Update on 3/27/13:
Overall I had a pretty good birthday weekend. On Saturday, Delly (one
of the registrars), along with her husband and daughter- Evelyn, came
to pick me up. Our plan had been to go to the craft market but turns
out it isn’t till next weekend. Instead we went to the “mall” which
consists of a few shops and a grocery store primarily catering to
expats living in Port Moresby. The grocery store, Food World, was
actually quite extensive (compared to my time in other countries you
really can buy most anything here… just have to do a bit of looking).
I was able to find an ATM, drink a coffee, and get a SIM card with the
hope of WIFI. Evelyn was very entertaining and I am quite envious of
her energy.
Delly is considered a senior registrar here which is about equivalent
to my level of training. We spent my entire first week on labor ward
together. She is a very skilled physician and delightful person. The
training system in PNG is a bit different than the States- it actually
takes longer!! After secondary school (high school), trainees enter
directly into medical school for 6 years, then they become a resident
for 2 years (this involves rotating on all services, similar to a
general intern year in the US), then on to service years (which from
what I can tell involves 1-2 years working in an undesirable location
as a generalist), and then onto specialty training where one is called
a registrar- OB/GYN here is 6 years. After completion you are called
a consultant (equivalent to an attending physician in the US). I
still haven’t entirely ironed out whether everybody has to do service
years. Most of the registrars are married and the majority of them
start their families during training. Delly said that on average
physicians are in their early to mid thirties when they have completed
their training.
On Saturday night, Skanda and I were invited to dinner at Florence’s
home. Florence is a midwife working for the WHO teaching midwifery at
a local university. She is from Australia. Along with her husband
Filipe (who is French) and son Archer, Florence has lived in several
different places doing humanitarian work. The evening starting with a
riveting game of Go Fish (Archer is 5) and ended with a conversation
about Florence’s work in Darfur. I really enjoy talking with her and
feel as though we are kindred spirits. She and Filipe were actually
in Timor-Leste at the same time as me in 2010… she too got dengue.
Sunday morning (my 29th birthday) Florence and Archer came to pick me
up for a swim at the Aviat Club. Archer surprised me with balloons, a
birthday horn, and a present… I pretty sure it’s because I’m such a
good Go Fish player. At the Aviat, I was able to do some lap swimming
(which felt great as I haven’t exactly been able to go out for a run
here) and play with Archer. We then went back to Florence’s place for
lunch and so I could use the internet (I was able to get Wifi working
at my hostel for a short period of time but it is very spotty… and
slow). For those that were able to get through- I appreciate the
birthday calls, text messages, and emails from home!! Sunday evening
Skanda, Professor Mola, 2 of the registrars, and I went out for a
birthday dinner (and Mom don’t worry I was even able to have birthday
cake). I hope being 29 is as good as being 28… and that it lasts
awhile… 30 doesn’t seem possible.
I decided to spend my second week in the operating theatre… which to
this point I am happy to say has been an excellent idea. There is one
registrar assigned to the operating theatre (which is Frank currently)
and a different attending physician each day. There is supposed to be
a resident as well… but they haven’t seemed to show up… lucky me .
The operating theatre handles all of the obstetric and gynecology
cases. There are 2 operating rooms, each with a dedicated anesthesia
and nursing staff (however… they don’t show up till 10 AM sometimes).
Anyways, overall the facilities are basic but serve their purpose. I
have never seen supplies conserved to this extreme- who knew 1 piece
of suture could be used to do an entire tubal ligation from start to
finish.
Each day’s case list is quite long… Frank and I start at the top and
just power through. The consultants are present- sometimes scrubbing
in to help and sometimes not. The most common procedure done is tubal
ligation… I think we are single handedly sterilizing PNG. No, in all
seriousness, there is a huge push for family planning here given the
poverty, lack of education, and overcrowding. Most days there are
6-10 tubal ligations completed under local anesthesia with a bit of
sedation. The remainder of the case list so far this week has
consisted of several dilation and curettage, several exams under
anesthesia (primary for advanced stage cervical cancer), a few
cesarean sections, several exploratory laps for ovarian cysts (think
the size of a watermelon), and a few hysterectomies. (and it is only
Wednesday!) The registrars have great autonomy here and are very
competent. The general principals in the OR are similar to home… with
a few modifications (the most drastic- there are no emergent, or even
urgent, cesarean sections- but with no fetal monitoring I’m not sure
what I was expecting). Today a cesarean section which was being done
for “fetal distress” was postponed till after a hysterectomy (I was a
bit anxious to say the least… but in the end the baby was ok…
luckily).
Regardless, I am looking forward to the rest of my week. Oh and
Maureen arrives not tomorrow but the next day (Friday March 29th)… I
had the hostel attendants make up her bed and bring in extra towels
Yah to not living alone anymore.
Wednesday, March 27, 2013
Friday, March 22, 2013
Week 1- 3/23/13
Sorry for the delay in posting… the internet situation around here is a bit ridiculous… no internet at my hostel (not surprised) and no internet at the hospital (surprised). Can you imagine no internet at OSUMC?? Anyways, I have arrived safely in Port Moresby, PNG and have completed my first week at the hospital… which has been interesting to say the least. I will try and hit on the high points.
I left LAX Tuesday, March 12th after a very informative 4 day conference on gynecologic cancer. I flew overnight on Virgin Australia to Sydney and then on to Cairns. I’m happy to say my 15hr trip from LAX to SYD involved having an entire row of seats on which I stretched out and slept soundly for 10 hours (may have been a bit behind). When I arrived in Cairns I was greeted by a dear friend, Dan Foster, who I worked with in Dili, Timor-Leste in 2010. Dan is currently a resident in Australia and lives with his girlfriend Lani in Cairns. I stayed with them for an evening and had some time to catch up/reminisce about our time in Timor-Leste. Dan took me to the airport Friday, March 15th for my flight to Port Moresby. Much like my flight to Timor 3 years ago, after just 1.5 hours in the air I went from the western world to a developing nation.
It took a bit to obtain a visa and get through customs at Port Moresby Airport… and then there was no one there (I was expecting Professor Glen Mola to pick me up). Having read heaps of things about how public transportation is not the safest for expats in PNG I surely wasn’t about the hail a cab or take a bus. I sauntered over to the Digicel stand and while purchasing a SIM card for my cell phone (not that I had any numbers to call once my phone was working) was approached by a man in a hotel uniform. Clearly he could tell I was a bit out of place. I told him I was just waiting from Prof Mola to pick me up. Now Port Moresby is a city of about 300,000 people so I did not expect this man to know who I was speaking of. However, he quickly explained the Prof Mola had done surgery on his mother, how he was a great doctor, and he would just give him a call. Shortly after Prof Mola and Skanda (an Australian OB/GYN who is working at Port Moresby General Hospital, PMGH, for about 6 months) arrived to pick me up. Sigh of relief.
From the airport we drove down pot hole ridden streets to my accommodations. I am staying in a hostel across the street from the hospital called the CWA. I have a private room with two single beds (one for Maureen when she arrives), a private bathroom, and shared kitchen facilities. When I arrived there were two ladies from Australia in one room, a Timorese doctor in another, a PNG doctor in another, and a biologist from Finland in another. The room is clean and very comfortable aside from the lack of AC. Just a bit hot/humid for this Midwest girl… but I am able to sleep at night with the ceiling fan on.
I dropped my bags and proceeded to PMGH for a tour of the OB/GYN department with Skanda. The department is set to the back of the hospital facilities. Overall, I would say the facilities are adequate and serve their purpose… nothing fancy. There are 4 wards- Ward 9 is the gynecology ward, Ward 10 is the antenatal ward, Ward 11 is the postnatal ward, and of course the labor ward. The operating theater and special care nursery are attached to labor ward. Each ward is open (Florence Nightingale style- no private rooms) with curtains between beds.
The remainder of my first weekend involved dinner with a group of expats (primarily nurse midwives from Malawi, Australia, and several European countries all working for the WHO teaching local midwives), some grocery shopping, visiting a local fruit/veg market, a swim at the Aviat Club (think country club pool with no golf course- Aafke, an OB/GYN from Finland who has worked at PMGH for 6 years and her husband took me), and trying to adjust to the time change.
I decided to spend my first week on labor ward (with plans to do GYN/OR and outpatient work the next two weeks). Every day begins with morning report (generally involves some sort of didactics for the residents, registrars, and medical students) and then ward round. Labor ward at PMGH has 24 beds, a small waiting room, and a triage room with 2 beds (although I have not really seen this triage room used- mostly mothers just labor on a bench until a bed becomes available). PMGH does about 12,500 deliveries a year… that breaks down to about 35 deliveries a day. It is an extremely busy unit staffed by residents/registrars and midwives with one attending (called a consultant here) overseeing.
