The end is near

november 5, 2008

Hello again!

Yes, the end is near and inevitable – in fact, after 10 weeks in the City I’m now on my way home! It’s been an extreme challenge with many and lasting impressions – actually way more than I had anticipated. I’ve learned and been exposed to so much that I don’t know where to start now that I have to summarize it all – in many aspects it far outweighs my previous 4 years of experience from home. Let me give you some numbers to put things into perspective:

During my 68 days in the city, I’ve worked 67 days (of which 51 consecutive) and 12 nights. I’ve done 122 cases under general anaesthesia (47 with intubation), 119 spinals, 23 laparotomies (11 during night), 1 thoracotomy, and each and every day except Sundays I’ve done pain rounds on approximately 65 pre- and postoperative patients. The EU law on working hours is as you understand not implemented here… BTW, did I say in my last post that I had the Sunday off? Well, that turned out to be not entirely true. At 00.10 the phone rang; the local anesthetist (out of approximately 10 to 15 in the whole City with a population of about of 2 million!) could not be on call and we had to go in and do a laparotomy on a pelvic gunshot wound. The patient was relative stable, but the blood bank fridge had little to offer – at the end of surgery he had an Hb of 42 g/l! Well, he made it, and a week later he got discharged home. I guess though that we won’t accept him as a blood donor for months to come…

Now for your questions that I promised to answer; first come first serve!

Rik: Yes! Let’s get wet when I come home – I can use some serious R&R! I’ll call you and you better stand up to your offer!

John: Well, now I’m on my way home as you can see and I also hope your food question has been answered. Yesterday it was Thursday and thus time for my weekly dose of mefloquine against malaria. Doxycycline is an alternative as some people have psychiatric side effects to mefloquine. However, I haven’t jonglerarnoticed anything; I’m completely normal, anybody saying the contrary has joined the conspiracy, nobody saw me, I’ve got an alibi, my friends made me, and does the voices in my head bother you?

Steffo: I think I have fully succeeded in one of my original goals, but the other goal has been a complete and utter catastrophe. I’ve rarely made it home before dark and it’s mostly been raining anyhow. However, indoors I have been able to perfect my 5 ball act somewhat, outdoor juggling has been impossible on all but a few occasions (see picture; and notice the Swiss leader on the top; thank you PPD-gang!). I guess my dream of 7 will be one that I won’t fulfill; and definitely not during this mission.

MJ: My previous experience with ketamine was extremely limited. I had the textbook knowledge, and I can remember using it twice: once on a ruptured aorta, and once on the field at the scene of a motorbike accident. I know it’s more widely used in other places, but by tradition (?) not so at my hospital at home. I definitely think I’ll now use it more frequently on severe traumas; I can in retrospect remember several cases that probably had been better off with ketamine. But one must remember that our resources are infinite at home; we have blood and fluid delivery systems that can keep up with virtually any blood loss, and our human resources and infrastructure is all but limitless. I know you folks at home might not agree with me on that; but trust me, we are extremely privileged.

Uffe: Yes, a bougie is same same as the blue thingy on the wall. It’s used to guide the breathing tube between the vocal cords when it’s tricky to get it down in the right place. It’s my favorite airway tool and I use it frequently, maybe too frequently as I should probably fiddle around a little more to get the perfect view without any additional tool. But, I’ve got a lifelong learning curve, so in a couple of years I might find myself using it less frequently. Thank you also for your warm and generous support to me and the Médecins Sans Frontières – you’ve probably already have more lives on your conscience (in a positive sense) than most!

Well, that concludes my story from my first mission with Médecins Sans Frontières! It seems like I’m off to my second mission in two weeks; this time to a country plagued by civil war and harsh weather. It’s not yet finalized and many changes might come down the road. I’ll continue this blog and add new posts; check in again in a couple of weeks to find out what’s happening!

Finally and again: thanks for all your support; I now understand just how much it means. Keep it up and I’ll try to do the same!

Getting ready for Nigeria!

augusti 14, 2008

Dear all!

