Experiences of a med student with an incurable travel bug.

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Doctor details devastation of Joplin

This incredible account of the Joplin tornado was originally published in The City Wire. It’s a long read, but well worth it. This is why most of us go into medicine — to help in a time of need. It’s not about insurance premiums, or the paycheck. It’s about the people, and helping where help is needed most. Hats off to all the healthcare workers and community members who stepped up during this incredible tragedy.

“My name is Dr. Kevin Kikta, and I was one of two emergency room doctors who were on duty at St. John’s Regional Medical Center in Joplin, MO on Sunday May 22,2011.

You never know that it will be the most important day of your life until the day is over.  The day started like any other day for me: waking up, eating, going to the gym, showering, and going to my 400pm ER shift. As I drove to the hospital I mentally prepared for my shift as I always do, but nothing could ever have prepared me for what was going to happen on this shift.Things were normal for the first hour and half.

At approximately 5:30 pm we received a warning that a tornado had been spotted. . Although I work in Joplin and went to medical school in Oklahoma, I live in New Jersey, and I have never seen or been in a tornado.  I learned that a “code gray” was being called.  We were to start bringing patients to safer spots within the ED and hospital.

At 5: 42pm a security guard yelled to everyone, “Take cover! We are about to get hit by a tornado!”  I ran with a pregnant RN, Shilo Cook, while others scattered to various places, to the only place that I was familiar with in the hospital without windows, a small doctor’s office in the ED. Together, Shilo and I tremored and huddled under a desk.  We heard a loud horrifying sound like a large locomotive ripping through the hospital.  The whole hospital shook and vibrated as we heard glass shattering, light bulbs popping, walls collapsing, people screaming,  the ceiling caving in above us, and water pipes breaking, showering water down on everything.

We suffered this in complete darkness, unaware of anyone else’s status, worried, scared. We could feel a tight pressure in our heads as the tornado annihilated the hospital and the surrounding area.  The whole process took about 45 seconds, but seemed like eternity. The hospital had just taken a direct hit from a category EF-4 tornado.

Then it was over.  Just 45 seconds.   45 long seconds.  We looked at each other, terrified, and thanked God that we were alive.  We didn’t know, but hoped that it was safe enough to go back out to the ED, find the rest of the staff and patients, and assess our loses.

Med flight helicopter at St. John's Regional Medical Center

“Like a bomb went off. ” That’s the only way that I can describe what we saw next.  Patients were coming into the ED in droves.  It was absolute, utter chaos.  They were limping, bleeding, crying, terrified, with debris and glass sticking out of them, just thankful to be alive.  The floor was covered with about 3 inches of water, there was no power, not even backup generators, rendering it completely dark and eerie in the ED.  The frightening aroma of methane gas leaking from the broken gas lines permeated the air; we knew, but did not dare mention aloud, what that meant.  I redoubled my pace.

We had to use flashlights to direct ourselves to the crying and wounded.  Where did all the flashlights come from ?  I’ll never know, but immediately, and thankfully, my years of training in emergency procedures kicked in.  There was no power, but our mental generators, were up and running, and on high test adrenaline. We had no cell phone service in the first hour, so we were not even able to call for help and backup in the ED.

I remember a patient in his early 20’s gasping for breath, telling me that he was going to die. After a quick exam, I removed the large shard of glass from his back, made the clinical diagnosis of a pneumothorax (collapsed lung) and gathered supplies from wherever I could locate them to insert a thoracostomy tube in him.  He was a trooper; I’ll never forget his courage. He allowed me to do this without any local anesthetic since none could be found. With his life threatening injuries I knew he was running out of time, and it had to be done. Quickly. Imagine my relief when I heard a big rush of air, and breath sounds again;  fortunately, I was able to get him transported out.

I immediately moved on to the next patient, an asthmatic in status asthmaticus. We didn’t even have the option of trying a nebulizer treatment or steroids, but I was able to get him intubated using a flashlight that I held in my mouth.

A small child of approximately 3-4 years of age was crying; he had a large avulsion of skin to his neck and spine.  The gaping wound revealed his cervical spine and upper thoracic spine bones.  I could actually count his vertebrae with my fingers.  This was a child, his whole life ahead of him, suffering life threatening wounds in front of me, his eyes pleading me to help him..  We could not find any pediatric C collars in the darkness, and water from the shattered main pipes was once again showering down upon all of us. Fortunately, we were able to get him immobilized with towels, and start an IV with fluids and pain meds before shipping him out.