Women labor without epidurals and without fetal monitoring. Some have IV access some don’t. There is one external fetal monitoring machine for the entire unit which is wheeled from bed to bed when there is concern for fetal distress (I won’t get into the nitty gritty details of L&D as this blog is for a diverse audience… but for those interested we can talk more later). Week one involved several cases of pre eclampsia, 2 cases of eclampsia, 3 vacuum deliveries, 3 twin deliveries (2 of which were undiagnosed and came from the antenatal unit- ultrasounds are not done routinely), 2 breech deliveries, only 1 cesarean section, and a few post partum hemorrhages. Antenatal care is spotty at best and doesn’t include things like accurate dating, determination of blood type, or determination of GBS status… just to name a few things. Doctors, nurses, and midwives all do each others’ jobs- everyone delivers babies, everyone starts IVs/draws blood, and everyone administers medications. To give some idea here are a couple stats for the month of December- there were 1066 deliveries, 11 of which were breech, 70 of which were vacuum assisted (really no forceps), and only 42 cesarean sections (rate of 3.8%). So yah… all in all it is an interesting place.
The staff at the hospital are lovely people and very helpful. Overall, everyone I have met is very kind and anxious to go out of their way to make me feel welcome. In the evenings I have been reading, writing, and wishing I had internet. I do have a cell phone (# 70596397) so feel free to call or text… it is a bit lonely- given concern for petty crime it sort of feels like I am on house arrest. I go from my hostel to the hospital (generally accompanied by someone) and back again. I look forward to Maureen’s company in less than 1 week.
I spent my Friday night having dinner with Aafke and her husband at their home. As I mentioned before Aafke is an OB/GYN who has been living in PNG and working at PMGH for about 6 years. Her husband (I can’t spell his name) is a professor of political science and works at the university. They are originally from Finland but have worked all over the world… primarily spending 20 some years in Africa. Aafke completed her training in England but has not worked in the western world at any point in her career. Needless to say they have great stories. Her husband is the first person I have met since leaving that knows exactly where Iowa and Ohio are (due to holding the first primary and being a swing state, respectively). It is always interesting to hear what others think of the States... Regardless we had a very nice meal and I appreciate their company.
As for the rest of my weekend… I plan to go to the craft market with Delly (one of the residents I worked with in labor ward) and hopefully buy a SIM card to set up WIFI at my hostel. A group of us may go to the fruit/veg market on Sunday morning to buy groceries for the week. Oh and I will turn 29 tomorrow… bummer. All for now.
I left LAX Tuesday, March 12th after a very informative 4 day conference on gynecologic cancer. I flew overnight on Virgin Australia to Sydney and then on to Cairns. I’m happy to say my 15hr trip from LAX to SYD involved having an entire row of seats on which I stretched out and slept soundly for 10 hours (may have been a bit behind). When I arrived in Cairns I was greeted by a dear friend, Dan Foster, who I worked with in Dili, Timor-Leste in 2010. Dan is currently a resident in Australia and lives with his girlfriend Lani in Cairns. I stayed with them for an evening and had some time to catch up/reminisce about our time in Timor-Leste. Dan took me to the airport Friday, March 15th for my flight to Port Moresby. Much like my flight to Timor 3 years ago, after just 1.5 hours in the air I went from the western world to a developing nation.
It took a bit to obtain a visa and get through customs at Port Moresby Airport… and then there was no one there (I was expecting Professor Glen Mola to pick me up). Having read heaps of things about how public transportation is not the safest for expats in PNG I surely wasn’t about the hail a cab or take a bus. I sauntered over to the Digicel stand and while purchasing a SIM card for my cell phone (not that I had any numbers to call once my phone was working) was approached by a man in a hotel uniform. Clearly he could tell I was a bit out of place. I told him I was just waiting from Prof Mola to pick me up. Now Port Moresby is a city of about 300,000 people so I did not expect this man to know who I was speaking of. However, he quickly explained the Prof Mola had done surgery on his mother, how he was a great doctor, and he would just give him a call. Shortly after Prof Mola and Skanda (an Australian OB/GYN who is working at Port Moresby General Hospital, PMGH, for about 6 months) arrived to pick me up. Sigh of relief.
From the airport we drove down pot hole ridden streets to my accommodations. I am staying in a hostel across the street from the hospital called the CWA. I have a private room with two single beds (one for Maureen when she arrives), a private bathroom, and shared kitchen facilities. When I arrived there were two ladies from Australia in one room, a Timorese doctor in another, a PNG doctor in another, and a biologist from Finland in another. The room is clean and very comfortable aside from the lack of AC. Just a bit hot/humid for this Midwest girl… but I am able to sleep at night with the ceiling fan on.
I dropped my bags and proceeded to PMGH for a tour of the OB/GYN department with Skanda. The department is set to the back of the hospital facilities. Overall, I would say the facilities are adequate and serve their purpose… nothing fancy. There are 4 wards- Ward 9 is the gynecology ward, Ward 10 is the antenatal ward, Ward 11 is the postnatal ward, and of course the labor ward. The operating theater and special care nursery are attached to labor ward. Each ward is open (Florence Nightingale style- no private rooms) with curtains between beds.
The remainder of my first weekend involved dinner with a group of expats (primarily nurse midwives from Malawi, Australia, and several European countries all working for the WHO teaching local midwives), some grocery shopping, visiting a local fruit/veg market, a swim at the Aviat Club (think country club pool with no golf course- Aafke, an OB/GYN from Finland who has worked at PMGH for 6 years and her husband took me), and trying to adjust to the time change.
I decided to spend my first week on labor ward (with plans to do GYN/OR and outpatient work the next two weeks). Every day begins with morning report (generally involves some sort of didactics for the residents, registrars, and medical students) and then ward round. Labor ward at PMGH has 24 beds, a small waiting room, and a triage room with 2 beds (although I have not really seen this triage room used- mostly mothers just labor on a bench until a bed becomes available). PMGH does about 12,500 deliveries a year… that breaks down to about 35 deliveries a day. It is an extremely busy unit staffed by residents/registrars and midwives with one attending (called a consultant here) overseeing.
Women labor without epidurals and without fetal monitoring. Some have IV access some don’t. There is one external fetal monitoring machine for the entire unit which is wheeled from bed to bed when there is concern for fetal distress (I won’t get into the nitty gritty details of L&D as this blog is for a diverse audience… but for those interested we can talk more later). Week one involved several cases of pre eclampsia, 2 cases of eclampsia, 3 vacuum deliveries, 3 twin deliveries (2 of which were undiagnosed and came from the antenatal unit- ultrasounds are not done routinely), 2 breech deliveries, only 1 cesarean section, and a few post partum hemorrhages. Antenatal care is spotty at best and doesn’t include things like accurate dating, determination of blood type, or determination of GBS status… just to name a few things. Doctors, nurses, and midwives all do each others’ jobs- everyone delivers babies, everyone starts IVs/draws blood, and everyone administers medications. To give some idea here are a couple stats for the month of December- there were 1066 deliveries, 11 of which were breech, 70 of which were vacuum assisted (really no forceps), and only 42 cesarean sections (rate of 3.8%). So yah… all in all it is an interesting place.
The staff at the hospital are lovely people and very helpful. Overall, everyone I have met is very kind and anxious to go out of their way to make me feel welcome. In the evenings I have been reading, writing, and wishing I had internet. I do have a cell phone (# 70596397) so feel free to call or text… it is a bit lonely- given concern for petty crime it sort of feels like I am on house arrest. I go from my hostel to the hospital (generally accompanied by someone) and back again. I look forward to Maureen’s company in less than 1 week.
I spent my Friday night having dinner with Aafke and her husband at their home. As I mentioned before Aafke is an OB/GYN who has been living in PNG and working at PMGH for about 6 years. Her husband (I can’t spell his name) is a professor of political science and works at the university. They are originally from Finland but have worked all over the world… primarily spending 20 some years in Africa. Aafke completed her training in England but has not worked in the western world at any point in her career. Needless to say they have great stories. Her husband is the first person I have met since leaving that knows exactly where Iowa and Ohio are (due to holding the first primary and being a swing state, respectively). It is always interesting to hear what others think of the States... Regardless we had a very nice meal and I appreciate their company.
As for the rest of my weekend… I plan to go to the craft market with Delly (one of the residents I worked with in labor ward) and hopefully buy a SIM card to set up WIFI at my hostel. A group of us may go to the fruit/veg market on Sunday morning to buy groceries for the week. Oh and I will turn 29 tomorrow… bummer. All for now.
Tuesday, May 4, 2010
Finishing Up…
5/3/2010-
I have only two days left at Hvidovre University Hospital here in Copenhagen. The four weeks went by fast… it was a great review of some basic OB/GYN (which will be helpful starting residency in the near future), the staff/students have been very helpful and friendly, and most of all the work hours have been more than reasonable. I am trying to savor every moment of free time here (there are plenty of them) with the knowledge that my life is about to change drastically to 80 hour work weeks and only 2 weeks of vacation all year. Scary! I have read a couple of books, been running and biking, and spending time with Rebecca around Copenhagen.
