First the Bad News – the heat went off in our apartment last week, so it remained 12 degrees in our bedrooms as well as in the common area. The Good News – it was corrected before the snow came on Thursday. It was brutally windy and cold for awhile, rattling the shutters in the middle of the night – it felt just like home! It snowed on & off for a couple days, but despite warnings and staff fears it never accumulated and it vanished rapidly when the sun came up. Lucky thing because I missed the instructions to turn the hot water heater back on in the evening, resulting in a “refreshing” morning shower. On a positive note, the freezer compartment of our refrigerator is cold enough that I’ve had ice cubes to go with the lemon twist in my drinks. I keep saying I lead a charmed life!
My sleep cycle is finally back to normal…I get up around 5:00 and have a nice leisurely coffee and breakfast with time left over to “work” online before we are picked up at 7:30. Jet-lag had been getting ridiculous – I began waking up earlier every day (at 02:30 the night after posting Installment-I). I was feeling pretty exhausted – I figured it was at least in part because there is no inhalational gas scavenging system in the operating theatres. Exhaled nitrous oxide and volatile anesthetic is vented into the room.
Then I realized we had performed spinal anesthesia on all the patients that day, so no gases were present . Trying to “catch up” by going to bed early seemed only to make it worse. The combination of exhaustion, winding roads and heavy smoking in the operating room lounge was causing serious nausea for awhile, but all is good now. Fortunately, I don’t have to take malaria prophylaxis, so I don't have to deal with the bizarre dreams and insomnia I experienced in Somalia.
Much to my chagrin, I have developed a taste for the instant coffee packages provided to us in the operating room – a sickly-sweet combination of Nescafe, Coffee Mate and sugar. I still prefer the Arabic coffee cooked on the stove (with cardamom) but I have to admit the instant stuff is simple and portable and it’s easy to find hot water. It has been fairly quiet in the operating room – one of the surgeons is away on vacation. He is scheduled to return on Sunday, so we might find things picking up. We have only been running one theatre so far, which has allowed me to get used to the procedures, meet the staff and give a few lectures ( I do love a “captive audience”).
MSF has outdone themselves with the anesthesia and surgical equipment. The surgical and patient complexity requires live X-ray (fluoroscopy) and advanced airway equipment (flexible fiberoptic bronchoscopy). Multi-tissue flaps and complex maxillofacial reconstruction are common and we have access to monitored postoperative care beds and even ICU ventilation.
Many patients have injuries which are several years old. Osteomyelitis is common and multi-resistant bacteria are the routine instead of the exception, so isolation protocols are rigidly enforced. It was explained to me than one gentleman in a private isolation room had both Pseudomonas and MRSA (a resistant staphylococcal strain) cultured from his wound on arrival in the program. Infections must be eradicated (or at least controlled) before considering implantation of tissue expanders, bone grafts or internal fixation devices.
Some patients present with serious systemic illness from their wound infections (why it is advantageous to have a good working relationship with a facility with an intensive care unit). Most patients expect to be in the program for several weeks to months. A hotel nearby the hospital has been leased and patients and their caregivers live there while recovering and awaiting their next surgical procedure. The building houses an advanced physiotherapy program, a psychology department (and even several kiosks in the Atrium).
Patients are transported to and from the hospital for some treatments and for follow-up appointments with surgeons in the attached Outpatient Department. Recently, the project was featured in a television news program (www…….) – putting MSF in a very positive light. The quiet days have allowed me to explore the city quite a bit. After Grand Ward Rounds on Saturday, Jorg and I went for another “Long Walk”, a combination of shopping and rubbernecking.
We descended the hill the hospital is perched on, weaved through much of the downtown markets and into the Coliseum. It has been partially restored and contains two museums with artifacts and displays of traditional apparel and weaving equipment. From the Coliseum we climbed up toward Al-Rainbow Street, managing to climb the wrong hill and having to backtrack several hundred meters (in distance and altitude). We made it eventually, also discovering a great restaurant for a greatly appreciated sandwich (shawerma) and bottle of water. Deciding discretion was the better part of valour, we hailed a cab for the remaining trip back to our apartments.
Jorg’s enthusiasm for walking (and his reassurance that the walk home from the hospital was only about 90 minutes) encouraged me to walk home after work on Sunday. As promised, I entered the Shmesani district and approached the apartment after an hour and a half. Maneuvering around the two tunnels along my route was “interesting”...mainly trying to avoid being run down in the traffic circles at ground-level. Jordanians drive quite aggressively, treating lane markings more as guidelines and using the car horns to mean anything from, “yes, please go ahead,” to, “hey Ahmed, nice to see you again,” or the more common, “What in the name of Allah are you doing?” Despite this, they ALWAYS stop before running into each other or into pedestrians. I’m certain their reflexes are better developed than ours in Canada. Cellular phones, while everywhere, seem to be used less commonly while driving. Tomorrow, Jorg travels back to Europe – a going-away party is planned and will be well attended (he seems to make friends everywhere he goes)! Live Large…