I am starting to feel like a 24 hour convenience store are hours are 7-11. Mosquitoes are out in full force. I started carrying a pair of tweezers in my pocket I figure that a man that can catch a mosquito with a pair of tweezers can do anything. The operating room or the theater is very interesting voltage stabilizers, step down transformers and 17 million power cords that spark and sizzle and none of it works, gas connections that do not hook up to anything, transport oxygen cylinders that weight more than I do.Things that work on 110 volts 220 volts and when things are connected to the wrong power source spark and smoke starts to fly. We have manage to create a small computer network and stream live video of the heart surgery from the operating room to several computer in different locations and quite frankly it better than anything we have at home. It has been a challenge to orchestrate all this stuff. In spite of all of this it has been rewarding even if what we do is just making a small dent in the grand scheme.
Ozzie
Thursday, April 30, 2009
Adapt and Overcome...
It is HOT here today, woke up to a bright steamy day. I’m generally not a night shift admirer; however night shift here, is really Day shift time back home so it makes it easier to acclimate (there is a method to my madness). But, the downside is trying to sleep during the day in
THEM: “Yes, ma’am, no pro-blem ma’am” as they bow away nodding.
Oh no, they ring the room looking for their coworkers, and are in and out of the apartment, all afternoon.
The upside is waking up at 5:30p, having a coffee (Instant)(Nescafe) while you hear these birds, and watch the kids across the way playing kick ball.
Apparently in times past, people worried about, say, enough oats for their horses, or enough ice blocks for their frig. Nowadays people can have entire meltdowns (Me) because they left the cell phone charger behind. Camera’s, PDA’s, phones, and computers; they all need a cord to keep them charged, and combine that with the electricity being 220 DC (the smell of electrical burning has been a common smell in our apartment-TAMMY) and the outlet looks like absolutely nothing we have in the states (and remembering to bring THAT adapter and stepdown unit)….it’s not a pretty site. “Oooh can I borrow that cord, I forgot mine..” becomes a familiar phrase.
The honeymoon is over people, the excitement of arrival has worn off and the reality has set in. We have a full ICU, we’re running out of supplies, people are getting tired, even the Ugandan Nurses look beat. We have a ton of oh, blue clamps and plastic yellow stethoscopes for instance, but, one more set of blood tubing and NO sxn catheters (for the non-medical people, both are not good). But I learned from my misson mentor the great Betsy Tirado, to “adapt and overcome”, as we always do, we get creative. And we are.
Happy day all!
-Lynda
P.S. no pictures from me, I forgot my cord.
Wednesday, April 29, 2009
Where's my ASCOM
Call room Mulago styleI just completed my first call night. I have some news for all of you back home. Strangely enough - life goes on without the ASCOM. I actually was able to take call and communicate with the nurses without a pager or a phone - weird. Other random things I discovered last night:
- I kinda dig blogging, but don't know if I am cool enough to Twitter
- No ice in the Mulago hospital
- Colola means cough in Lugandan
- Malaria preps here come back quicker than RSV swabs
- blood gas results can take less than 2 minutes
- Ugandan Mountain Dew is delicious
All is not perfect in Uganda though - I slept (~2 hours) in a top bunk designed for someone 5 feet tall with a mosquito net....no flat screen TV's, and no private bathrooms.
Rollin' on
Klugs
Mosquitoes are overrated
Carrying on Dobson's tradition of bloggin on or soon after ones call night...I present you with my call night blog. I am on call tonigh for our "biggest OR day" of the trip. We did an 11y girl with a mod secundum ASD and a 7kg 2yo with a large VSD and larger cleft lip and palate. 2 cases and out of the OR at 9:50 pm. Crazy - the OR team is working like dogs. Again - seniority carries with it no priviledges. Nearing the 5th year of my fellowship I still don't get pick of calls - even in Uganda. It is a busy night by the standards here - 4 CICU patients and one stepdown.
While I am sure all can tell the CICU aspects of this work are pretty straight forward (except figuring what drugs we actually have, and whether or not they have expired yet), the echo part is grueling and amazing. I think we did upwards of 30-40 echoes today and saw everything from normal (which is actually an anomaly here) to a 26y unrepaired ebsteins to AP window to truncus to a large DORV canal with TGA and interrupted arch. Fortunately, my clinic has prepared me well. The weird thing is none of my patients have asked me if I am a model. One; however, did tell me "I am going to beat you" while I was doing her echo...this all with a smile on here face (jack ass Klugman thought she liked me).