Two weekends ago Rebecca and I did some shopping, wandered through the palace/royal church, enjoyed ice cream, saw Alice In Wonderland in 3D (AWESOME), and went to a ballet titled Shakespeare in Motion. Rebecca flew straight from Africa (where she was completing another medical elective) to Copenhagen… needless to say her bags did not follow her here. Then the volcano erupted… so about 2 weeks later Rebecca finally got her luggage. However… there is a silver lining. She had travel insurance which will cover $500 worth of expenses per 24 hours you are without your luggage up to $1500. This translated into shopping spree to both Rebecca and I. I helped her pick out some cute clothes from the shops downtown!! (I refrained however seeing as the exchange rate is no good… I did not lose my luggage… and everything is expensive anyway) The movie and ballet were both entertaining. Rebecca and I had to do a bit of research after the ballet was over as we were totally lost as to which Shakespearian story involves a dancing bear… I was made very aware of my lack of cultural exposure (it is a stage direction in A Winter’s Tale). Oh well… we still had a wonderful time.
This past weekend we had big plans of a picnic/afternoon of reading in the park and a day at Tivoli (amusement park in Copenhagen). But… plans change. It rained almost all weekend. Instead of a picnic Rebecca and I went to our local bakery and each got 3 pastries for 25 kroner (about $5). What a deal. So we ate pastries for lunch and watched My Girl on TV while it poured down rain. Friday night we met up with some friends for drinks downtown… a very nice evening. On our Tivoli day we ended up going to a park where all of the political parties of Denmark gathered for a 1st of May celebration… basically looked like any city fair (tents, music, food/drink). Since we didn’t understand any of the political speeches (they were in Danish) and it was raining we didn’t stay too long…. well we stayed long enough to partake in lunch. Crepes with ice cream anyone??? Sunday… it was finally SUNNY! Rebecca and I went down to the waterfront near our apartments and spent the day reading in the grass. The wind was a bit chilly but the sun warmed us. There were a few crazy Danes swimming… it is not warm enough to go swimming here.
For my last week in Copenhagen I have big plans. I have finished up the requirements to get credit for this elective… so I am technically done with medical school!! How exciting is that? Thought the day would never come. So now for celebration... on Wednesday a group of us are going to a soccer game… if I understand correctly it is the club championship for Demark. One of the teams is from Copenhagen and the other from just outside the city. It should be a fun evening. On Thursday I have to return my bike (sad) and then Rebecca and I are going to attempt an afternoon at Tivoli. Fingers crossed for good weather. Friday Matt is coming to Copenhagen!!! He is in Europe for work right now and is coming to visit me for my last weekend here. Andres, Anne, Matt, and I will travel to Aarhus on Friday to see Matt’s former foreign exchange student (and Andres’ sister) Mette defend her PhD thesis. It will be a great chance for Matt to see Mette again and for me to meet her/the rest of the Larsen family. We plan on returning to Copenhagen on Friday evening. Matt and I will be going to a play in Copenhagen on Saturday night and then meeting with one of the actors for a beer afterwards (Matt’s Aunt Laura is an actress and while studying in Denmark in the past met an actor here… we will be seeing his play and meeting up with him afterwards). Sunday… hopefully Matt and I can have a quiet day together before the craziness of graduation/moving/residency starts. Monday morning Matt will head to Italy for work and I will head home. Graduation is Friday.
I have had a great time here in Copenhagen but am ready to be home with family and friends for a bit before the next step. Given the restrictiveness of residency I will likely not be traveling/blogging for a bit… so for those how have been reading thanks and I hope you have enjoyed it. Until the next adventure.
I have only two days left at Hvidovre University Hospital here in Copenhagen. The four weeks went by fast… it was a great review of some basic OB/GYN (which will be helpful starting residency in the near future), the staff/students have been very helpful and friendly, and most of all the work hours have been more than reasonable. I am trying to savor every moment of free time here (there are plenty of them) with the knowledge that my life is about to change drastically to 80 hour work weeks and only 2 weeks of vacation all year. Scary! I have read a couple of books, been running and biking, and spending time with Rebecca around Copenhagen.
Two weekends ago Rebecca and I did some shopping, wandered through the palace/royal church, enjoyed ice cream, saw Alice In Wonderland in 3D (AWESOME), and went to a ballet titled Shakespeare in Motion. Rebecca flew straight from Africa (where she was completing another medical elective) to Copenhagen… needless to say her bags did not follow her here. Then the volcano erupted… so about 2 weeks later Rebecca finally got her luggage. However… there is a silver lining. She had travel insurance which will cover $500 worth of expenses per 24 hours you are without your luggage up to $1500. This translated into shopping spree to both Rebecca and I. I helped her pick out some cute clothes from the shops downtown!! (I refrained however seeing as the exchange rate is no good… I did not lose my luggage… and everything is expensive anyway) The movie and ballet were both entertaining. Rebecca and I had to do a bit of research after the ballet was over as we were totally lost as to which Shakespearian story involves a dancing bear… I was made very aware of my lack of cultural exposure (it is a stage direction in A Winter’s Tale). Oh well… we still had a wonderful time.
This past weekend we had big plans of a picnic/afternoon of reading in the park and a day at Tivoli (amusement park in Copenhagen). But… plans change. It rained almost all weekend. Instead of a picnic Rebecca and I went to our local bakery and each got 3 pastries for 25 kroner (about $5). What a deal. So we ate pastries for lunch and watched My Girl on TV while it poured down rain. Friday night we met up with some friends for drinks downtown… a very nice evening. On our Tivoli day we ended up going to a park where all of the political parties of Denmark gathered for a 1st of May celebration… basically looked like any city fair (tents, music, food/drink). Since we didn’t understand any of the political speeches (they were in Danish) and it was raining we didn’t stay too long…. well we stayed long enough to partake in lunch. Crepes with ice cream anyone??? Sunday… it was finally SUNNY! Rebecca and I went down to the waterfront near our apartments and spent the day reading in the grass. The wind was a bit chilly but the sun warmed us. There were a few crazy Danes swimming… it is not warm enough to go swimming here.
For my last week in Copenhagen I have big plans. I have finished up the requirements to get credit for this elective… so I am technically done with medical school!! How exciting is that? Thought the day would never come. So now for celebration... on Wednesday a group of us are going to a soccer game… if I understand correctly it is the club championship for Demark. One of the teams is from Copenhagen and the other from just outside the city. It should be a fun evening. On Thursday I have to return my bike (sad) and then Rebecca and I are going to attempt an afternoon at Tivoli. Fingers crossed for good weather. Friday Matt is coming to Copenhagen!!! He is in Europe for work right now and is coming to visit me for my last weekend here. Andres, Anne, Matt, and I will travel to Aarhus on Friday to see Matt’s former foreign exchange student (and Andres’ sister) Mette defend her PhD thesis. It will be a great chance for Matt to see Mette again and for me to meet her/the rest of the Larsen family. We plan on returning to Copenhagen on Friday evening. Matt and I will be going to a play in Copenhagen on Saturday night and then meeting with one of the actors for a beer afterwards (Matt’s Aunt Laura is an actress and while studying in Denmark in the past met an actor here… we will be seeing his play and meeting up with him afterwards). Sunday… hopefully Matt and I can have a quiet day together before the craziness of graduation/moving/residency starts. Monday morning Matt will head to Italy for work and I will head home. Graduation is Friday.
I have had a great time here in Copenhagen but am ready to be home with family and friends for a bit before the next step. Given the restrictiveness of residency I will likely not be traveling/blogging for a bit… so for those how have been reading thanks and I hope you have enjoyed it. Until the next adventure.
Friday, April 23, 2010
Two weeks almost over already...
4/23/2010-
So… I have now been in Copenhagen for almost 2 weeks (1/2 of my time) and I haven’t blogged since I arrived… where has the time gone? Okay, here is an abbreviated update. I started at Hvidorve Hospital in the Ob/Gyn department and so far my time there has been great. I am on a rotation with about 12 Danish students and one other foreigner, Rebecca, from New Zealand (my new best friend). The hospital is a relatively large teaching facility associated with the University of Copenhagen. The level of care available is very similar to the US- which has been nice after spending time in an area with limited resources. It feels good to be able to offer patients optimal services. So far I have been rotating through the gynecology department (I will do obstetrics at the end of my time here). I have spent days on the inpatient ward, the operating theatre, the same day procedure room, and the outpatient clinic. Our mornings start at 8 AM with general rounds and then we go with our assigned physician for the day. Things tend to wrap up around 3 PM…. that’s right… the day last from 8 AM till 3 PM (Danes have a great appreciation for quality of life which means work hours are extremely reasonable). I have been biking to and from the hospital with Rebecca (who is basically my neighbor… so convenient) and it has been great. The trip is about 12 km one way and is a nice start and finish to the day- especially when you have time (minus getting stuck in the rain the other day). I have also been running by the water almost daily… the trails through the city are extremely well kept.