We felt paralyzed and helpless ourselves. I didn’t even know a lot of the RN’s I was working with. They were from departments scattered all over the hospital. It didn’t matter.  We worked as a team, determined to save lives. There were no specialists available — my orthopedist was trapped in the OR.  We were it, and we knew we had to get patients out of the hospital as quickly as possible.

As we were shuffling them out, the fire department showed up and helped us to evacuate.   Together we worked furiously, motivated by the knowledge and fear that the methane leaks could cause the hospital could blow up at any minute.

Things were no better outside of the ED. I saw a man crushed under a large SUV, still alive, begging for help; another one was dead, impaled by a street sign through his chest.  Wounded people were walking, staggering, all over, dazed and shocked.

All around us was chaos, reminding me of scenes in a war movie, or newsreels from bombings in Bagdad.Except this was right in front of me  and it had happened in just 45 seconds . My own car was blown away. Gone. Seemingly evaporated.  We searched within a half mile radius later that night, but never found the car, only the littered, crumpled  remains of former cars. And a John Deere tractor that had blown in from miles away.

Tragedy has a way of revealing human goodness.  As I worked , surrounded by devastation and suffering,  I realized I was not alone.  The people of the community of Joplin were absolutely incredible.  Within minutes of the horrific event, local residents showed up in pickups and sport utility vehicles, all offering to help transport the wounded to other facilities, including Freeman, the trauma center literally across the street. Ironically, it had sustained only minimal damage and was functioning (although I’m sure overwhelmed). I carried on, grateful for the help of the community.

At one point I had placed a conscious intubated patient in the back of a pickup truck with someone, a layman, for transport. The patient was self-ventilating himself, and I gave instructions to someone with absolutely no medical knowledge on how to bag the patient until they got to Freeman.

Within hours I estimated that over 100 EMS units showed up from various towns, counties and four different states.Considering the circumstances, their response time was miraculous. Roads were blocked with downed utility lines, smashed up cars in piles, and they still made it through.

We continued to carry patients out of the hospital on anything that we could find: sheets, stretchers, broken doors, mattresses,wheelchairs — anything that could be used as a transport mechanism.

As I finished up what I could do at St John’s, I walked with two RN’s, Shilo Cook and Julie Vandorn, to a makeshift MASH center that was being set up miles away at Memorial Hall.

We walked where flourishing neighborhoods once stood,astonished to see only the disastrous remains of flattened homes, body parts, and dead people everywhere.  I saw a small dog just wimpering in circles over his master who was dead, unaware that his master would not ever play with him again. At one point we tended to a young woman who just stood crying over her dead mother who was crushed by her own home.  The young woman covered her mother up with a blanket and then asked all of us, “What should I do?” We had no answer for her, but silence and tears.

By this time news crews and photographers were starting to swarm around, and we were able to get a ride to Memorial Hall from another RN. The chaos was slightly more controlled at Memorial Hall. I was relieved to see many of my colleagues, doctors from every specialty, helping out. It was amazing to be able to see life again.

It was also amazing to see how fast workers mobilized to set up this MASH unit under the circumstances. Supplies, food, drink, generators, exam tables, all were there — except pharmaceutical pain meds. I sutured multiple lacerations, and splinted many fractures, including some open with bone exposed, and then intubated another patient with severe COPD, slightly better controlled conditions this time, but still less than optimal.

But we really needed pain meds. I managed to go back to St John’s with another physician, pharmacist, and a sheriff’s officer. Luckily, security let us in to a highly guarded pharmacy to bring back a garbage bucket sized supply of pain meds.

At about midnight I walked around the parking lot of St. John’s with local law enforcement officers looking for anyone who might be alive or trapped in crushed cars. They spray painted “X”s on the fortunate vehicles that had been searched without finding anyone inside. The unfortunate vehicles wore “X’s” andsprayed-on numerals, indicating the number of dead inside, crushed in their cars, cars which now resembled flattened recycled aluminum cans the tornado had crumpled  in her iron hands, an EF4 tornado, one of the worst in history, whipping through this quiet town with demonic strength.

