Blantyre: Screening and the first day of surgery

This is Roy, our plastic surgeon, checking his email.

I ran into Roy Kim in the line for check-in at the airport. The lady who checked me in was very friendly. She asked if I could eat a seafood dinner and when I replied, "I'm on a seafood diet. When I see food, I eat it." she gave me a high five. You don't see that at the Minneapolis airport. The airport in Blantyre is smaller than I expected but eventually we got all our gear and headed for the CURE Beit hospital to unload and organize. I looked at the anesthesia machines and hope they will let us use the one that has both halothane and isoflurane vaporizers. The two make a good combination: halothane for induction, isoflurane for maintenance. There seems to be plenty of anesthesia supplies so I should be in good shape.

Blantyre airport, Malawi. Nice big 737 from J'burg.

I talked to Kristie Bishop, a lady I've worked with in Egypt, about my plan for analgesia for the kids. She thought it sounded do-able so I'm anxious to get started. We got back to the hotel about 2:30 and talked, had some lunch, talked some more. The internet works best in the courtyard and there is a tent with table and chairs that is very pleasant. I managed to stay awake all through dinner and turned in at 8:00.

Later Sunday night


We just got back from the screening clinic. Twenty children and adults came through; we put 17 on the schedule for the coming week. One lady, 17 years old, came in for a cleft lip repair and we put her 3 month old daughter with a cleft lip on as well. She was hesitant to approve her daughter's surgery (someone told her the child was too young) so I went over the rule of tens with her: ten weeks, ten pounds and a hemoglobin of 10 g/dl. Fortunately there was a calendar on the desk I was using because she wanted to know how I'd calculated her age. Oh, and I got to practice my singing skills. The ditty about the fishies and the hootchie-cootchie dance was a big hit.

Courtney Bradley, RN from Cedars-Sinai LA, checking pulse
oximetry on one of our prospective patients.

Our first day of surgery went well. We ended up in an operating room with no windows and an anesthesia machine that was under the weather. The CURE staff switched it out for another and we were under way. Our four cases, all lip repairs, went well. I worked with Polena, an excellent CRNA, who was interested to learn about LTA for mask induction and infraorbital nerve blocks. Also got to treat some halothane dysrhythmias (nothing serious).

Immaculately clean and well-staffed hospital.

Kuche Kuche, the pride of Malawi. The Pride
of San Francisco in the background.

Polena, the CRNA who worked with me on Monday.
She's terrific.

Precious, our first patient, the resting after surgery

Berthe, our second patient Monday, enjoys a little porridge.