With spending comparatively few hours at the hospital, Rebecca and I have had ample time to explore the city. Copenhagen is beautiful, clean, organized, and just all around pleasant. Only drawback… it has been a bit chilly and windy here (a result of being so close to the ocean). So what have we done in the city to far….
Last Friday was the Queen of Denmark’s 70th Birthday. It was a great celebration. Rebecca and I were wondering downtown and before we knew it people were handing out Danish flags and lining up for a parade. Shortly after a small band, lots of uniformed Danes riding horses, and the Queen waving in a carriage passed by. We followed the parade and group of people to the City Square where she went to the balcony of City Hall to wave at her adoring people. After her appearance there was cake… that’s right… in the middle of City Square there were several large tables set up covered with free birthday cake for the people who had gathered. It was delicious! Rebecca and I spent the remainder of the day strolling around the city.
On Saturday… Rebecca and I took a canal tour which was a great way to get the lay of the land. We found a pizza buffet near the Central Station and enjoyed pizza and a beer for dinner. Rebecca is also a final year medical student interested in Ob/Gyn. She recently spent 6 weeks in Africa on placement at an HIV/AIDS clinic. We have many similarities and I am so thankful she is here. It is always more fun exploring with a friend. After dinner we met with Tobias, my mentor, and some of his friends for a few beers. The evening was very nice… except my phone was stolen out of my coat pocket at one of the pubs… bummer. So I now have a new number (Andres and Anne had an extra phone I will be using… just had to get another SIM card) +45 71 14 57 18.
Sunday, Andres and Anne picked me up at 10:00 AM and we drove north of Copenhagen to a castle (Kronborg), the oldest amusement park in Denmark (Andres and I took a trip on the wooden rollercoaster), and to the royal forest/hunting ground. It was a truly great day and I so appreciate their hospitality. Upon returning to Copenhagen we went over to Andres’ brother Soren’s house for dinner. Soren and his wife Anya have two beautiful children, Camilla and Mickel. Dinner was a delicious traditional Danish meal complete with crepes and ice cream for dessert. YUM!! Andres’ sister, Mette, was an exchange student of Matt’s family when he was in high school. Their mother, Bodil, was an exchange student of Matt’s mom when she was in high school. Mette is a physician in Denmark and will be defending her PhD thesis on my last Friday here. I hope to travel with Andres and Anne to see the defense and finally meet Mette (and the rest of the Larsen family).
Week two at the hospital was as enjoyable as the first. Rebecca and I went in on Wednesday when all of the other students had classes in Danish. Being the only students there… the head of the department was so pleased to see us at morning rounds he did part of them in English in our honor (it was so nice to be able to understand). I also got to be first assist in 3 urogyn. surgeries which was great. That evening we went to a movie at the Cinema with Tobias and his friend Frederick. In Denmark all films are shown in the original language with subtitles… so Rebecca and I could understand!!! Yeah. The theatre is in the newer part of Copenhagen… basically a large shopping center and apartments very similar to what you would see in the US.
This weekend Rebecca and I have more big plans of exploring the city… maybe some shopping, touring a few museums, wandering around the palace/royal cathedral, and possibly seeing a ballet. We have a list of things we would like to do before our time in Copenhagen is over…. So we just keep moving.
Side note- an obligatory part of exploring any new city/country is partaking in the local cuisine. In case there was any concern… Rebecca and I are doing a wonderful job of this… pastries, lattes and cake, ice cream, sea food, fresh salads w/ amazing bread. It is all sooo delicious. I am trying to exercise some self control. That is all for now. Hope all is well on the other side of the pond.
So… I have now been in Copenhagen for almost 2 weeks (1/2 of my time) and I haven’t blogged since I arrived… where has the time gone? Okay, here is an abbreviated update. I started at Hvidorve Hospital in the Ob/Gyn department and so far my time there has been great. I am on a rotation with about 12 Danish students and one other foreigner, Rebecca, from New Zealand (my new best friend). The hospital is a relatively large teaching facility associated with the University of Copenhagen. The level of care available is very similar to the US- which has been nice after spending time in an area with limited resources. It feels good to be able to offer patients optimal services. So far I have been rotating through the gynecology department (I will do obstetrics at the end of my time here). I have spent days on the inpatient ward, the operating theatre, the same day procedure room, and the outpatient clinic. Our mornings start at 8 AM with general rounds and then we go with our assigned physician for the day. Things tend to wrap up around 3 PM…. that’s right… the day last from 8 AM till 3 PM (Danes have a great appreciation for quality of life which means work hours are extremely reasonable). I have been biking to and from the hospital with Rebecca (who is basically my neighbor… so convenient) and it has been great. The trip is about 12 km one way and is a nice start and finish to the day- especially when you have time (minus getting stuck in the rain the other day). I have also been running by the water almost daily… the trails through the city are extremely well kept.
With spending comparatively few hours at the hospital, Rebecca and I have had ample time to explore the city. Copenhagen is beautiful, clean, organized, and just all around pleasant. Only drawback… it has been a bit chilly and windy here (a result of being so close to the ocean). So what have we done in the city to far….
Last Friday was the Queen of Denmark’s 70th Birthday. It was a great celebration. Rebecca and I were wondering downtown and before we knew it people were handing out Danish flags and lining up for a parade. Shortly after a small band, lots of uniformed Danes riding horses, and the Queen waving in a carriage passed by. We followed the parade and group of people to the City Square where she went to the balcony of City Hall to wave at her adoring people. After her appearance there was cake… that’s right… in the middle of City Square there were several large tables set up covered with free birthday cake for the people who had gathered. It was delicious! Rebecca and I spent the remainder of the day strolling around the city.
On Saturday… Rebecca and I took a canal tour which was a great way to get the lay of the land. We found a pizza buffet near the Central Station and enjoyed pizza and a beer for dinner. Rebecca is also a final year medical student interested in Ob/Gyn. She recently spent 6 weeks in Africa on placement at an HIV/AIDS clinic. We have many similarities and I am so thankful she is here. It is always more fun exploring with a friend. After dinner we met with Tobias, my mentor, and some of his friends for a few beers. The evening was very nice… except my phone was stolen out of my coat pocket at one of the pubs… bummer. So I now have a new number (Andres and Anne had an extra phone I will be using… just had to get another SIM card) +45 71 14 57 18.
Sunday, Andres and Anne picked me up at 10:00 AM and we drove north of Copenhagen to a castle (Kronborg), the oldest amusement park in Denmark (Andres and I took a trip on the wooden rollercoaster), and to the royal forest/hunting ground. It was a truly great day and I so appreciate their hospitality. Upon returning to Copenhagen we went over to Andres’ brother Soren’s house for dinner. Soren and his wife Anya have two beautiful children, Camilla and Mickel. Dinner was a delicious traditional Danish meal complete with crepes and ice cream for dessert. YUM!! Andres’ sister, Mette, was an exchange student of Matt’s family when he was in high school. Their mother, Bodil, was an exchange student of Matt’s mom when she was in high school. Mette is a physician in Denmark and will be defending her PhD thesis on my last Friday here. I hope to travel with Andres and Anne to see the defense and finally meet Mette (and the rest of the Larsen family).
Week two at the hospital was as enjoyable as the first. Rebecca and I went in on Wednesday when all of the other students had classes in Danish. Being the only students there… the head of the department was so pleased to see us at morning rounds he did part of them in English in our honor (it was so nice to be able to understand). I also got to be first assist in 3 urogyn. surgeries which was great. That evening we went to a movie at the Cinema with Tobias and his friend Frederick. In Denmark all films are shown in the original language with subtitles… so Rebecca and I could understand!!! Yeah. The theatre is in the newer part of Copenhagen… basically a large shopping center and apartments very similar to what you would see in the US.
This weekend Rebecca and I have more big plans of exploring the city… maybe some shopping, touring a few museums, wandering around the palace/royal cathedral, and possibly seeing a ballet. We have a list of things we would like to do before our time in Copenhagen is over…. So we just keep moving.
Side note- an obligatory part of exploring any new city/country is partaking in the local cuisine. In case there was any concern… Rebecca and I are doing a wonderful job of this… pastries, lattes and cake, ice cream, sea food, fresh salads w/ amazing bread. It is all sooo delicious. I am trying to exercise some self control. That is all for now. Hope all is well on the other side of the pond.
Tuesday, April 13, 2010
Welcome to Copenhagen...