I continued back to Memorial hall into the early morning hours until my ER colleagues told me it was time for me to go home. I was completely exhausted. I had seen enough of my first tornado.

How can one describe these indescribable scenes of destruction? The next day I saw news coverage of this horrible, deadly tornado. It was excellent coverage, and Mike Bettes from the Weather Channel did a great job, but there is nothing that pictures and video can depict compared to seeing it in person. That video will play forever in my mind.

I would like to express my sincerest gratitude to everyone involved in helping during this nightmarish disaster.  My fellow doctors, RN’s, techs, and all of the staff from St. John’s.  I have worked at St John’s for approximately 2 years, and I have always been proud to say that I was a physician at St John’s in Joplin, MO.  The smart, selfless and immediate response of the professionals and the community during this catastrophe proves to me that St John’s and the surrounding community are special. I am beyond proud.

To the members of this community, the health care workers from states away, and especially Freeman Medical Center, I commend everyone on unselfishly coming together and giving 110% the way that you all did, even in your own time of need.St John ‘s Medical Center is gone, but her spirit and goodness lives on in each of you.
EMS, you should be proud of yourselves. You were all excellent, and did a great job despite incredible difficulties and against all odds.

For all of the injured who I treated, although I do not remember your names (nor would I expect you to remember mine) I will never forget your faces.  I’m glad that I was able to make a difference and help in the best way that I knew how, and hopefully give some of you a chance at rebuilding your lives again.  For those whom   I was not able to get to or treat, I apologize whole heartedly.

Last, but not least, thank you, and God Bless you, Mercy/St John for providing incredible care in good times and even more so, in times  of the unthinkable, and for all the training that enabled us to be a team and treat the people and save lives.

Sincerely,
Kevin J. Kikta, DO
Department of Emergency Medicine
Mercy/St Johns Regional Medical Center, Joplin”

Abortion Saved My Life

Oh, did that get your attention?

Good.

Now go read this. It’s short, but here’s a quick synopsis: A mother of two experienced a difficult pregnancy but attempted to carry to term despite the risks. At 20 weeks she began hemorrhaging, and was virtually left to die in her hospital room because the physician on call refused to do abortions and failed to contact a doctor who would and could — this despite the fact that the fetus was not viable, that it was already dying. Fortunately, a nurse risked her job and contacted a different doctor who was able to save this woman’s life.

Abortion is a medical procedure necessary for adequate women’s healthcare. This story is just one of the many real reasons women get abortions, reasons that we have no right to judge when it is anyone’s body but our own. This woman would have died without the abortion of her already dying fetus. I fail to see the logic in how it makes more sense to let a woman die, leaving her two children motherless and her husband a widow, than to remove fetus that was going to die anyway. To be clear, I do not think this is the only acceptable situation in which women should have abortion access — it’s just one that highlights exactly why not having abortion access is so extremely problematic.

No, I have not been saved by an abortion. But I could be. Or maybe it will be you. Or your sister. Your significant other, mother, daughter, or friend. God forbid you ever be in that situation, don’t you think you’d want the doctor to save your/her life?

I thought so.

Giving Life After Death Row

“According to the United Network for Organ Sharing, there are more than 110,000 Americans on organ waiting lists. Around 19 of them die each day. There are more than 3,000 prisoners on death row in the United States, and just one inmate could save up to eight lives by donating a healthy heart, lungs, kidneys, liver and other transplantable tissues.”

Interesting piece. The author does a decent job of addressing many of the counter arguments and making his case. Rather than rehashing it all, I’ll just leave you to check out the preceding link to the NY Times article.

Should prisoners be denied the right to decide what happens to their bodies and organs after their death? Are there legitimate reasons for refusing to allow those on death row to be organ donors when they pass screening measures and the lethal injections don’t damage the organs? I am not taking a side in the death sentence debate here, I’m just pointing out an interesting aspect from one prisoner’s point of view. If his organs are viable, why should eight people have to wait any longer for a life-saving transplant? Interesting.

Lady Docs get the Shaft

Lest you think that we’re working towards some concept of equality, new research once again proves otherwise.(1) Not only has the gender gap in physician salaries not improved, it’s actually gotten worse over the last 10 years — nearly five times worse. This gap is often explained away by the fact that many women opt for the lower paying specialties and fewer hours because their vaginas need time to pop out some babies, but when factors like specialty and hours are accounted for women STILL earn an average of $16,819 less than their male counterparts.

