i arrived home on wednesday night - wow, time really does seem to whiz by here. since coming back, i've felt a little out of place. life is very different here (naturally); to me, it is quite idyllic - a happy, safe, prosperous place where people can settle down and lead bliss-filled lives.
i really enjoy edmonton, especially my dear, dear friends. the weather in the summer is quite lovely and is paired with verdant scenery to boot. i am a frigid-loving fellow, and so even the incessant sea of white (and white-brown) that visits us every winter i find quite enjoyable. you could really settle here and lead quite a happy, happy life.
alas, i think it is important not to forget the deserts beyond the oasis. this i must tell myself as much or more than i would admonish others. when i was in zambia, i met some folks who felt that they found their niche in that society. it was a place that they naturally clicked with, that made them feel emotionally fulfilled. this isn't me: i am emotionally fulfilled where my friends are, but i am logically drawn to faraway places.
i think my travels have shifted me a few points in the direction of the latter and away from the former. i think this is something that is important to do if doing extended work in different locales is what i want to do
Saturday 27 June 2009
Wednesday 17 June 2009
midnight sun
i am currently in iceland at a hotel at the edge of skaftafell national park. it is 13 minutes to midnight, and it is as bright as day outside. fascinating, yet so unfortunate for one´s circadian rhythms. and to think that in winter the opposite is true, with almost 100% darkness... shudder
i find writing about social issues so much more interesting than just about natural beauty or scenery (i will leave that to facebook photos).
fun facts - iceland is one of the world´s wealthiest countries (5th) and also one of the world´s most economically egalitarian ones (4th by Gini coefficient, a means of measuring inequality). iceland also generates 70% of its power from renewable geothermal sources. iceland also has the world´s first openly homosexual head of state - and she is a woman at that.
i wonder if all this is possible only because of iceland´s unique natural heritage and it´s small population (a little over 300,000).
i find writing about social issues so much more interesting than just about natural beauty or scenery (i will leave that to facebook photos).
fun facts - iceland is one of the world´s wealthiest countries (5th) and also one of the world´s most economically egalitarian ones (4th by Gini coefficient, a means of measuring inequality). iceland also generates 70% of its power from renewable geothermal sources. iceland also has the world´s first openly homosexual head of state - and she is a woman at that.
i wonder if all this is possible only because of iceland´s unique natural heritage and it´s small population (a little over 300,000).
Wednesday 10 June 2009
they (they i think being stalin) say that the death of one person is a tragedy, but the death of a million is a statistic. it is fascinatingly human how we need the closeness of experience to most effectively galvanize our emotions. we try to condition ourselves to think with logic, in the abstract realm of probabilities and statistics, but to make another trite quotation, these don't speak as loud as our hearts.
the life expectancy of the average zambian is 40.9 years. the life expectancy of the average canadian is around 80 years . the per capita income of the average zambian is $395. the per capita income of the average canadian is $39183. what does this mean?
i am working at university teaching hospital, probably one of zambia's best non-private, non-expat hospitals. today as we were doing our major rounds, one of our patients started gasping for air. he had been admitted five days ago at emergency with a three-week history of headache. the day before admission, he had stopped talking. he had been in a semi-comatose state since then, but for whatever reason i don't think that the necessary tests for the likeliest diagnosis (a fungal infection of the brain and meninges - cryptococcal meningoencephalitis) was never done.
some more background - corruption scandals in the zambian government have led to widespread strikes across the public sector. first it was the junior doctors, then it was the nurses, and as of today several other government agenices have gone one strike as well. as the number of strikers has gone up, the quantity and quality of care that we provide has declined. our unit would normally be in charge of 40-50 patients; now we manage only 16 as aggresive discharging has been the modus operandi in response to manpower shortages. the hospital is manned by the few senior doctors we have and a load of student nurses and medical students.