4/13/10-
Just a short note to let you know I have arrived safely in Copenhagen and am settling in well. I landed on Sunday around noon and was met at the airport by my mentor, Tobias. He is a final year medical student at the University of Copenhagen. We will both be spending the next month at Hvidovre Hospital in the OB/GYN department. Tobias spent some time at the University of Iowa last summer/fall working in cardiology. He was kind enough to meet me at the airport and help me navigate public transportation to the apartment I will be renting for the next month. I am staying in a two bedroom unit in Amagar, which is just south of the city. The accommodations are very nice… complete with kitchen, bathroom, internet, and cable. What more could a girl want? I will be here alone till the beginning of May when an Italian engineering student will move into the other bedroom.
After dropping my bags off Tobias and I had lunch and saw a bit of the city. I returned to my apartment, went for a run, and tried to stay awake as long as possible… attempting to adjust to the new time zone. I made it till 9 PM… and awoke at 8 AM Monday morning feeling refreshed. I explored my neighborhood, found the local Aldi grocery store, and then jumped on the metro to the city. I activated my cell phone… so feel free to call +45 50 17 58 66. Tobias and I again met for lunch. And… I got a bicycle!!! Everyone gets around Copenhagen on bicycles… so now I fit in. Tobias looked a bit concerned about my cycling abilities (I don’t have a bike in IC so it has been several years since I have ridden). I said “No worries Tobias…” and rode to the grocery store and then home. This morning (Tuesday) I went for a run along the water and will be heading into the city shortly. I am meeting up with Andres and Anne (friends of Matt and I’s who live in Denmark- we stayed with them in Jamaica three years ago over a spring break) this evening for dinner. My placement at the hospital begins on Wednesday which should be interesting. All I know so far is we work from 8 AM-3 PM Monday-Friday… pretty nice!
Just a short note to let you know I have arrived safely in Copenhagen and am settling in well. I landed on Sunday around noon and was met at the airport by my mentor, Tobias. He is a final year medical student at the University of Copenhagen. We will both be spending the next month at Hvidovre Hospital in the OB/GYN department. Tobias spent some time at the University of Iowa last summer/fall working in cardiology. He was kind enough to meet me at the airport and help me navigate public transportation to the apartment I will be renting for the next month. I am staying in a two bedroom unit in Amagar, which is just south of the city. The accommodations are very nice… complete with kitchen, bathroom, internet, and cable. What more could a girl want? I will be here alone till the beginning of May when an Italian engineering student will move into the other bedroom.
After dropping my bags off Tobias and I had lunch and saw a bit of the city. I returned to my apartment, went for a run, and tried to stay awake as long as possible… attempting to adjust to the new time zone. I made it till 9 PM… and awoke at 8 AM Monday morning feeling refreshed. I explored my neighborhood, found the local Aldi grocery store, and then jumped on the metro to the city. I activated my cell phone… so feel free to call +45 50 17 58 66. Tobias and I again met for lunch. And… I got a bicycle!!! Everyone gets around Copenhagen on bicycles… so now I fit in. Tobias looked a bit concerned about my cycling abilities (I don’t have a bike in IC so it has been several years since I have ridden). I said “No worries Tobias…” and rode to the grocery store and then home. This morning (Tuesday) I went for a run along the water and will be heading into the city shortly. I am meeting up with Andres and Anne (friends of Matt and I’s who live in Denmark- we stayed with them in Jamaica three years ago over a spring break) this evening for dinner. My placement at the hospital begins on Wednesday which should be interesting. All I know so far is we work from 8 AM-3 PM Monday-Friday… pretty nice!
Tuesday, March 9, 2010
3/8/2010
Last entry for this trip…
The week of 2/22-2/26 was filled with mobile clinics. Eva and I were able to go to a number of them together which was great. We loaded up in the 4 wheel drive after rounds and got out of Dili for the day. The majority of complaints at mobile clinic are things like headache, backache from working in the fields, cough/runny nose, diarrhea/vomiting, a few fevers, and skin infections. As far as treatment that can be offered to the patients at mobile clinic, we tend to give out Tylenol, ibuprofen, multivitamins, vitamin C, occasionally antibiotics, and albendazole (for all of the little kids with intestinal worms). We are also able to do rapid malaria tests and take sputum sample to evaluate for tuberculosis. While only the antibiotics and the albendazole are actual therapeutic treatments by western standards the majority of these patients are satisfied by the placebo effect provided by the vitamins and the like. It is important that these patients not leave the consult empty handed and feeling as though the visit wasn’t worth their time (this could deter them from seeking care on other occasions when they may be affected by more serious illness). Patients are always encouraged to return if they do not feel better and given that all services are free the system seems to function rather well. Recently a midwife was added to the mobile clinic staff which is great as the majority of women in more remote locations receive no pre or post natal care.
The week passed by quickly and on Friday the 26th we all got together to celebrate Dan’s 31st birthday (or the 10th anniversary of his 21st as we referred to it, side note- While turning 21 is a big deal for Americans due to the legal drinking age this is not the same for Australians who can drink at 18. However, turning 21 is significant to them for a different reason. In Australia, when you turn 21, you get the keys to your parents’ house… symbolizing you are old enough to come and go as you please….?. This tradition is still a bit puzzling to me as I wonder why one is living at home at 21- Dan suggested it is just an old tradition and admitted it doesn’t make a whole lot of sense. (Crazy Aussies.) Anyways, we went out for Indian food and surprised Dan with a chocolate cake with candles which read, “Parabeins Maun Dan” (Happy Birthday Brother Dan in Tetun). Dan was still not feeling well (turns out he got dengue also) but put on a good face and even joined us for a couple of beers after dinner. We said goodbye to Liam Friday night before heading home as he left Timor Saturday morning. Eva and I are so thankful for all of the people we have met here in Timor and have found the goodbyes a bit sadder than we anticipated.
The remainder of our last weekend in Timor was rather uneventful. We rounded in the mornings, enjoyed a few cups of café Timor (organic coffee grown in the mountains of Timor is one of the country’s most promising sources of income- it is soooo good), went to Hotel Timor for lunch and dessert buffet, hunted for internet, and had an afternoon by the pool. The weather continues to be extremely warm and humid. While it is currently wet season… the rain has not been overly impressive as it has been a “dry wet season.” The increase in dengue on the island has been attributed in part to this- a dry wet season means more standing water and thus more mosquito breeding ground (when there is more rain the rate of water turnover in the rivers/fields/puddles is greater).
Eva and I worked at the clinic on Monday and Tuesday of last week. We took Wednesday and Thursday to see a bit of Dili, wrap of loose ends, and pack before flying to Darwin on Friday. Unfortunately our last two days of clinic were disheartening. On Monday, we received news that a 15 year old boy who had been at BPC for well over a week passed away after being referred to Dili National on Sunday. It was again another example of referring the patient on too late in the disease course leading to a bad outcome. The boy had come for consult, was found to have significant lung disease (likely tuberculosis with a superimposed infection), received less than adequate care due to resource/staffing issues at BPC (we couldn’t provide oxygen by face mask for this patient), he continued to decline, the suggestion of transfer to a more appropriate facility was made several times by several people, these suggestions were dismissed, the patient declined further until his oxygen saturation on room air was in the 40% (normal is over 90%), at this point he was transferred …. He died shortly after leaving our clinic not because he received poor care at Dili National but because we waited too long to send him. It was unnecessary and frustrating.
On Tuesday, we returned to clinic with mixed emotions- relieved it was our last day but not looking forward to saying goodbye to some of the great people we have met/worked with. After morning rounds Eva and I went to separate mobile clinics which were both within 30 minutes of Dili. We were back to BPC by early afternoon. I did a few dressing changes in the “emergency room” and drained a rather impressive abscess (about the size of an egg on a man’s neck). On AM rounds we had heard of a patient which was being brought in from the mountains in labor- she was pregnant with twins, had delivered the first twin at 6:30 AM in her home, and was unable to deliver the second twin which was breech (feet first). After finishing up in the ER the ambulance arrived with this woman (about 8-9 hours after the delivery of the first infant). Eva and I followed the patient in to maternity unsure of what had occurred since the AM. While the first twin was doing well, the second one was still in the birth canal and no longer alive- the body was almost entirely out but the arms and head remained. Dr Dan went through the steps of delivering a breech infant with us. With the assistance of suprapubic pressure he delivered the second twin. While the deceased infant was cleaned, dressed, and given to the family, Mom was encouraged to breastfeed the first twin to avoid further complications. It was a sobering moment for all of us. Eva and I finished afternoon ward rounds, took photos, exchanged e-mail addresses, and said our thank yous and goodbyes to the staff and volunteers at BPC.