And that’s just average. Need heart surgery? Your female surgeon will make an average of $27,103 less than a dude. Kid needs ear tubes for all those ear infections? A lady otolaryngologist/ENT (ear, nose & throat) makes $32,207 less than a male. Been a little short of breath from your lung disease lately and need to see a pulmonary disease specialist? The one with the boobs makes $44,320 less than the one with danglies. And remember, that’s AFTER normalizing/accounting for differences in specialty choice, hours worked, and even area cost of living. These women are receiving the exact same training, accumulating the exact same debt, and performing the exact same job, yet they are earning only a fraction of the pay.

This and previous studies have sought an explanation for the gaps and have yet to produce satisfactory explanations and results. One previous argument proposed that female physicians are just a males; these studies tend to merely measure number of patients seen and ignore things like the quality of care, patient outcomes, and patient satisfaction. Maybe it’s just my little lady-brain, but I seem to remember a few lessons from med school and life that seemed to say quantity does not equal quality. The other main historical argument has been that women disproportionately go into the lower-paying primary care fields, but not only has that trend diminished in recent years, women are still earning significantly less than their male colleagues in the same field. Family/marital status has also been shown to have little direct influence on physician salary.

The only explanation that still seems plausible after the data analysis is that there are fundamental differences in the jobs taken by female physicians beyond the specialty field and hours worked. Perhaps women are willing to sacrifice equal pay for a position that allows them more flexibility or is more amenable to their family responsibilities. It has recently been demonstrated that the field of medicine is indeed shifting to a greater focus on quality of life, but here’s the thing — both men and women are placing greater importance on jobs that permit a greater quality of life, NOT just women.

Again – both men AND women increasingly want family-friendly jobs that afford greater flexibility, yet women continue to earn $16,819 less than men. That’s nearly five times worse than the gap of $3,600 in 1999. FIVE TIMES WORSE. Disgusting.

Rants? Theories? Condolences? Distract me with your comments!

 

1. LoSasso AT, Richards MR, Chou CF, Gerber SE. The $16,819 Pay Gap For Newly Trained Physicians: The Unexplained Trent of Men Earning More than Women. Health Affairs. Feb. 2011; 30(2):193-201

Doctor Mom

I think it’s generally accepted that people can be a bit crazy when it comes to their own kids. This is especially true when they’re still tiny humanoids who can’t actually tell you what’s wrong and instead just cry and do their best to make everyone around them unhappy, too. I get it, the center of your universe is in distress, and that puts stress on everyone else. Luckily, doctors are trained to interpret the mysterious ways of the tiny humans and determine a diagnosis. Logic would imply that a physician should therefore be able to rationally decipher the situation when their own miniatures get sick, right? hah. logic.

Today in clinic I saw a 12 month old physician’s daughter for “persistent rhinorrhea, wheezing, intermittent emesis, and coughing.”

Translation: “continued runny nose, odd breath sounds, occasional vomiting, and coughing.” These symptoms had been going on for 10 days and were also accompanied by one other important symptom: sneezing!

Survey says: your kid has the common cold!

Patient’s mom continued to fire questions at the doc challenging the diagnosis, which the doc patiently answered: “No, this is not metabolic…No, this is not an allergy… No, she does not need steroids… No, cow’s milk is not a problem… No, you are not missing a rare disease. No, there is not something more serious going on… Is there something specific you’re concerned about?”

Manic momma: “No…Just…I keep thinking I’m missing something huge, something rare!”

Doc: “No, your child is fine, you’re not missing anything rare. She just has the common cold. She will be fine.”

BOTH of this girl’s parents are PHYSICIANS. One is actually a pulmonologist — a LUNG doctor. A specialty that requires one to differentiate between things like a cold and pneumonia every.single.day.

Apparently having kids makes even the smartest people…crazy.

Let’s get it started in here (again)!

You may have noticed that I’ve been on hiatus for a few months. Unfortunately it wasn’t for any fun, exciting travels or adventures — it was for trying to acclimate to the second year of medical school. I’ve finally come to terms with the fact that I’m always going to be swamped and feel like I have no free time, so rather than waiting around I’m going to go ahead and start blogging again anyway.

