Our First Day at Raffidiah Hospital

View from the breakfast area of Al Yasmeen hotel, our home base.

I arrived in Nablus about three pm. It was cold: see your breath in the hotel lobby cold! I met Samer, the neurosurgeon from St. Louis. His parents are from Jordan and he was born in Kuwait. We had about a dozen patients waiting for us at the hospital so when Teresa and Ahmal, the two nurses on our team, returned from buying sweaters and gloves we headed out. We saw ten patients in clinic and a couple on the ward. One boy in the ICU had surgery for a tumor at the base of his brain about two weeks ago. Over the last two days he had become unresponsive with downward looking pupils. This is called "sunset eyes", the result of poor function of the third, fourth and sixth cranial nerves, and is a sign of increased intracranial pressure. By this time I was out on my feet, so Samer put an external spinal fluid drain in to relieve some of the pressure. He did this under local anesthesia. Meanwhile, slug that I am, off to bed I went.

Long Wednesday, short Thursday

Wednesday and early Thursday in Damoh

Wednesday looked to be a typical long day until out last case, a four year-old from the wait list for a palatoplasty. Surgery went well and the field looked dry at the conclusion, but he was bled in PACU. His airway was problematic so we took him back to surgery for examination. There was a bleeder in the floor of the nose. The field was arid extra dry at the end and I extubated him deep to avoid coughing. He didn't tolerate extubation so I intubated him again, suctioned blood from his trachea twice, gave him naloxone (a drug that reverses the effects of narcotics) and gave him another shot at extubation. This time he flew, but for safety's sake we kept him in PACU overnight. Three of us stayed over: one of the nurses, one of our pediatricians and me. He looked great after about three am. The three of us went back to the orphanage for breakfast and a nap.

The rest of Thursday

I floated for the early part of the afternoon and did one case, a soft palate repair on a 1.5 year old. She had reportedly been fasting for four days, so I tried jot start an IV before surgery. THIS DID NOT INTEREST HER in the least. After three tries by two people I decide to give us all a break and wait until she was asleep. That made it easy and the rest of the case went smoothly. Back to the orphanage by 21:00. The van for the airport leaves at 5:30.

Our first day at CICM

Monday, first day at CICM hospital

I was up bright and early after what I thought was a good night's sleep.
We had breakfast and a devotion led by Dr. Craig Hobar, the founder of LEAP. We arrived at the hospital after a bumpy ten-minute drive. I was set up and had my first patient in the room by 7:50, but the induction was a little rocky ( laryngospasm, had to give succinylcholine choline) and we didn't get started until 8:30. I worked with Dr. Hobar, Heather Martin (a surgical tech who I met last year), and Lee, an excellent circulating nurse from Dallas. It was a long day but everything went smoothly. I got back to the orphanage about 10:30.

Going to India

The road to Damoh

Getting here has been quite a process. I made my AA flight MSP-ORD Thursday without difficulty and was given my seat assignment for London, only to find that the BAW airplane developed some serious engine problems and wouldn't be flying to London that night. It was after midnight before we got to a hotel, but we had seats on an AA ORD-DEL for Friday afternoon. I spent a cozy night in a king-size bed, went to fitness in the morning and ha d what I thought might be my last hot shower for a while. Despite having to return to the hotel for my iPad I made the flight in plenty of time. We flew in a 777, smaller than the aircraft I've taken for long flights before. It made for some long waits at the restroom, but otherwise very pleasant. I sat next to an Indian gent who lives in Chicago, works for an IT firm, and was going to Delhi Friday afternoon with the intention of returning on MONDAY. Him I do not envy, nor his wife with their two daughters under three years old.

Immigration and customs was problem- free. Perhaps it was coming through during daylight hours, but there was no attempt to extort us this year. I was very happy to see Rai, our travel agent, the moment I emerged from the customs area. We spent Saturday night in a hotel near the airport, with a comfy king-size bed and my second last hot shower.

We were up at 4:30 Sunday morning to meet the train to Bhopal. There was some difficulty with the seats, so for the first two hours I had a first class seat among a European family being guided around India by a son in his thirties who had business interests here. I recognized Spanish and German and they spoke English when they wanted to communicate as a group. Next I moved to second class where I sat at a table with some Indian guys. My final seat was next to Rachel Graves, one of our team members, in a different first class car. We had lunch in Bhopal and spent the next six hours driving to Damoh. I saw two cranes and a stork from the train and lots of brown kites while driving.

On the road to Manila...and then to Labo.

This post should have been at the beginning of the Philippines series, but I'm not very good at using my iPad to post.

Getting here was more fun than I expected. Thursday in St. Paul I got an email saying that my flight to Tokyo would be delayed and that I would miss my connecting flight to Manila. So, like a good traveller, I made an itinerary that would keep me in Japan overnight and get me to Manila by 1:30 pm Saturday. On the strength of this I wrote to Yuki O'Hara, my dancing anesthesiologist colleague from Cuenca last summer, to try to arrange a meeting. While waiting @ MSP I decided to invest in a bottle of Jameson Irish whisky.

We left MSP about 3:00 pm. The flight attendant said that we world be only ten minutes late arriving in Japan and that Delta would hold the Manila flight rather than house me overnight. She also said she might be interested in my whisky, since I wouldn't be able to take it through airport security in Japan. Interested, but not enough to pay full price! I decided to mitigate my loss by taking a couple of snorts prior to the exchange. This was going well, I had my cash in hand, but when she saw the evidence of my quality control she advised me that I was in violation of FAA regulations by drinking my own hootch while aboard. She also wanted her $15 back. Negotiations ensued. I came out of it with no whisky, no $15, and 5000 miles added to my account. I hope she disposed of the Jameson in a responsible manner (after hepatic metabolism and renal filtration).

My luck held and my bag arrived with me. I spent forty minutes looking for the pickup crew at Manila airport, worried because I thought they might not be expecting me. Thanks to the help of a man employed by the hotel and a lady from the tourist board I met my party, but had a couple of hours wait for a larger group arriving on a later flight. I don't know what time it was when I got to my room. Turns out Yuki couldn't see me due to work, so no harm done. Wrote a note to Rosanne and hit my rack.


A ten hour bus ride from Manila to Labo. Can't take pictures from the bus.


Melons stacked up in a pyramid along the side of the road. This doesn't work with coconuts. Open air shacks with color TV. A mama water buffalo and her calf. Iglesias ni Christo newer and more numerous than Catholic. Newly planted rice. Brilliant green young rice. I didn't know what green means until I saw young rice. Golden rice ready for harvest. A twelve year-old hoisting a sheaf of rice onto his shoulder. Naked little boy playing on his doorstep. Folks washing their hair in a pail on their doorstep. A teen-age boy getting a haircut on his doorstep. A four year-old boy with a killer mullet. A two year-old girl with a cranial synostosis and thin hair. Three kids walking down the side of the road, their arms around each other's shoulders. Sign says: Saraman High Performance Hog Food. Three pigs top hats and tails (of course) singing Putting on the Ritz. This last only in my head.