22. Blogging at 9,000 feet

In Ecuador for my 7th overseas medical trip, some words about the previous six (nb, dates are approximate):
#1 Montalvo, Ecuador 2004. Blankets hung over ropes for exam rooms, major gyn surgery in an OR previously used only for cesarean deliveries, real questions about risks and limits of overseas surgery. An evangelical group (mmint.org) with three goals: medical care, support for the local church, and a spiritual experience for the participants, many of whom came with no medical skills or background. These goals were at times in conflict, but don’t be mislead by my habitual second-guessing; a tremendous experience.
#2 Accra, Ghana 2005. The organizer could not deliver on his promises so no real medical work, but whoa, what an amazing place. We stayed with a local family, met with government and church health system administrators. African art came alive.
#3 Chengdu China 2006. A first hand view of modern Chinese medicine (at least as practiced in large cities) . Should Western medicine feel complimented as China hurtles towards a Western health care system? Yes and no.
#4 Vietnam 2007: A medical exchange; I lectured with a bust of Uncle Ho looking over my shoulder; tried to assist with a hysterectomy, only to have language prove to be an unsurmountable barrier; listened to medical students explain why thy chose medicine, a mixture of filial duty and personal, usually negative, experiences with the medical system.
#5 Mozambique 2007: Sounded like a perfect setting: a rural Methodist-funded hospital with two ORs a couple of anesthesiologist, and no local gynecologist. Ii even knew some Portughuese! Though hindered by the absense of any prior screening, I helped with some deliveries and confronted the most difficult hystectomy I have ever done. And an unanticipated bottleneck: the small autoclave (sterilizer) couldn’t keep up, so some cases cancelled simply because there were no sterile drapes/gowns. But also an opportunity to appreciate the perspective of local chronically overworked operating room staff: I came wanting to do lots of surgery; but for them, I just represented extra and uncompensated work.
#6 Guayaquil Ecuador 2008: A group from Phoenix with a local connection to provide access to military hospitals and almost completely self-sufficient (no want of sterile drapes/gowns). In 8 days I saw 50 outpatients and performed 12 major surgeries and a couple of minors. My fingers were literally sore from tying so much suture. Finally.

21. Flu Stories

The distribution of theH1N1 flu vaccine has been unpredictable in terms of both timing and quantity; when our clinic received its first small batch, an email went out advising staff that they were high priority and should go to the injection room to get their vaccine. A few minutes later, a second email arrived: "Make sure if you come up to the fourth floor injection room check in, that you are quiet as to why you are here. Patients are told we do not have any flu vaccine in our clinic. Thank you."

Two public servants in Alberta were fired for having provided the flu vaccine to members of a professional hockey team, disregarding established priorities. The team doctor who ordered the vaccines, and the team manager who concocted the scheme suffered no repercussions.

Somehow our clinic in Federal Way received more vaccine than it needed. Tacoma was short. No problem, we said, just put some in a box and bring it to Tacoma. Nope... it seems that vaccines can’t cross county lines.

20. Priorities

A 28-year old in her 26th week of pregnancy is in the ICU, near death. The pandemic flu. A story repeated across the nation.

Meanwhile in the clinic patients are dithering about whether to accept the vaccine, especially the preservative-free vaccine, which was available first.

19. Whatever Works

I complemented A. on her well-behaved daughter, quietly sitting in a chair during her mother's antepartum exam.

"Oh, I just told her she was getting a shot."

18. Twilight

J. delivered on Halloween, naming her baby girl Bella. I don't know whether the Twilight series will have much staying power, but if it does, then in about 15 years her daughter will either think that her mother was awfully clever or had a misdirected sense of humor.

J., though, is clueless: "Twilight what?" she says.