I can’t promise regular posts or coherent themes but I can promise random updates and musings about medicine, school, news, global health and events, and random interesting tidbits as determined by yours truly.

Stay tuned, and start checking back more often — there should be new posts here soon!

ED: Emergency Dysfunction

Considering that I’m a relatively healthy individual, I’ve spent more than my share of time in Emergency Rooms, or as they now prefer, Emergency Departments; who thought it was a good idea to switch the initials from “ER” to “ED” is beyond me, but that’s a point for another day. I’m going to stick to “ER” since I’m not mature enough not to giggle every time I type “ED.”

Last week started with me, bleary eyed and sleep deprived, shuffling over to work (yes, work as in job. I have two. In medical school. Post forthcoming.) when I was notified that my father was heading to the ER.  This is, unfortunately, not an unusual occurrence; I learned at a very young age to be wary of any unexpected phone call, and to this day my stomach drops a little when those calls come in.

Thus began yet another ludicrous ER experience.

Upon arriving at the eerily quiet ER (no cars in the lot and only one room occupied…which never happens…), he was immediately checked in, roomed, and saw the nurse. One would expect the next logical step to be seeing the doctor.

One would be silly to expect such things.

Instead, one should expect to be virtually ignored for the next few hours. The most contact that can be expected will be the ER resident running through the room, pausing just long enough to say that they’re not really sure what’s going on but the attending will be by soon. Oh, and they’ll call transplant since no medical personnel in the contiguous United States are willing to touch a transplant patient unless, of course, they only work with transplant patients. The nurse will stop by again, berate the attending for not stopping in yet but assure you that you’re next on the list. Several more hours will pass, over which time the ER will actually become busy and suddenly every medical staff member in a three mile radius will appear in your room in an effort to treat you as fast as possible so they can put someone else in your bed.

Now that several hours have passed and they have yet to actually do anything aside from verbally acknowledging that something must be wrong since you’re here, the docs finally concede to do some testing. Really, we were fortunate this time; during his last hospitalization for the exact same thing, they didn’t bother to culture the infection until 24 hours later after they’d pumped him full of antibiotics. Now, call me crazy, but my problem solving skills have led me to one universal conclusion in life: if you don’t know what’s wrong, you can’t fix it. Culturing an infection is the only way to find out precisely what’s wrong; if you don’t know exactly what’s causing the infection, you can’t effectively treat it. Like I was saying, we were fortunate this time because they actually remembered to do a culture, so they were able to put him on the most effective antibiotics more quickly. They also managed to both schedule him for and take him to get a CT to positively identify the cyst.

By the time they wheeled him up to CT, the ER was swamped, so they booted my mom from the room so they could put someone else in it. No problem, that’s what the waiting room is for…as long you come back for the people who are waiting. Again with the silly expectations. I mean, when you ask explicitly that 1. Someone come get you as soon as the procedure is over and 2. The patient, your family member, not be taken elsewhere before getting you, and the nurse vehemently states that she will be sure these things happen, why would you believe her? Clearly it’s far more reasonable to just leave the family members in the waiting room indefinitely and hope they just forget why they’re even there and just go home.

As long as patient and family wishes are being ignored here, it’s no surprise that they went ahead and violated stipulation #2 and took the patient straight to the room he’s getting admitted to at the other end of the hospital. In order to do this, a specialist gets called in: you see, the hospital employs highly skilled personnel specifically to wheel patients around the hospital and deposit them in various locales. So, this individual picked my dad up from the CT room and began the trek across the hospital, managing to get within one floor of their destination before things went awry. My dad questioned why they were getting off one floor below the transplant ward, but he was assured that “Oh, they take everybody here!” and was promptly wheeled into “his” room – only to find some guy (I’ll call him Ned) already in “his” bed. After many phone calls and a mild panic involving the concern that Ned didn’t belong in that room and that the guy who did must be missing, they finally realized that all the orders had been crossed – Ned did indeed belong in that room and had, in fact, been in CT earlier that day….someone just forgot to mark that he’d been taken care of , so when this young lady went to pick him up, she instead got the guy who was currently in the room, my dad. Eventually she figured out where he actually belonged (surprise, on the transplant floor!) and, I assume, found the poor orderly who was likely searching for my dad for the past hour.