I think the hardest thing about my call night tonight will be not having my 3 Niles before bed. Oh well, I can have 6 tomorrow.
Last of my random thoughts and loose associations....while the mosquitoes here carry the threat of malaria (which would obviousy suck) they certainly are not as nasty and aggressive as the asian tigers in my backyard back home. Also, no swine flu.
Pics to follow.
Klugs
While I am sure all can tell the CICU aspects of this work are pretty straight forward (except figuring what drugs we actually have, and whether or not they have expired yet), the echo part is grueling and amazing. I think we did upwards of 30-40 echoes today and saw everything from normal (which is actually an anomaly here) to a 26y unrepaired ebsteins to AP window to truncus to a large DORV canal with TGA and interrupted arch. Fortunately, my clinic has prepared me well. The weird thing is none of my patients have asked me if I am a model. One; however, did tell me "I am going to beat you" while I was doing her echo...this all with a smile on here face (jack ass Klugman thought she liked me).
I think the hardest thing about my call night tonight will be not having my 3 Niles before bed. Oh well, I can have 6 tomorrow.
Last of my random thoughts and loose associations....while the mosquitoes here carry the threat of malaria (which would obviousy suck) they certainly are not as nasty and aggressive as the asian tigers in my backyard back home. Also, no swine flu.
Pics to follow.
Klugs
Cultural Adjustment and Our New Driver
Hello All,
Last night was my first night on in the CICU in Uganda. It was the first time I have ever had to remember to pack insect repellent for a call night...but I digress. Tammy and Lynda (go night team!) were on with me. I stayed up until 1AM talking with Tom, one of the Ugandan CV surgeons. We discussed pre- and post-op management here versus the U.S. But most of all we discussed his experiences in the theater. Actually, that is a cultural difference. Here the OR is known as "The Theater." Incidently, when the head nurse told me she would like to leave our clinic yesterday to go to the theater. I thought it odd, but I figured there was a movie she really wanted to see. I understand now.
On an unrelated note, one important factoid about Craig Sable that none of you ever knew. His greatest aspiration (beyond perhaps being a member of the Steelers) is to be a bus driver in Kampala. He keeps saying things like, "I now know my way around here... I think I am going to drive next time...I think I could drive this bus better, don't you?"
Luv,
Craig
Last night was my first night on in the CICU in Uganda. It was the first time I have ever had to remember to pack insect repellent for a call night...but I digress. Tammy and Lynda (go night team!) were on with me. I stayed up until 1AM talking with Tom, one of the Ugandan CV surgeons. We discussed pre- and post-op management here versus the U.S. But most of all we discussed his experiences in the theater. Actually, that is a cultural difference. Here the OR is known as "The Theater." Incidently, when the head nurse told me she would like to leave our clinic yesterday to go to the theater. I thought it odd, but I figured there was a movie she really wanted to see. I understand now.
On an unrelated note, one important factoid about Craig Sable that none of you ever knew. His greatest aspiration (beyond perhaps being a member of the Steelers) is to be a bus driver in Kampala. He keeps saying things like, "I now know my way around here... I think I am going to drive next time...I think I could drive this bus better, don't you?"
Luv,
Craig
Transport Nurses RULE the Night.....
Hi All-
We are sitting here in our apartment in Kampala, listening to the Stork birds chatter away, having coffee and juice. Africa is so amazing it's hard to really put it in to words, so we won't try!
We arrived late Sunday after probably the worst international flight I've ever had. Let's just put it this way, the Steward fell in the aisle trying to make it back to his jump seat. Krista, who doesn't like to fly anyway almost broke the armrest with her death grip, Neha stealthily grabbed her barf bag from the back of the seat and I later found out Jen Schuette was silently chanting "planes don't just fall out of the sky...planes just don't fall out of the sky..". I did hear from behind us someone asking me if they wanted me to dart Krista with a tranquilizer gun...it's all funny now...ha ha ha...but what a rollercoaster ride!
But, we made it to Entebbe late Sunday, sweaty, but safe and sound. We loaded up our bus and van and headed to Kampala where we unloaded into our respective guest houses and passed out. All of which you've heard about from our fellow bloggers.