On Wednesday morning Eva and I, accompanied by Luis (a Timorese friend who lives in Switzerland and was staying across the hall at our hostel while visiting family), went shopping. We visited the local craft market in Dili and wandered through downtown. Tais, which fill the craft market with color, are impressive traditional woven pieces made by the Timorese. We had a wonderful morning and Luis was of tremendous help guiding Eva and I with his insider knowledge. He has become a great friend and resource for us. Wednesday evening Dan cooked dinner in honor of our coming departure… we had vegetable curry with rice, wine, and fresh baked chocolate chip cookies with ice cream (we brought the dessert). Again there was a large group of people at Tracy’s (where Dan lives) for dinner- two Japanese, a middle easterner (didn’t get all his info), an Aussie, a Swiss, a Welsh, and us two Americans.
Our final day in Timor was wonderful! Eva and I set out relatively early in the morning to hike up to a statue of Jesus which overlooks the city of Dili (given by the Portuguese to Timor- for those who don’t know Timor was a Portuguese colony, the vast majority of Timor is Catholic). The views from where Jesus stands were beautiful. We then proceeded to “backside beach.” This is a beach just on the other side of the mountain from Jesus (from the beach you can see his backside… thus the name). To get to the beach we took a foot path which heads down the back of the mountain- backside is supposed to be one of the nicer beaches in Dili because it is a bit harder to get to- less crowded and dirty. We trekked down to a completely empty, completely beautiful beach! It was just Eva and I and a few stray goats for the afternoon. We lazed around, read our books, ate a picnic lunch, and enjoyed the sun. After we had had our fill we trekked back to Dili… it was oh so sweaty!! We met Maggie, the Australian physician who is now working at BPC, for an iced coffee to say goodbye and then headed home to pack. The day ended with Thai food, Bintang (Indonesian beer… the best we have found here), and saying goodbye to Dan (he still has 2 weeks left in Timor). Through all the ups and downs of this experience I think both of us agree we are glad we came. We have both learned a lot… (maybe not what we anticipated learning) and met some wonderful people.
Friday morning our flight left Dili at 8 AM and by 10 we had returned to the developed world… it was a huge culture shock! Generally, in my past experiences anyway, it has taken at least a day of travel to go from somewhere as underdeveloped as Timor to somewhere as developed as Australia. Eva and I checked into our budget hotel (clean white sheets, AC, and our own mosquito free bathroom!!), ate lunch at Subway, and wandered downtown Darwin/the grocery store/shops with wide eyes. It is just so crazy… we live in such excess. Again we headed down to the water front for dinner. Eva was adventuresome and tried a kangaroo burger…. I stuck with a Greek salad- less exciting but still good. Our weekend in Darwin/The Top End (as the Aussies call it) was spent exploring two national parks- Litchfield on Saturday and Kakadu on Sunday. While I won’t go into all of the details we hiked, swam under waterfalls, saw crocodiles/other wildlife, visited Aboriginal sites with rock paintings, and just enjoyed ourselves. The days were long but well worth it.
Currently we are on our flight to Sydney and should arrive early afternoon. A friend of mine from undergrad, Zack, will be flying out of Sydney today so I am hoping we can meet for a quick coffee before he leaves… the plan is for him to be at baggage claim when we arrive. We will then explore Sydney as cheaply as possible (we are staying with a friend of a friend and then Eva’s family). We will be back in Iowa in no time… both of us are anxious to see friends, families, Matts, and our dogs. I think we are also a bit anxious given that Match Day is only 5 days after our return… being in another country is like living someone else’s life for a bit… soon it will be back to reality (which is a mixed blessing). Anyways, hope you have all enjoyed reading the blog and I apologize for being a bit inconsistent in my posting. Much love from somewhere over Australia, Kim
The week of 2/22-2/26 was filled with mobile clinics. Eva and I were able to go to a number of them together which was great. We loaded up in the 4 wheel drive after rounds and got out of Dili for the day. The majority of complaints at mobile clinic are things like headache, backache from working in the fields, cough/runny nose, diarrhea/vomiting, a few fevers, and skin infections. As far as treatment that can be offered to the patients at mobile clinic, we tend to give out Tylenol, ibuprofen, multivitamins, vitamin C, occasionally antibiotics, and albendazole (for all of the little kids with intestinal worms). We are also able to do rapid malaria tests and take sputum sample to evaluate for tuberculosis. While only the antibiotics and the albendazole are actual therapeutic treatments by western standards the majority of these patients are satisfied by the placebo effect provided by the vitamins and the like. It is important that these patients not leave the consult empty handed and feeling as though the visit wasn’t worth their time (this could deter them from seeking care on other occasions when they may be affected by more serious illness). Patients are always encouraged to return if they do not feel better and given that all services are free the system seems to function rather well. Recently a midwife was added to the mobile clinic staff which is great as the majority of women in more remote locations receive no pre or post natal care.
The week passed by quickly and on Friday the 26th we all got together to celebrate Dan’s 31st birthday (or the 10th anniversary of his 21st as we referred to it, side note- While turning 21 is a big deal for Americans due to the legal drinking age this is not the same for Australians who can drink at 18. However, turning 21 is significant to them for a different reason. In Australia, when you turn 21, you get the keys to your parents’ house… symbolizing you are old enough to come and go as you please….?. This tradition is still a bit puzzling to me as I wonder why one is living at home at 21- Dan suggested it is just an old tradition and admitted it doesn’t make a whole lot of sense. (Crazy Aussies.) Anyways, we went out for Indian food and surprised Dan with a chocolate cake with candles which read, “Parabeins Maun Dan” (Happy Birthday Brother Dan in Tetun). Dan was still not feeling well (turns out he got dengue also) but put on a good face and even joined us for a couple of beers after dinner. We said goodbye to Liam Friday night before heading home as he left Timor Saturday morning. Eva and I are so thankful for all of the people we have met here in Timor and have found the goodbyes a bit sadder than we anticipated.
The remainder of our last weekend in Timor was rather uneventful. We rounded in the mornings, enjoyed a few cups of café Timor (organic coffee grown in the mountains of Timor is one of the country’s most promising sources of income- it is soooo good), went to Hotel Timor for lunch and dessert buffet, hunted for internet, and had an afternoon by the pool. The weather continues to be extremely warm and humid. While it is currently wet season… the rain has not been overly impressive as it has been a “dry wet season.” The increase in dengue on the island has been attributed in part to this- a dry wet season means more standing water and thus more mosquito breeding ground (when there is more rain the rate of water turnover in the rivers/fields/puddles is greater).
Eva and I worked at the clinic on Monday and Tuesday of last week. We took Wednesday and Thursday to see a bit of Dili, wrap of loose ends, and pack before flying to Darwin on Friday. Unfortunately our last two days of clinic were disheartening. On Monday, we received news that a 15 year old boy who had been at BPC for well over a week passed away after being referred to Dili National on Sunday. It was again another example of referring the patient on too late in the disease course leading to a bad outcome. The boy had come for consult, was found to have significant lung disease (likely tuberculosis with a superimposed infection), received less than adequate care due to resource/staffing issues at BPC (we couldn’t provide oxygen by face mask for this patient), he continued to decline, the suggestion of transfer to a more appropriate facility was made several times by several people, these suggestions were dismissed, the patient declined further until his oxygen saturation on room air was in the 40% (normal is over 90%), at this point he was transferred …. He died shortly after leaving our clinic not because he received poor care at Dili National but because we waited too long to send him. It was unnecessary and frustrating.
On Tuesday, we returned to clinic with mixed emotions- relieved it was our last day but not looking forward to saying goodbye to some of the great people we have met/worked with. After morning rounds Eva and I went to separate mobile clinics which were both within 30 minutes of Dili. We were back to BPC by early afternoon. I did a few dressing changes in the “emergency room” and drained a rather impressive abscess (about the size of an egg on a man’s neck). On AM rounds we had heard of a patient which was being brought in from the mountains in labor- she was pregnant with twins, had delivered the first twin at 6:30 AM in her home, and was unable to deliver the second twin which was breech (feet first). After finishing up in the ER the ambulance arrived with this woman (about 8-9 hours after the delivery of the first infant). Eva and I followed the patient in to maternity unsure of what had occurred since the AM. While the first twin was doing well, the second one was still in the birth canal and no longer alive- the body was almost entirely out but the arms and head remained. Dr Dan went through the steps of delivering a breech infant with us. With the assistance of suprapubic pressure he delivered the second twin. While the deceased infant was cleaned, dressed, and given to the family, Mom was encouraged to breastfeed the first twin to avoid further complications. It was a sobering moment for all of us. Eva and I finished afternoon ward rounds, took photos, exchanged e-mail addresses, and said our thank yous and goodbyes to the staff and volunteers at BPC.
