Mansoura Egypt Cleft Lip & Palate Surgical Volunteers International October 2012

This year my path to Egypt took me through Zurich. 

I flew Swiss International from Zurich to Cairo (here’s a picture of the flight over the Alps). They hand out chocolate bars in economy, a big improvement over the pretzel bits you get on US carriers. 

After arrival in Cairo we waited for a second wave of team members and then loaded up and headed for Mansoura. We had a good turn out for clinic the next morning. Here’s a video of the waiting room, fairly early in the morning. The man in the hat was a character; I saw him later that week when his relative had surgery. The waiting room in Mansoura

 The evening after clinic we went to dinner at a club along the Nile. On the way back we passed a circus, but were too tired to go in.

 I can’t say enough good things about the medical students in Mansoura. They were helpful in clinic, well prepared in basic science and eager to get some clinical experience. Dr. Laura Monson is an excellent plastic surgeon with cranio-facial experience and there was always a crowd around her table. I didn’t have much of a view but I could watch the bag move up and down.

I talked about the technique of direct laryngoscopy and tracheal intubation all week and on our last day I let one of the students go after it without me beside him. This is how we did it: an inhalational induction with oxygen and volatile anesthetic, followed by an IV under deep inhalation anesthesia. I do my own laryngoscopy, to make sure there are no surprises, and spray lidocaine on the vocal cords. 

Then I gently control ventilation until the patient is apneic. At that point I hand the laryngoscope to the student and walk to the end of the table. Holding tightly onto the table, I breathe slowly and don’t let go until the pulse oximeter reading falls below 94%.

Here are some photos of the students at work. I gained a new understanding of co-operative learning. And, yes, they got the child intubated. 

Gaza Peds Urology PCRF September 2012

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We stayed at Al-Mathaf Hotel on the north end of the Gaza strip.

http://www.almathaf.ps/hotel/.

Al-Mathaf is a first-class hotel with a good restaurant and a museum that displays artifacts found in Gaza. Some date back more than two thousand years. Across the road a mosque is under construction. The site overlooks the Mediterranean and the mosque will be beautiful when it is completed.

 

Our morning commute was always interesting. We travelled to and from the hospital in an ambulance. Horse-drawn carts are common.  Passing depends on the relative abilities of your vehicle and the one being overtaken, as well as a snap assessment of the character and motivation of motorists in the opposite lane. I think Gaza would offer a good surfing venue if it wasn’t so difficult to get in and out. Here's a YouTube clip of the commute: http://youtu.be/7wi_FMvqQ8w

The fish market was interesting. We usually got there after the peak of activity, but some days there was still some commerce underway. 

http://www.youtube.com/watch?v=oEBskDFDg_4&feature=g-upl

You could also see guys on sailboards fishing closer to shore.  Fishermen who go too far out will be chased by the Israeli coast guard.   -->

We worked at the Al Aqsa Martyr’s Hospital in central Gaza. http://topics.nytimes.com/topics/reference/timestopics/organizations/a/al_aksa_martyrs_brigades/index.html

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The staff at the hospital is uniformly friendly and helpful. Our host, Dr. Fayez Zeidan, is a kind and generous physician who worked very long hours while we were in town. Here you see Dr. Fayez and Dr. John Gazak operating to correct a kidney deformity in a three year-old girl. She had beautiful red hair. She was not personally pleased to be there but her parents were very grateful that we could help her.

 

 

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Getting home from Tel Aviv was a bad news, good news story. Part of the problem was my fault: I got to the airport at 9:30 pm, only two hours before departure. Also, I don’t think that Ben-Gurion airport puts their A-list security team on duty during the Shabbat that abuts Rosh Hashanah. They X-rayed my gear a couple of times and then had to consult with higher authorities (probably about why they had to X-ray it so much). The guy who seemed to be in charge had undergone a major craniotomy within the last six months and I wonder if the plate in his head is seated properly.

I was told that a man travelling alone is suspect. Thus, the family: My husband, my daughter from a previous marriage, and "our" son.

The good news? I met some swell people who also missed their United flight.  We were routed through Moscow on Aeroflot (try the lamb). The Aeroflot flight attendants’ outfits are to die for. I loved the hammer-and sickle-on the cuffs.

Two of the attendants in economy wore name tags saying "Ekaterina".  One more and I would have been concerned.