Monday we unpacked everything and set-up the OR (Theatre) and the ICU. A huge Thanks to everyone who has helped us out with supplies, toys, thoughts and prayers. Despite what you may think, your efforts go a long way here, so THANK YOU! Katie, the T-shirts were a hit, although the Ugandans were wondering why we didn't print an Obama logo too!
We did our first case, a PDA, by about 2:30p - 3p and she came out of the OR around 5:30p. We pulled a 24hr shift and worked nights Monday. We were so delirious Tuesday morning we don't even remember being brought home, eating breakfast...or the case of beer we drank (just kidding) . By the time we reached our 34th hour of night shift and we were waiting for Jen Schuette (our o/n attending) to wake, we had completely lost it and were quoting Monty Python and laughing at, pretty much, anything. "Oh your socks are SO DIRTY...ha ha ha" (you get the picture). Meanwhile, Jen gets up from the call room, and enters the ICU to our craziness. The poor thing sat there, also sleep deprived, and not to mention, had just woken up, thinking she just walked into the nursing loony bin (and i'm sure she was regretting leaving us in charge of the ICU o/n). And she, well practiced in the art of exhaustion, wondering why we couldn't be as lucid as she was...(sorry Jen!) But we digress....The PDA was extubated in the OR and did great o/n, she is walking around and looks awesome, probably to the step down tomorrow!
Today we did an ASD and a VSD, so tonight we have 3 in the ICU. The ASD, unfortunately had terrible pericarditis (cultures are still out), and they closed chest and brought him out to the ICU. So, Abx for him, and perhaps surgery at a later date.
3 yo Emmanuel, the VSD was extubated in the unit and flew through the night, we had him dancing in bed, and I'm sure the great (*cough*) day shift nurses will have him OOB and tuned up by the time we get back there in a few hours. Oh, it's ON, day shift vs. night shift.....bring it!!
We don't want to see any Foley's in place. Chest PT for everyone.
Oh, one other thing..attempting to put together the pressure line's for Duane's cases at 3am...not a good idea, and the source of much more innane laughing. Heparin...what? 500U, ( oh we're not in the US we can write our own orders and use "Do not Use abbreviations") in how many mL's?? Even that seemed impossible. We bow to the doctors...Kings and Queen's of exhaustion.
We Are..
The Night Nurses (Lynda & Tammy)
WE ROCK!!!
(I'm not dead yet)
We are sitting here in our apartment in Kampala, listening to the Stork birds chatter away, having coffee and juice. Africa is so amazing it's hard to really put it in to words, so we won't try!
We arrived late Sunday after probably the worst international flight I've ever had. Let's just put it this way, the Steward fell in the aisle trying to make it back to his jump seat. Krista, who doesn't like to fly anyway almost broke the armrest with her death grip, Neha stealthily grabbed her barf bag from the back of the seat and I later found out Jen Schuette was silently chanting "planes don't just fall out of the sky...planes just don't fall out of the sky..". I did hear from behind us someone asking me if they wanted me to dart Krista with a tranquilizer gun...it's all funny now...ha ha ha...but what a rollercoaster ride!
But, we made it to Entebbe late Sunday, sweaty, but safe and sound. We loaded up our bus and van and headed to Kampala where we unloaded into our respective guest houses and passed out. All of which you've heard about from our fellow bloggers.
Monday we unpacked everything and set-up the OR (Theatre) and the ICU. A huge Thanks to everyone who has helped us out with supplies, toys, thoughts and prayers. Despite what you may think, your efforts go a long way here, so THANK YOU! Katie, the T-shirts were a hit, although the Ugandans were wondering why we didn't print an Obama logo too!
We did our first case, a PDA, by about 2:30p - 3p and she came out of the OR around 5:30p. We pulled a 24hr shift and worked nights Monday. We were so delirious Tuesday morning we don't even remember being brought home, eating breakfast...or the case of beer we drank (just kidding) . By the time we reached our 34th hour of night shift and we were waiting for Jen Schuette (our o/n attending) to wake, we had completely lost it and were quoting Monty Python and laughing at, pretty much, anything. "Oh your socks are SO DIRTY...ha ha ha" (you get the picture). Meanwhile, Jen gets up from the call room, and enters the ICU to our craziness. The poor thing sat there, also sleep deprived, and not to mention, had just woken up, thinking she just walked into the nursing loony bin (and i'm sure she was regretting leaving us in charge of the ICU o/n). And she, well practiced in the art of exhaustion, wondering why we couldn't be as lucid as she was...(sorry Jen!) But we digress....The PDA was extubated in the OR and did great o/n, she is walking around and looks awesome, probably to the step down tomorrow!