On Wednesday morning Eva and I, accompanied by Luis (a Timorese friend who lives in Switzerland and was staying across the hall at our hostel while visiting family), went shopping. We visited the local craft market in Dili and wandered through downtown. Tais, which fill the craft market with color, are impressive traditional woven pieces made by the Timorese. We had a wonderful morning and Luis was of tremendous help guiding Eva and I with his insider knowledge. He has become a great friend and resource for us. Wednesday evening Dan cooked dinner in honor of our coming departure… we had vegetable curry with rice, wine, and fresh baked chocolate chip cookies with ice cream (we brought the dessert). Again there was a large group of people at Tracy’s (where Dan lives) for dinner- two Japanese, a middle easterner (didn’t get all his info), an Aussie, a Swiss, a Welsh, and us two Americans.
Our final day in Timor was wonderful! Eva and I set out relatively early in the morning to hike up to a statue of Jesus which overlooks the city of Dili (given by the Portuguese to Timor- for those who don’t know Timor was a Portuguese colony, the vast majority of Timor is Catholic). The views from where Jesus stands were beautiful. We then proceeded to “backside beach.” This is a beach just on the other side of the mountain from Jesus (from the beach you can see his backside… thus the name). To get to the beach we took a foot path which heads down the back of the mountain- backside is supposed to be one of the nicer beaches in Dili because it is a bit harder to get to- less crowded and dirty. We trekked down to a completely empty, completely beautiful beach! It was just Eva and I and a few stray goats for the afternoon. We lazed around, read our books, ate a picnic lunch, and enjoyed the sun. After we had had our fill we trekked back to Dili… it was oh so sweaty!! We met Maggie, the Australian physician who is now working at BPC, for an iced coffee to say goodbye and then headed home to pack. The day ended with Thai food, Bintang (Indonesian beer… the best we have found here), and saying goodbye to Dan (he still has 2 weeks left in Timor). Through all the ups and downs of this experience I think both of us agree we are glad we came. We have both learned a lot… (maybe not what we anticipated learning) and met some wonderful people.
Friday morning our flight left Dili at 8 AM and by 10 we had returned to the developed world… it was a huge culture shock! Generally, in my past experiences anyway, it has taken at least a day of travel to go from somewhere as underdeveloped as Timor to somewhere as developed as Australia. Eva and I checked into our budget hotel (clean white sheets, AC, and our own mosquito free bathroom!!), ate lunch at Subway, and wandered downtown Darwin/the grocery store/shops with wide eyes. It is just so crazy… we live in such excess. Again we headed down to the water front for dinner. Eva was adventuresome and tried a kangaroo burger…. I stuck with a Greek salad- less exciting but still good. Our weekend in Darwin/The Top End (as the Aussies call it) was spent exploring two national parks- Litchfield on Saturday and Kakadu on Sunday. While I won’t go into all of the details we hiked, swam under waterfalls, saw crocodiles/other wildlife, visited Aboriginal sites with rock paintings, and just enjoyed ourselves. The days were long but well worth it.
Currently we are on our flight to Sydney and should arrive early afternoon. A friend of mine from undergrad, Zack, will be flying out of Sydney today so I am hoping we can meet for a quick coffee before he leaves… the plan is for him to be at baggage claim when we arrive. We will then explore Sydney as cheaply as possible (we are staying with a friend of a friend and then Eva’s family). We will be back in Iowa in no time… both of us are anxious to see friends, families, Matts, and our dogs. I think we are also a bit anxious given that Match Day is only 5 days after our return… being in another country is like living someone else’s life for a bit… soon it will be back to reality (which is a mixed blessing). Anyways, hope you have all enjoyed reading the blog and I apologize for being a bit inconsistent in my posting. Much love from somewhere over Australia, Kim
Wednesday, February 24, 2010
2/22/2010
Filling you in on the last week…
On Sunday (Valentine’s Day) Eva and I met the two Australian medical students (Dan and Liam) at Hotel Timor for lunch, dessert buffet, some pool time, and the hope of free wireless internet. As usual things did not go quite as planned- lunch and the all you can eat dessert buffet were amazing, we snuck into the pool area and lazed around for hours no problem…. the internet however was of course a myth (thus the delay in the last posting and no new picture). I have realized how much I take internet access (on laptops and iphones) for granted at home.
I returned to clinic Monday morning after basically recovering from dengue (although my legs were still covered in a rash for a few more days). I spent last week traveling to a few mobile clinics- seeing around 50 patients in 2 hours at one Eva and I went to together which was a 3 hour drive west of Dili (the evaluation at mobile clinic is very brief and really serves as a means of identifying those few patients who are very ill needing to be brought into Dili for further evaluation/treatment as well as to ensure these communities feel their health concerns/needs are supported). I was able to assist in/observe a few deliveries this week which was also exciting. I have been a bit disappointed in the amount of obstetrics Eva and I have been involved in… the midwives at the clinic handle the majority of the deliveries and it always seems our days are filled with other tasks- unable to just hang out in maternity.
The malnutrition program continues to function and has been greatly aided by the addition of a pediatrician from Australia. Her name is Maggie and she will be spending several months here in Dili. She was excited to work with Grace and I on the program and (as I have hoped to see other parts of the care provided by BPC) she has basically taken over coordinating the daily efforts. We continue to have a large inpatient population of tuberculosis (TB) patients which has been quite interesting. The advanced stage TB presents in Timor Leste is basically unheard of in the United States. Eva and I are both learning a great deal about the varied presentations, treatment, and prevention strategies. Aside from malnutrition and TB patients there are several cases of malaria, dengue, pneumonia, pylonephritis, urinary tract infection, pelvic inflammatory disease, leprosy, mastitis, and gastrointestinal worms.
Last Monday Eva and I were invited to dinner at Tracy Morgan’s home by Dan (one of the Australian medical students). Tracy Morgan is an expat living in Timor Leste working for an NGO… she is fairly well known due to the length of time she has been active in the country/Dili community and because she owns a large home where she houses many foreigners traveling through Timor Leste (Dan is currently living there). The dinner party was in honor of one of the Irish girls living with Tracy and Dan as she is leaving the country to return to Ireland. It was a wonderful dinner and I write about it only to give some insight into the diverse group of foreigners we have met who are here in Timor all working on various projects. There was the Irish girl working for the UN, an Australian working for the police force in Dili, an Australian working for the education system, an Australian working for Marie Stopes Clinic (a family planning center), a Japanese girl working for the office of immigration, a Tasmanian pediatrician, two Australian medical students, two American medical students (Eva and I), and Tracy who is a lawyer by trade. Needless to say dinner conversation was interesting as we enjoyed pasta with marinara and feta, egg plant, garlic bread, red wine, and mango crisp with ice cream for dessert (definitely the best we have eaten since our arrival). It has been great to interact with so many individuals from varied backgrounds.
Now… for the highlight of this blog… and possible the entire trip!! Eva and I spent the weekend in Atauro, which is a small island about 30km north of Dili. The island is 140 sq-km, has a population that totals around 8,000, and only two small cities with occasional electricity. Dan, Liam, Eva, and I all decided it was time to get out of Dili for a weekend and explore Atauro. We boarded a ferry on Saturday morning for the two hour ride across the Wetar Strait. Upon arrival we walked to our accommodations for the weekend called Nemas. Run by an Australian named Barry, Nemas, includes 5 thatched huts right on the beach. We were fortunate to stay in the largest hut which actually had sleeping space for around 8 people and open air bathroom facilities in back. The other huts were occupied by a group of 3 Australians, 2 Portuguese, and a group with 1 Australian and 2 Portuguese. We all enjoyed each other’s company as we dined together in the main hut where Barry and his extended Timorese family live.
After arriving on Saturday, eating a bit of lunch, and getting settled in we spent the afternoon enjoying the beach, reading in the hammock, and playing a bit of Frisbee on the beach. Dinner was served again in the main hut and then the majority of the guests at Nemas returned to our hut for some music. Dan is a talented guitar player and singer (Eva joined in on a few songs and experimented with the harmonica which was great). It was really the perfect ending to an excellent day.
On Sunday, after breakfast and a café Timor or two (East Timor is known for its wonderful coffee), most of us guest loaded in Barry’s small boat for some snorkeling. Having never snorkeled before I was a bit apprehensive but let me just say it was amazing!!! The coral reefs around Timor are supposed to be some of the best in the world and I was reminded over and over again by the other guests how fortunate I was to have this be my first look at life in the sea. We spend several hours flipping around the crystal clear water looking at all sorts of sea creatures… just long enough for both Eva and I to burn our backsides. The remainder of Sunday afternoon was spent in the same manner as Saturday afternoon. I finished another wonderful book in our hammock, the title being “What is the What” and recommend it to anybody looking for something to read. The only downside of going to Atauro for the weekend is the only way to return to Dili is by fishing boat on Monday morning (the ferry only goes for the day on Saturday leaving around 3 PM- not enough time to enjoy the island). So at 3:15 AM Monday morning the alarm went off, all of the guest from Nemas enjoyed one more cup of café Timor together, and loaded in the back of a truck at 4 AM to head to Vilo to catch our boat. The fishing boat was better than I anticipated (we had heard horror stories of foreigners scooping buckets of water out of the bottom of boats as waves crashed over the edge wishing they had a life jacket). Our boat was much different than the image I had in my head. The majority of people stretched out on the deck and slept during the 3 hour trip back to Dili. I stayed awake, saw a few dolphins and flying fish in the early morning light, enjoyed the ride/breeze, and watched the sunrise over the water and Timor. It was truly a wonderful/perfect weekend- great atmosphere and great company. Eva and I returned to BPC refreshed for another week.