Eventually, we all end up making it to his room, but the fun doesn’t stop there. The next visit, which of course takes hours to occur, is from the pharmacist. As it turns out, transplant is just about the only part of the hospital not yet utilizing electronic records (ironic, considering the chronic nature of the illnesses and the frequent hospital visits); instead, they keep their own paper charts. This would be fine if they managed to keep accurate records. Emphasis on “if”. Considering that he was admitted three months ago on that very ward, they should have had an extremely up to date medication list, but somehow they had one that was utterly and completely wrong. Shocking, I know.

Ultimately everything worked out; he was treated and discharged in just a few days, and everything is back to normal. But does that excuse the absolutely abysmal experience in the ER? Absolutely not. Was this perhaps a fluke, was this just maybe a bad day and the ER is usually not that dysfunctional? Absolutely not. We have had similar experiences time and again, and not just in our home ER, but at others across both our and at least one neighboring state. This is an appalling, and worse, a DANGEROUS standard of patient care. He was lucky; there were so many opportunities where these mistakes could have easily been detrimental to his health and outcome rather than simply irritating.

Absolutely appalling.

Go. Treat. Heal.

Go. Seek out adventure. Travel. Don’t wait for life and solutions to its problems to come to you; go where you’re needed, meet challenges head on and….

Treat. Address the issues you encounter. Whether it be a lack of clean water in Uganda or inadequate health care access in your community, do something in an effort to…

Heal. Remedy the situation. Whether it’s a physical disease or societal problem, whether you are the one being healed or doing the healing, mend and recover to the best of your ability.

Refugees, concerts, and bobotie

On Saturday I went downtown with my roommate Amanda to meet Muhammed Ali, a Darfur refugee she met the other day. He’s really amazing; he was a doctor in Darfur, and he was imprisoned by the rebels when he continued to practice and to help all injured people/anyone who needed to help. While in prison, he was tortured and God only knows all of his experiences. He was fortunate enough to escape, at which point he literally ran through the jungles to seek refuge in South Africa, sneaking across the border as he didn’t have passport or anything of the sort. SA has a policy that permits all Darfur refugees to remain here, so he is allowed to remain here as he tries to rebuild his life. Currently he is selling his and others’ art downtown to help pay for necessities while he is earning his Masters in Public Health. Though he is no longer a “practicing” doctor per se, he continues to help all sorts of street and poor people in the area that can’t afford health care when they fall ill.

On Sunday we went to Kirstenbosch Botanical Gardens for the sunset concerts that they have there all summer. We got there early so we could wander around the vast, beautiful gardens at the base of Table Mountain before picnicking at the concert. The Rudimentals were playing that night, a ska band that’s pretty big here. It was a very fun time, will definitely be doing it again.

Today, Monday, was the first official day of classes. It went pretty well, and my courses should be relatively interesting. Tonight Graham and Claire had a big party at their house since Graham’s sisters, Sandy and Sharon, were both in town from India and California, respectively. It was a blast; their whole family was there, plus all their friends, so it was a huge party. I obviously didn’t know hardly anyone, but it was very fun, and it was kinda cool to be on the opposite side of things for once – it was interesting to see what people experience when they come to my family holidays! Graham and the family were warning me initially about how there’d be so many people and they’d all be curious about me so I’d be kinda in the spotlight, but then they’d say that actually it shouldn’t be too bad, that it probably wouldn’t be anything compared to my family’s gatherings and that I’d be used to it! Lol, I guess I do come from a bit of a sizeable, rambunctious family, don’t I…

Claire made bobotie for the party, a traditional Cape Malay dish that was positively amazing. It was kind of like meat loaf, but better. She also made ice cream. When I left they insisted on sending home leftovers with me – clearly the concept of the poor, hungry college student is universal, and I was glad to have them!

Kampala, Uganda

During our last few days in Kampala, I shadowed doctors at Mulago hospital for three days, one day each in Endocrinology, the Labor Ward, and Pediatrics.

Monday: Everyone in Endocrinology had Type II diabetes, often with other afflictions and always with the diabetic foot; several patients had gangrene. We went to some of the local craft markets on Buganda Road and at the National Theatre to have a look around and then met Annette for dinner (liver, rice and chips). Annette was the other doctor who showed us around last year with JB, and she’s incredible. Quite the life story, but she’s one of the only Ugandans I know who likes schedules and organization — it’s a nice change!