This is my first attempt at a blog, but I’ll do my best in the challenge to convey my experiences and impressions from my six week mission with Doctors Without Borders, or MSF (Médecins Sans Frontières), in Port Harcourt, Nigeria. I’ll try to keep it short and down to the point so you surely can find the time to read it, but bear with me as this first post is a little longer! I’ll try to keep you updated every week, but I can’t promise anything. Also, please let me know how I’m doing and give me feedback for improvement!

When writing this first entry I’m still at home in Sweden. I’m working as an anesthesiologist at a university hospital (Karolinska Sjukhuset) in Stockholm, and I’ve been in the pipeline for a long time to go on a mission with MSF. Finally it’s becoming a reality and all my training and preparatory courses are done with.

The reasons for me to volunteer with MSF are not in any way complicated nor with a belief of doing something heroic or altruistic. I volunteer with MSF for the same reasons I’m working back home: with a strong wish of doing something meaningful and helping people in need. However, and in contrast with my work at home, I think my ambition will be much more condensed with MSF and the results hopefully more obvious. At home we have next to endless resources and there is always a fully manned and equipped team to help me if I need – this will not always be true in the field with MSF! I strongly sympathize with the ethics and charter of MSF (more of this later); but, again, I don’t see any fundamental difference from my humanitarian work back home or my coming work in Nigeria. It’s the same humans, with the same medical and humanitarian needs. Maybe I’ll soon find out how incorrect and naïve my vision is…

Now for some background so you’ll get an idea of the MSF world! My hospital at home has an annual budget of 1213 million Euro (yes, 1.2 billion Euro!). With those more than a thousand of million Euro there are 15000 employees that annually deliver 10000 babies, perform 60000 operations, and do 1.5 million consultations. MSF on the other hand has a total worldwide budget of 568 million Euro. However, in spite of less half of the funding, MSF manages to annually employ some 30 000 people in more than 70 countries, deliver 100000 babies, perform 64000 operations, and do 10 million consultations. Those already quite impressive figures become even more impressive realizing that much of the work is done in a setting with extremely poor infrastructure and social and/or political instability. I feel honored to become a part of that work, but before anybody at home gets mad I must also emphasize that I really value and cherish my work at home! My friends and colleagues deliver first class health care and they are all a great bunch to work with. After all, if that was not so, I don’t think I would be ready for my mission with MSF. Thus, gang at home: keep it up, you are the best!

So – what am I up to? In less than a week I’m off to Teme Hospital Trauma Center in Port Harcourt, Nigeria. I don’t have the setting 100% clear, but I think the expat crew will consist of me, an anesthetist nurse, a general surgeon and an orthopedic surgeon. Together with logisticians and coordinators we make a total of 10 expatriates in the mission.

The Teme Hospital is active in a very turbulent city with a large number of victims of violence. I’m told there are around 20 knife or gun traumas every week; the city also has its share of “ordinary” traffic, work and domestic traumas. I’ll describe an ordinary day at work as soon as I can, but I think I can safely assume that the days will be very long and extremely challenging.

Speaking of challenge; I conclude this first entry by stating my two goals of my mission, each of equal importance: first I’m determined to do my best. For sure I’ll have to learn, for sure there will be times when I feel insufficient or frustrated due to a lack of resources, knowledge, or energy. However, I’m determined to nevertheless do my best and to be able to say to my patients, colleagues, MSF, and (most importantly) myself that I always did my best. I leave it to others to evaluate if my best was enough; at least I’ll rest assured knowing that I can’t do better, no matter the outcome.

The second goal might seem unrelated, unimportant, or even irrelevant; but in reality it’s not: I’ll try to learn to juggle seven balls during my mission. Considering the expected workload and my determination towards the first goal, I’m sure I need lots of stress relief, rest and recreation; I can’t think of any better or more effective than try to improve my juggling skills! While I’m determined to fulfill my first goal, I will merely attempt the second – we’ll see how well I succeed in my mission!