryngoscope with a variety of blades, a drug & equipment cart and most importantly, a small equipment table for us to use as a desk. The other theatre has only basic equipment and the monitor is missing half of its cables. Since the project opened, it has been used only for short (10 minute) dressing and debridement procedures; no spinal anesthetics or cases even remotely likely to need endotracheal intubation.

While there is no automated anesthesia ventilator, there is a simple manual device complete with a vaporizer capable of delivering isoflurane or halothane. No-one in the project, myself included, had the slightest clue how it works, so I asked and immediately received an instruction manual by email from my Anesthesia “Boss”, Xavier in Paris. I ran an impromptu workshop where the National Anesthesiologist, the National Anesthesia Assistant and I sat down and assembled the gadget piece by piece. Then we substituted it (briefly, for practice) in the operation of the next intubated patient. I was encouraging my team to learn the system to increase their knowledge and flexibility for the time in the future when and if the project became busier. I was pleasantly surprised to discover them using the machine for every intubated case over the next couple days, without further requests, coercion or whining on my part.

My work here is done!

PS: The PC has promised an Expat field-trip if security is acceptable. Not sure where or when and I really don’t care about the details – sign me up!

Manual Ventilator © Mark Kostash

“The postings and views expressed here are mine alone, and do not necessarily represent the position of Medecins Sans Frontieres”.