Tuesday: The Labor Ward was positively overflowing, with women on the floors and in the hallways nearly ready to give birth. I even saw a live birth, it was amazing! Now I’ve held the youngest baby in my life; the baby came out, it’s cord was cut, it was wiped off a bit and put into a blanket, and then the sisters let me pick him up! Less than three minutes old and he was holding my finger and trying to suckle the air — it’s amazing! That night we went to Krua Thai with Regina, another woman we met last year. She runs the CHAIN program that a few of us visited and that I looked closely at for my research project last January. She took us to her house afterwards for drinks and to show us the promotional video they’ve made for CHAIN.

Wednesday: In pediatrics the doctor would see each child for maybe 10 minutes before the next one came in, and he was still hardly able to make any progress through the huge line of people waiting. Nearly every child we saw had a herniated umbilicus (I believe that’s what he called it), and of course there were TB and other illnesses. Their pediatric operating room wasn’t able to be used for a month already when I was there as sewer was backing up into it, and they figured it would be at least another month before it would be open again. This lead to many cases that should have been operated on being postponed indefinitely, with only the most emergent being refered. Just the previous day they had someone come in with a severely broken foot, with one of the bones cutting through the skin. The doctors had want to properly set the break through surgery, but as they were unable to they just filed down the protruding bone, set the foot and sent the child on his way. Unfortunately it seems as though this is going to continue for some time. That night we met up with Miriam, a girl who came to the UW for a month last year and Molly got to know, for tea and sandwiches at her home. She’s married and pregnant now, so that was exciting!

That night we finished up our packing and got ready to leave at 5am to catch our flight to South Africa.

The morning of our flights was sufficiently chaotic. At 6am we were checking in for our flight to Johannesburg, at which point the woman behind the counter informed us that my luggage was about 20 kilograms overweight. uhhh, what?!? Having checked all the luggage restrictions before leaving, I knew that I should have been allowed two bags at 23 kilos each since my origin point for the trip was the US; however, since we were checking back in at Entebbe/Uganda, they decided we should only be allowed 23 kilos total, the limit for flights within the continent. After attempting to sort it all out with the one South African Airways person working at that hour, I redistributed weight as best I could and ended up paying ~$200 to get everything here, as did Molly. Positively ridiculous, but I’m working with SAA to try to get it refunded.

The layover in Joburg was relatively painless apart from the impressively pushy employees. Porters insisted on pulling our luggage, literally wrestling it out of our hands, even after we told them several times that we had zero money. When we got to our point to check back in as we had to go through customs, they lingered and insisted we tip them for the 50 foot journey. Nope, we told them we didn’t have anything and we weren’t lying, we hadn’t been able to exchange or withdraw any cash yet. In our line to check back in we were surrounded by two big groups of bikers, likely heading to Cape Town to train for the upcoming race. A uniformed employee ushered us through to the counter since we’d be quick and the bicyclists were going to take a looong time. Of course, after we checked our stuff he follows us half way to our gate, demanding a tip. As we still didn’t have money, and he really didn’t do anything, there was no tip for him either. After all of this and Joburg’s reputation for losing the most luggage of any airport on the planet, we were convinced that our luggage would never make it to Cape Town. After the two hour flight, we waited for quite a while for our luggage to come off the plane, and miraculously it all made it!! We couldn’t believe it, so many other people I’ve met here lost luggage coming through Joburg.

There was someone from UCT waiting for us at the airport, and after a few more students arrived a big van took us to all our different houses, dropping each of us off on the curb with our luggage and driving off. Apparently they had called ahead to all of our landlords, so there was someone to let us in.

So, after three weeks of constant travel, I arrived in Cape Town! I’m living a beautiful old historic Victorian row home, just two houses down from the first house my Aunt Mona lived in when she moved to Cape Town!! Small world. My room is on the second floor at the top of the stairs, overlooking the back garden. It’s painted green and has old wooden furniture; it’s very nice. The living room is painted a deep red with white covers on the couches, and the kitchen is in good condition. This place is so much nicer than any student housing at Madison, and cheaper! I even have my own room, and it’s almost twice the size of the room I’m going to have next year!