Today we did an ASD and a VSD, so tonight we have 3 in the ICU. The ASD, unfortunately had terrible pericarditis (cultures are still out), and they closed chest and brought him out to the ICU. So, Abx for him, and perhaps surgery at a later date.
3 yo Emmanuel, the VSD was extubated in the unit and flew through the night, we had him dancing in bed, and I'm sure the great (*cough*) day shift nurses will have him OOB and tuned up by the time we get back there in a few hours. Oh, it's ON, day shift vs. night shift.....bring it!!
We don't want to see any Foley's in place. Chest PT for everyone.
Oh, one other thing..attempting to put together the pressure line's for Duane's cases at 3am...not a good idea, and the source of much more innane laughing. Heparin...what? 500U, ( oh we're not in the US we can write our own orders and use "Do not Use abbreviations") in how many mL's?? Even that seemed impossible. We bow to the doctors...Kings and Queen's of exhaustion.
We Are..
The Night Nurses (Lynda & Tammy)
WE ROCK!!!
(I'm not dead yet)
Tuesday, April 28, 2009
I can't believe I am here again
So this is my second trip to Uganda. I was not all that anxious about coming back... I suppose it was because at least I was coming back to something familiar. How great it was to see friends made on the last trip here. Being just a tad bit obsessive, you can only imagine how day one was for me trying to organize back in the OR. But once we started the first case, all seemed to be better. Today was full, but the kids did well.
It is so exciting to be spending time with my old friend, JoAnn Starr. She is our cardiac surgeon. We were in fellowship together at Seattle Children's ELEVEN years ago. Ugh. Time sure flies.
Pretty tired to this entry is short. Keep us all in your thoughts and prayers. This is no vacation. Challenging, but rewarding.
Duane
It is so exciting to be spending time with my old friend, JoAnn Starr. She is our cardiac surgeon. We were in fellowship together at Seattle Children's ELEVEN years ago. Ugh. Time sure flies.
Pretty tired to this entry is short. Keep us all in your thoughts and prayers. This is no vacation. Challenging, but rewarding.
Duane
We Can Do Better Than That...
Welcome to the first (kind of) official CNMC/Uganda Blog Party. We signed on tonight expecting to be the first posters to the blog since our arrival in Uganda--imagine our horror to see only information about Dobson's questionable literary tastes. Read on for the true story about the start of our journey...
We practically fell out of the sky, I'm not sure if it was a new pilot, turbulence, or engine errors but our plane tried to simply drop 5000 feet in ten seconds. Caught amidst a wind tunnel we faced death and somehow managed to hover and maintain air. Yes, my fears came to a head.... After our 12 hour airplane ride we all feel grateful for making it to Uganda. All jokes aside our adventure has begun. We have flown many, many, miles, composed of an incredible team of RN, MD, RT, perfusionists, PA, and engineers to work together with one vision in mind.
Thank you for all of those who helped in donating and gathering the much needed supplies: PICU, LifeBridge, Sam.... Krista
Ok so the first 24 hours of this journey i have to say we have gotten so much closer. Accentuated by the fact that none of us had a shower for close to 36 hours give or take 12. Needless to say that after a while we fit right in with the general populations feelings on deodorant. As you might already suspect the people are really nice here, not full of attitude like you (reader). We decided to write and check in on you all to let you know that we understand if the Hospital is in real trouble over this past week since le creme de le creme is here in Uganda. You know you miss us, admit it... Rienzi
Okay so my arm has been twisted since I am the only non-CMNC member to post on the blog. As a member of the Florida team our journey has begun before the members had assembled at Dulles. Saturday began with luggage that managed to catapult down Dr. Sable's staircase in his beautiful 2 story home. I was sure that 50+ lbs. would go busting through the door and underwear would hang from the trees like a bad toilet paper wrapping party. Within the first 24 hours a noise maker & hair-dryer went up in smoke (literally). Needless to say the team is very nervous that I am contributing to the blog. Hopefully the rest of the trip will not involve any incidents but I am sure that another 2 cents will be offered by the wonderful CNMC members that have graciously allowed us to be a part of this team. ....Amy
P.S. I also blew up an electrical teapot that I placed on the stove.
