Shisha (Shipshape) and Snacks Up Top

As the hospital is now only able to deal with war wounds they are running at 50% capacity. The team are looking at options for the future to use this capacity especially as the hosptial in Amman is running at full capacity.

You just have to laugh (‘cuz otherwise you would have to cry). “Autocorrect” does some very silly things. For example, when I typed that we were having Shisha (spiced tobacco through an elaborate water-pipe), the computer figured I was just straightening up. And when texting to my Sweetie back home my strong desire to have internet access for email and IM, it decided I was a fuzzy hoofed quadruped – “I just Goat be Online!”? Whatever floats your boat.

© Mark Kostash

AD is the Team Shisha Maker. It takes a fair amount of time, so I volunteered to help (and to be an alternate so he would miss less socializing time). Proper hygiene is almost as important as careful “construction”; after all, dried out old bits of debris in the pipe or water aren’t likely to enhance the flavour.

© Mark Kostash

Now don’t get me wrong – I am rabidly anti-smoking. Most Anesthesiologists are, since it is the single patient habit which complicates our work the most (a close second being morbid obesity, and don’t get me started about really fat smokers). But as they say,”When in Rome…”

HN is back from her week-long visit to the project in Khamer. As I understand it, the project is high in the mountains, where the air is thinner and colder (she was warned to pack a sweater). I look forward to telling her about PC joking that she was shivering up there in the cold. Poor taste since he sent her there in the first place; actually, he’s been saying he rented her out). Funny, but still in poor taste! Might earn him a punch to the arm. At least she will get a warm welcome “home” to Aden.

Narrowing our “Scope of Practice” to “War Wounds” (or more accurately, victims of violence) certainly has had an effect on how busy we are. Prior to this decision in December, the program also accepted referrals of patients injured in RTAs (Road Traffic Accidents). We remain at about 50% capacity for inpatients and are averaging five cases a day in the Operating Theatre.

With “advertising” and referrals, as well as the occasional Mass Casualty event, it is expected that we will gradually become busier again. One possible plan for the future is to expand the project to become an advanced rehabilitation unit (similar to the program I worked at in Amman, Jordan).There is a long waiting list for Amman and certainly a need for another reconstructive surgery program. We have all been asked to put in a “Wish List” and explanation of upgrades which might be needed if Aden Hospital were to open their doors for treatment of osteomyelitis, resistant infections, reconstruction (bone grafts, maxillofacial reconstruction, flaps and myocutaneous flaps). I have made a list of anesthesia equipment needed to expand the second OT to “full service”. It will be interesting to see what happens over the next one to two years.

OT classroom © Mark Kostash

I’ve been able to slip in a few teaching sessions between operations and naps. NA and AA have been keen to discuss anesthesia-related topics and HM has booked me in to give lectures at the weekly Physician Teaching sessions. I’ve covered Fluid Therapy and Management of Acute & Chronic Pain so far. I also spent an enthusiastic hour with the OT team today teaching how to do bedside ABO blood type testing.

Blood typing © Mark Kostash

Just about every team member poked themselves and confirmed their own blood type – it was very well received. As expected, almost everyone was “A” or “O” but they were excited when one of the female nurses turned out to be “AB”. We think she is very lucky since she could receive blood from anyone on the team in an emergency! This is all in addition to teaching NA to do some of the lower-risk nerve blocks for surgery and pain control. She has already had the opportunity to do five around the shoulder, wrist and foot and you never know what tomorrow may bring.

I have always said that “Chivalry is not dead”. This may well be the case, but on this mission, it’s really hurting. I stood by, helpless as our slight, attractive, Big Boss Lady from the regional office in Dubai carried a 20 kg replacement water bottle up the stairs and hefted it onto our water dispenser so I could have coffee one morning. This is after I have (not so grudgingly) surrendered the snow-shovelling of our driveway and patio to my wife at home. As if my back and leg pain was not bad enough, now my ego has been severely bruised. I may need a self-image transplant before too much longer. The only good thing about getting old… is that it beats our only alternative (getting cold and stiff).

I have been fortunate this trip that the vivid dreams often associated with malaria prophylaxis have not been a big problem (I refer you to my first mission where I awoke to witness the Log and Hospital Manager passing dead babies through my bedroom window and stuffing them into my pillowcase – while it makes interesting breakfast conversation, it does not make for restful nights of sleep).

I have taken a different anti-malaria drug on subsequent missions and not had problems. However the combination of jet-lag, back pain and gastro did lead to one particularly vivid dream involving the headless torso of my dead mother (sorry Mum, it was as disturbing to me as it probably is to you reading this).

I have discovered a down-side to living in a large, open building with lots of tile and high ceilings (not Celine’s <sigh>); it makes an incredible echo-chamber. When the wind catches an open door, the resulting “SLAM” is truly impressive. Especially when it happens at three in the morning, or when PC or ES get called to the Emergency Room and they close their door with a little too much enthusiasm. Enough to wake the dead (or the deaf).

Review of Abbreviations:

Expat Team

PC – Project Coordinator

LO – Log

PH – Physio

AD – Admin/HR

OS – Orthopedic Surgeon (Expat)

HM – Hospital Manager

HN – Head Nurse

MIA – Anesthesiologist (Yours Truly; Mark In Aden)

OT – operating theatre (what at home we refer to as the OR)

ER – Emergency Room (Resuscitation Room)

NA – National Anesthesia Doctor

AA – National Anesthesia Assistant

And to conclude; yes I went over the wall (with permission of course).

AD and I went with a driver to a nearby hotel (previously a Five-Star Sheraton but now slipped to Three officially… and a Seven-Star as far as this Expat is concerned). The drive across town was very interesting and I took copious notes between bouts of motion-sickness. No photos unfortunately at the specific command of the Powers That Be. No point irritating our hosts (and military installations, security checkpoints, police & vehicles and women would have to be excluded anyway). Still, I would have loved to take a photo of “Little Big Ben”, a clock tower built no doubt by a homesick English Expat. Right down the street was a miniature Eiffel Tower. I immediately thought of Las Vegas!

Crossing the causeway/bridge over extensive tidal pools and mudflats we saw thousands of flamingos wading, foraging, or just standing around on one leg. Lots of other shorebirds too among the wading or rafting fishermen & women. As we approached the coast, a number of roadside shops appeared displaying a variety of swimming attire and toys. I lost track of how many bright yellow ducks I saw hanging above the street, looking like a bunch of small yellow inner tubes with smiling heads. I even spotted a few giraffes (yah, yah – pun intended).

Pool at Gold Mohur © Mark Kostash

The hotel is situated on a quiet sandy beach. Far off in the distance, a number of freighters and tankers rested at anchor. We ordered a couple pizzas and a bucket-full of ice water and spent the afternoon chatting, swimming and suntanning. I was diligent with my sunscreen so no restless night of lobster-flesh would ensue. AD introduced me to a few Expats from ICRC who were also enjoying the fine sunny day. The water temperature felt about 23 or 24 C – a perfect, refreshing temperature. I gathered a handful of seashells at the waterline to send to a couple not-so-small girls I know out in Nova Scotia who used to enjoy collecting

© Mark Kostash

I know, life just sucks! But it still beats the alternative!


PS: As you might have guessed, the geological formation in the last photograph aboveis indeed called “Elephant Rock”. One of my kind colleagues told me the story… Many years ago a group of elephants made its way from Africa all the way to the Arabian Peninsula and then down here to its Southern tip. When they saw how beautiful it was, they decided to stay forever.

.Monday, January 20th, 2014

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