This week looks to be very similar to those previous. Eva and I plan to head out to several mobile clinics after morning rounds and spend our evenings with the friends we have made here. We went to the US embassy this evening as a birthday party was being held in George Washington’s honor- turned out to be a standard BBQ by the onsite pool. Eva and I enjoyed a cheeseburger, Diet Coke (for me), and a beer (for Eva) while chatting with several military personal who are working with the Mercy Ship (a naval boat with first class facilities that travels to foreign countries providing medical care). Turned out to be an interesting evening… the US embassy grounds are almost embarrassingly extravagant compared to the surroundings (not sure what else I expected). On Thursday we plan to go out to dinner, maybe Thai, as both Liam and one of the Australian doctors we have spent time with will be returning home on Saturday. Friday is Dan’s 31st birthday (Australian medical student not Dr. Dan) … the plan was to celebrate, however Dan became ill after returning from Atauro… so we will have to wait and see how he is feeling by Friday. Regardless it should be a good week.
Eva and I have booked our return tickets to Australia. We will be spending some time in Darwin and Sydney both before heading home on March 13th. Hope this message finds everybody well... and for those in Iowa while it is scary to say… I miss the snow.
(PS- I apologize for any typos/improper grammar as I have not been proof reading)
On Sunday (Valentine’s Day) Eva and I met the two Australian medical students (Dan and Liam) at Hotel Timor for lunch, dessert buffet, some pool time, and the hope of free wireless internet. As usual things did not go quite as planned- lunch and the all you can eat dessert buffet were amazing, we snuck into the pool area and lazed around for hours no problem…. the internet however was of course a myth (thus the delay in the last posting and no new picture). I have realized how much I take internet access (on laptops and iphones) for granted at home.
I returned to clinic Monday morning after basically recovering from dengue (although my legs were still covered in a rash for a few more days). I spent last week traveling to a few mobile clinics- seeing around 50 patients in 2 hours at one Eva and I went to together which was a 3 hour drive west of Dili (the evaluation at mobile clinic is very brief and really serves as a means of identifying those few patients who are very ill needing to be brought into Dili for further evaluation/treatment as well as to ensure these communities feel their health concerns/needs are supported). I was able to assist in/observe a few deliveries this week which was also exciting. I have been a bit disappointed in the amount of obstetrics Eva and I have been involved in… the midwives at the clinic handle the majority of the deliveries and it always seems our days are filled with other tasks- unable to just hang out in maternity.
The malnutrition program continues to function and has been greatly aided by the addition of a pediatrician from Australia. Her name is Maggie and she will be spending several months here in Dili. She was excited to work with Grace and I on the program and (as I have hoped to see other parts of the care provided by BPC) she has basically taken over coordinating the daily efforts. We continue to have a large inpatient population of tuberculosis (TB) patients which has been quite interesting. The advanced stage TB presents in Timor Leste is basically unheard of in the United States. Eva and I are both learning a great deal about the varied presentations, treatment, and prevention strategies. Aside from malnutrition and TB patients there are several cases of malaria, dengue, pneumonia, pylonephritis, urinary tract infection, pelvic inflammatory disease, leprosy, mastitis, and gastrointestinal worms.
Last Monday Eva and I were invited to dinner at Tracy Morgan’s home by Dan (one of the Australian medical students). Tracy Morgan is an expat living in Timor Leste working for an NGO… she is fairly well known due to the length of time she has been active in the country/Dili community and because she owns a large home where she houses many foreigners traveling through Timor Leste (Dan is currently living there). The dinner party was in honor of one of the Irish girls living with Tracy and Dan as she is leaving the country to return to Ireland. It was a wonderful dinner and I write about it only to give some insight into the diverse group of foreigners we have met who are here in Timor all working on various projects. There was the Irish girl working for the UN, an Australian working for the police force in Dili, an Australian working for the education system, an Australian working for Marie Stopes Clinic (a family planning center), a Japanese girl working for the office of immigration, a Tasmanian pediatrician, two Australian medical students, two American medical students (Eva and I), and Tracy who is a lawyer by trade. Needless to say dinner conversation was interesting as we enjoyed pasta with marinara and feta, egg plant, garlic bread, red wine, and mango crisp with ice cream for dessert (definitely the best we have eaten since our arrival). It has been great to interact with so many individuals from varied backgrounds.
Now… for the highlight of this blog… and possible the entire trip!! Eva and I spent the weekend in Atauro, which is a small island about 30km north of Dili. The island is 140 sq-km, has a population that totals around 8,000, and only two small cities with occasional electricity. Dan, Liam, Eva, and I all decided it was time to get out of Dili for a weekend and explore Atauro. We boarded a ferry on Saturday morning for the two hour ride across the Wetar Strait. Upon arrival we walked to our accommodations for the weekend called Nemas. Run by an Australian named Barry, Nemas, includes 5 thatched huts right on the beach. We were fortunate to stay in the largest hut which actually had sleeping space for around 8 people and open air bathroom facilities in back. The other huts were occupied by a group of 3 Australians, 2 Portuguese, and a group with 1 Australian and 2 Portuguese. We all enjoyed each other’s company as we dined together in the main hut where Barry and his extended Timorese family live.
After arriving on Saturday, eating a bit of lunch, and getting settled in we spent the afternoon enjoying the beach, reading in the hammock, and playing a bit of Frisbee on the beach. Dinner was served again in the main hut and then the majority of the guests at Nemas returned to our hut for some music. Dan is a talented guitar player and singer (Eva joined in on a few songs and experimented with the harmonica which was great). It was really the perfect ending to an excellent day.
On Sunday, after breakfast and a café Timor or two (East Timor is known for its wonderful coffee), most of us guest loaded in Barry’s small boat for some snorkeling. Having never snorkeled before I was a bit apprehensive but let me just say it was amazing!!! The coral reefs around Timor are supposed to be some of the best in the world and I was reminded over and over again by the other guests how fortunate I was to have this be my first look at life in the sea. We spend several hours flipping around the crystal clear water looking at all sorts of sea creatures… just long enough for both Eva and I to burn our backsides. The remainder of Sunday afternoon was spent in the same manner as Saturday afternoon. I finished another wonderful book in our hammock, the title being “What is the What” and recommend it to anybody looking for something to read. The only downside of going to Atauro for the weekend is the only way to return to Dili is by fishing boat on Monday morning (the ferry only goes for the day on Saturday leaving around 3 PM- not enough time to enjoy the island). So at 3:15 AM Monday morning the alarm went off, all of the guest from Nemas enjoyed one more cup of café Timor together, and loaded in the back of a truck at 4 AM to head to Vilo to catch our boat. The fishing boat was better than I anticipated (we had heard horror stories of foreigners scooping buckets of water out of the bottom of boats as waves crashed over the edge wishing they had a life jacket). Our boat was much different than the image I had in my head. The majority of people stretched out on the deck and slept during the 3 hour trip back to Dili. I stayed awake, saw a few dolphins and flying fish in the early morning light, enjoyed the ride/breeze, and watched the sunrise over the water and Timor. It was truly a wonderful/perfect weekend- great atmosphere and great company. Eva and I returned to BPC refreshed for another week.
This week looks to be very similar to those previous. Eva and I plan to head out to several mobile clinics after morning rounds and spend our evenings with the friends we have made here. We went to the US embassy this evening as a birthday party was being held in George Washington’s honor- turned out to be a standard BBQ by the onsite pool. Eva and I enjoyed a cheeseburger, Diet Coke (for me), and a beer (for Eva) while chatting with several military personal who are working with the Mercy Ship (a naval boat with first class facilities that travels to foreign countries providing medical care). Turned out to be an interesting evening… the US embassy grounds are almost embarrassingly extravagant compared to the surroundings (not sure what else I expected). On Thursday we plan to go out to dinner, maybe Thai, as both Liam and one of the Australian doctors we have spent time with will be returning home on Saturday. Friday is Dan’s 31st birthday (Australian medical student not Dr. Dan) … the plan was to celebrate, however Dan became ill after returning from Atauro… so we will have to wait and see how he is feeling by Friday. Regardless it should be a good week.
Eva and I have booked our return tickets to Australia. We will be spending some time in Darwin and Sydney both before heading home on March 13th. Hope this message finds everybody well... and for those in Iowa while it is scary to say… I miss the snow.
(PS- I apologize for any typos/improper grammar as I have not been proof reading)
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