Hello CNMC from our blogging party in Uganda. So as Aparna has decided to be too tired to blog I have been nominated for both of us. As you have read the trip has been eventful and an experience. We already started the morning with bird calls that sound like car alarms and cat call and by tonight we had a noise complaint from our neighbor tonight due to our american loudness. I will officially start patient care as of tomorrow night so lets hope all goes well and I don't come across the hospital rat tomorrow night or the screaming Ugandan women in labor.
I did have my first outing today with Amy to the market to make house here. We ended up looking like the locals with our cart full of supplies and like americans with a cart full of beer. To no ones worries I did venture out with SPF 90, DEET, my J-LO glasses and hat (u know I can't get dark, because who will marry me then! ;) )
Wish me luck. -Neha
This will be a brief entry because I can hardly keep my eyes open. I just want to say that in spite of the little glitches..major turbulence in air... lack of fans.. mosquito nets..shoe bite...it's been amazing and I am so glad to be working with people who keep me entertained =) Thanks to the CICU innovation committee we were able to bring much needed medical supplies to Uganda Heart Institute. Although I think we now have enough stethoscopes for every person in Uganda.
I will probably take a zillion photos and since I do not have a Facebook account, make sure your inbox has lots of room.
Aparna ;-)
We will close with just a few pictures, as our wireless connection is so slow that additional photos being added to the blog will hinder our ability to deliver patient care in the morning. Enjoy...
The OR in Uganda, a.k.a., "the theatre".
Sadly, Duane found himself behind bars early on in our journey.
Our CNMC team demonstrates how it's done--and so joyful in their work!
We practically fell out of the sky, I'm not sure if it was a new pilot, turbulence, or engine errors but our plane tried to simply drop 5000 feet in ten seconds. Caught amidst a wind tunnel we faced death and somehow managed to hover and maintain air. Yes, my fears came to a head.... After our 12 hour airplane ride we all feel grateful for making it to Uganda. All jokes aside our adventure has begun. We have flown many, many, miles, composed of an incredible team of RN, MD, RT, perfusionists, PA, and engineers to work together with one vision in mind.
Thank you for all of those who helped in donating and gathering the much needed supplies: PICU, LifeBridge, Sam.... Krista
Ok so the first 24 hours of this journey i have to say we have gotten so much closer. Accentuated by the fact that none of us had a shower for close to 36 hours give or take 12. Needless to say that after a while we fit right in with the general populations feelings on deodorant. As you might already suspect the people are really nice here, not full of attitude like you (reader). We decided to write and check in on you all to let you know that we understand if the Hospital is in real trouble over this past week since le creme de le creme is here in Uganda. You know you miss us, admit it... Rienzi
Okay so my arm has been twisted since I am the only non-CMNC member to post on the blog. As a member of the Florida team our journey has begun before the members had assembled at Dulles. Saturday began with luggage that managed to catapult down Dr. Sable's staircase in his beautiful 2 story home. I was sure that 50+ lbs. would go busting through the door and underwear would hang from the trees like a bad toilet paper wrapping party. Within the first 24 hours a noise maker & hair-dryer went up in smoke (literally). Needless to say the team is very nervous that I am contributing to the blog. Hopefully the rest of the trip will not involve any incidents but I am sure that another 2 cents will be offered by the wonderful CNMC members that have graciously allowed us to be a part of this team. ....Amy
P.S. I also blew up an electrical teapot that I placed on the stove.
Hello CNMC from our blogging party in Uganda. So as Aparna has decided to be too tired to blog I have been nominated for both of us. As you have read the trip has been eventful and an experience. We already started the morning with bird calls that sound like car alarms and cat call and by tonight we had a noise complaint from our neighbor tonight due to our american loudness. I will officially start patient care as of tomorrow night so lets hope all goes well and I don't come across the hospital rat tomorrow night or the screaming Ugandan women in labor.