back to our patient. i can't say i know much about him - i know his name - francis, and i know his age - 30. i haven't talked to him really, being in the comatose state that he is in. today, at around 9:50 am, francis started gasping for air. we tried to give him oxygen, but the wall attachment for oxygen was not working so we moved him beds. i think he was in fairly acute respiratory distress, so we tried to get him onto a ventilator in the ICU. alas, all of them were being used (even in our hospital's reduced state) and so we moved him to the neighbouring bed were the oxygen wall socket was working better. he was producing major secretions that were blocking his airways, so we began suctioning. we gave him adrenaline as his condition declined. we gave him cpr as his condition declined some more. we gave him another shot of adrenaline.
at 10:50, my senior shined a torch into francis's eyes to look for a reaction, and found none. he placed his stethoscope on francis's chest and heard nothing. he moved his fingers over francis's radial artery and felt fruitlessly for a pulse.
certified dead, 10:50 am, june 10, 2009.
a young man, only 30 years old. while i never talked to francis, i remember everytime we rounded we spoke to his 'collateral' - a family member that stayed with him and looked after his needs (this is very common in zambia, and practically everyone in hospital has one or two). so francis had family. i'm going to venture that francis had friends like we all do, memories like we all do, aspirations like we all do. 30 is a young age to pass away at. if any of my friends (many of whom will be 30 in a few years give or take) were to pass away, i would be heartbroken.
it is very human that over a single story we will shed tears and reflect (and maybe even blog), but we can not bat an eyelash as the most gruesome numbers
___
yet another trite quotation - we take these truths to be self-evident, that all men are created. equal. what does being born into a country with a per capita income of $395 mean? it means that your country is probably not wealthy enough to mount an effective public health campaign against hiv/aids and so prevalence rates will be high - 20%, let's say. it means you won't have the resources to be screened for hiv/aids as the disease wrecks havoc with your immune system. it means you won't hace access to the family doctor when you begin to feel troubling symptoms. it means you will come to the hospital in a semi-comatose state, your relatives desperate for care, but your doctor knowing that the prognosis is quite, quite dismal. it means being certified dead on at 10:50 am, on June 10, 2009. i am going to venture to say that this would probably not happen in canada, where our income is a tad higher.
can we truly say that all men are created equal when we are born into such inequality? can we rest with confidence on our laurels when all it took was a flip of the cosmic dice?
and let me just reiterate that university teaching hospital is one of zambia's best hospitals. i am sure things are worse in rural areas, where people are poorer and the facilities are shoddier. i am sure that things are even worse in refugee camps and war-torn areas, where a perfect storm of overcrowding, infections, unsanitary conditions, and co-morbidities can easily decimate populations.
last night i watched atonement, a movie about a woman's desire to seek atonement for the sins she has committed, sins that have caused the deaths of her sister and her lover.
if you were walking by a river and saw a child fall from the tree into the water, if you saw that she could not swim and would drown in minutes without assistance, and just walked away because you didn't want to get your new shirt wet, how could you seek atonement for this sin of omission... is there really any difference between that and the relationship between us in rich nations and our fellows in poor nations? so we add the element of distance, and differences in language and culture to the formula, but nothing has fundamentally changed: the links in the chain of causation remain lucent - we have the ability to change the outcome from death to life, but we walk on by
hahaha - too much pontification! stories and didactic examples and statistics aside, while it is true that the issues are complex and many, solutions are within our grasp :)
the life expectancy of the average zambian is 40.9 years. the life expectancy of the average canadian is around 80 years . the per capita income of the average zambian is $395. the per capita income of the average canadian is $39183. what does this mean?
i am working at university teaching hospital, probably one of zambia's best non-private, non-expat hospitals. today as we were doing our major rounds, one of our patients started gasping for air. he had been admitted five days ago at emergency with a three-week history of headache. the day before admission, he had stopped talking. he had been in a semi-comatose state since then, but for whatever reason i don't think that the necessary tests for the likeliest diagnosis (a fungal infection of the brain and meninges - cryptococcal meningoencephalitis) was never done.