I did have my first outing today with Amy to the market to make house here. We ended up looking like the locals with our cart full of supplies and like americans with a cart full of beer. To no ones worries I did venture out with SPF 90, DEET, my J-LO glasses and hat (u know I can't get dark, because who will marry me then! ;) )
Wish me luck. -Neha
This will be a brief entry because I can hardly keep my eyes open. I just want to say that in spite of the little glitches..major turbulence in air... lack of fans.. mosquito nets..shoe bite...it's been amazing and I am so glad to be working with people who keep me entertained =) Thanks to the CICU innovation committee we were able to bring much needed medical supplies to Uganda Heart Institute. Although I think we now have enough stethoscopes for every person in Uganda.
I will probably take a zillion photos and since I do not have a Facebook account, make sure your inbox has lots of room.
Aparna ;-)
We will close with just a few pictures, as our wireless connection is so slow that additional photos being added to the blog will hinder our ability to deliver patient care in the morning. Enjoy...
Krista expresses her feelings about the last leg of our flight. (You should have seen her BEFORE the tranquilizer dart.)
Our mascot, the hospital kitty. (Could be tomorrow's dinner.)
Our mascot, the hospital kitty. (Could be tomorrow's dinner.)
The OR in Uganda, a.k.a., "the theatre".
Sadly, Duane found himself behind bars early on in our journey.
Our CNMC team demonstrates how it's done--and so joyful in their work!
Our first patient--a PDA ligation-- peacefully recovers in our four bed CICU. (Photo of overnight RNs force feeding her water respectfully ommitted.)
Echoing, Ugandan style.
All work and no play is a no-no in Uganda.
This was for you, Low-ELL. All is good here, and we're happy and proud to have made the journey--and especially proud to have been a part of the first blog party.
jen
"Do not go gentle into that good night; rage, rage against the dying of the light." -DylanThomas
Lowell - you got your office....not
Craig S. has reassured us - no matter how much he loves Kampala - the more Uyen and I hassle him, the less likely it is that you get an office. So - we will continue to hassle him......a lot until we get you a corner office with a view - and carpet.
Maiden Voyage
Its' Darren, Uyen, Craig S, Stephanie Lacey, Bill Nikotra, Aleida Alvarez, Ozzie Rivera, Duane Stillions welcome you to Kampala Uganda...
Saturday, April 25, 2009
Off we go....
Fittingly on this day, World Malaria Day, we are leaving DC and heading back to Uganda. Last night we picked up the 'Jacksonville Crew' (Stephanie, Cardiologist; Tammy and Amy, ICU Nurses) at Dulles. Today all 15 of us will meet up at check-in with each of our (hopefully) 50Lb. medical supply box, luggage and carry-ons and begin the long flight to Amsterdam, change planes and then head south to Uganda landing at Entebbe Airport around 8pm. Once there we gather all of the above mentioned supplies, luggage and equipment, load up the bus and head to Kampala, our final destination! (Oh, and one thing....WE LOVE KLM!!)
We have been emailing and preparing for this months, so we are very excited to meet up with our Ugandan colleagues Monday, set-up the ICU and OR and begin surgeries.
It is amazing to see all of the hard work Dr. Sable has put into this and watch everything come to fruition. The staff in Uganda are amazing, the doctors and nurses are dedicated and so great to work with, it won't be the last time any of us say that in this blog, I'm sure.
We'll post on Monday once we're settled.
-Lynda
We have been emailing and preparing for this months, so we are very excited to meet up with our Ugandan colleagues Monday, set-up the ICU and OR and begin surgeries.
It is amazing to see all of the hard work Dr. Sable has put into this and watch everything come to fruition. The staff in Uganda are amazing, the doctors and nurses are dedicated and so great to work with, it won't be the last time any of us say that in this blog, I'm sure.
We'll post on Monday once we're settled.
-Lynda
Friday, April 24, 2009
T-Minus 1 Day
Our journey begins tomorrow, and despite the months of preparation, the departure date always seems to creep up on you.
Tomorrow we head to Amsterdam and on to Entebbe arriving Sunday night. Monday is unpack and set-up day and possibly our first case.
Stay tuned...more to come!
Tomorrow we head to Amsterdam and on to Entebbe arriving Sunday night. Monday is unpack and set-up day and possibly our first case.
Stay tuned...more to come!
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