some more background - corruption scandals in the zambian government have led to widespread strikes across the public sector. first it was the junior doctors, then it was the nurses, and as of today several other government agenices have gone one strike as well. as the number of strikers has gone up, the quantity and quality of care that we provide has declined. our unit would normally be in charge of 40-50 patients; now we manage only 16 as aggresive discharging has been the modus operandi in response to manpower shortages. the hospital is manned by the few senior doctors we have and a load of student nurses and medical students.
back to our patient. i can't say i know much about him - i know his name - francis, and i know his age - 30. i haven't talked to him really, being in the comatose state that he is in. today, at around 9:50 am, francis started gasping for air. we tried to give him oxygen, but the wall attachment for oxygen was not working so we moved him beds. i think he was in fairly acute respiratory distress, so we tried to get him onto a ventilator in the ICU. alas, all of them were being used (even in our hospital's reduced state) and so we moved him to the neighbouring bed were the oxygen wall socket was working better. he was producing major secretions that were blocking his airways, so we began suctioning. we gave him adrenaline as his condition declined. we gave him cpr as his condition declined some more. we gave him another shot of adrenaline.
at 10:50, my senior shined a torch into francis's eyes to look for a reaction, and found none. he placed his stethoscope on francis's chest and heard nothing. he moved his fingers over francis's radial artery and felt fruitlessly for a pulse.
certified dead, 10:50 am, june 10, 2009.
a young man, only 30 years old. while i never talked to francis, i remember everytime we rounded we spoke to his 'collateral' - a family member that stayed with him and looked after his needs (this is very common in zambia, and practically everyone in hospital has one or two). so francis had family. i'm going to venture that francis had friends like we all do, memories like we all do, aspirations like we all do. 30 is a young age to pass away at. if any of my friends (many of whom will be 30 in a few years give or take) were to pass away, i would be heartbroken.
it is very human that over a single story we will shed tears and reflect (and maybe even blog), but we can not bat an eyelash as the most gruesome numbers
___
yet another trite quotation - we take these truths to be self-evident, that all men are created. equal. what does being born into a country with a per capita income of $395 mean? it means that your country is probably not wealthy enough to mount an effective public health campaign against hiv/aids and so prevalence rates will be high - 20%, let's say. it means you won't have the resources to be screened for hiv/aids as the disease wrecks havoc with your immune system. it means you won't hace access to the family doctor when you begin to feel troubling symptoms. it means you will come to the hospital in a semi-comatose state, your relatives desperate for care, but your doctor knowing that the prognosis is quite, quite dismal. it means being certified dead on at 10:50 am, on June 10, 2009. i am going to venture to say that this would probably not happen in canada, where our income is a tad higher.
can we truly say that all men are created equal when we are born into such inequality? can we rest with confidence on our laurels when all it took was a flip of the cosmic dice?
and let me just reiterate that university teaching hospital is one of zambia's best hospitals. i am sure things are worse in rural areas, where people are poorer and the facilities are shoddier. i am sure that things are even worse in refugee camps and war-torn areas, where a perfect storm of overcrowding, infections, unsanitary conditions, and co-morbidities can easily decimate populations.
last night i watched atonement, a movie about a woman's desire to seek atonement for the sins she has committed, sins that have caused the deaths of her sister and her lover.
if you were walking by a river and saw a child fall from the tree into the water, if you saw that she could not swim and would drown in minutes without assistance, and just walked away because you didn't want to get your new shirt wet, how could you seek atonement for this sin of omission... is there really any difference between that and the relationship between us in rich nations and our fellows in poor nations? so we add the element of distance, and differences in language and culture to the formula, but nothing has fundamentally changed: the links in the chain of causation remain lucent - we have the ability to change the outcome from death to life, but we walk on by
hahaha - too much pontification! stories and didactic examples and statistics aside, while it is true that the issues are complex and many, solutions are within our grasp :)
Monday 8 June 2009
nurses strike
the interns and PGs have been on strike for about a week and a half now, and the nurses have now joined the picket lines. the hospital is now crewed by senior doctors, medical students, nursing students, and the few interns on attachment from other countries we cannot strike.
half the wards on internal medicine are now closed. reading the newspaper, it seems that other parts of the country are being affected even more seriously than here in lusaka. the government seems slow to respond, and i'm sure many people are dying as a result. corruption - not a very good thing at all
half the wards on internal medicine are now closed. reading the newspaper, it seems that other parts of the country are being affected even more seriously than here in lusaka. the government seems slow to respond, and i'm sure many people are dying as a result. corruption - not a very good thing at all
safari
this past weekend (my last in zambia) i went to a safari at kafue national park. it was pretty much what i expected out of a safari - we camped in the national park for two nights and went on a game walk and a game drive during our stay.
there were loads of hippos there - and at night they are one of the loudest creatures so staying in the tent you always think they are closer than they actually are, ready to bring the rampage down on you. there were even more loads of the antelope-family creatures - puku, impala, etc... we saw some zebras as well. someone has to explain to me how black and white striping is evolutionarily advantageous camouflage against the golden serengeti backdrop. we saw a few elephants, a few hyenas, and various smaller creatures including jannets (spelling?), hares, and civets. unforunately, we did not come across any of the big cats (lion, leopard, cheetah) and there were no giraffes or rhinos in that park.
one thing that amazed me was the moon. we had near-on full moons both night we stayed, and it was incredibly bright. the light cast by the moon blotted out many of the stars and created a permanent twilight that didn't dissipate until around 530 AM when the moon set and the starts came out to play again. perhaps its the bright city lights that takes away from the majesty of the moon at home
there were loads of hippos there - and at night they are one of the loudest creatures so staying in the tent you always think they are closer than they actually are, ready to bring the rampage down on you. there were even more loads of the antelope-family creatures - puku, impala, etc... we saw some zebras as well. someone has to explain to me how black and white striping is evolutionarily advantageous camouflage against the golden serengeti backdrop. we saw a few elephants, a few hyenas, and various smaller creatures including jannets (spelling?), hares, and civets. unforunately, we did not come across any of the big cats (lion, leopard, cheetah) and there were no giraffes or rhinos in that park.
one thing that amazed me was the moon. we had near-on full moons both night we stayed, and it was incredibly bright. the light cast by the moon blotted out many of the stars and created a permanent twilight that didn't dissipate until around 530 AM when the moon set and the starts came out to play again. perhaps its the bright city lights that takes away from the majesty of the moon at home
Thursday 4 June 2009
arrest
a senior registar, dr nyirenda, and some medical students were doing a tutorial on lower limb motor exam when a nursing student called us over to see a patient who was in convulsions. dr. n asked to review the file, and about a minute later the nursing student came and told dr. n that the patient was now gasping. i believe his underlying condition was endstage renal failure
we walked over to where he was, and after listening to his heart, realized he was in cardiac arrest. dr. n started chest compressions and i was holding a facemask giving him oxygen (although i really had no idea about the timing or number of breaths or anything really about basic life support). i could feel that his neck and face were quite cold, and couldn't feel a carotid pulse. we tried to inject him with adrenaline, but after a few minutes of chest compressions dr. n said that he was dead.
a few minutes after that, we walked back to where the tutorial was (just 10 meters away in our very open ward) and the family of the man who had passed started wailing
that was the first time anyone has died right in front of me
i was quite sad and started tearing when the family started wailing. dr. n just went right ahead and did the tutorial with no apparent emotions. he must have seen hundreds of patients die like that
we walked over to where he was, and after listening to his heart, realized he was in cardiac arrest. dr. n started chest compressions and i was holding a facemask giving him oxygen (although i really had no idea about the timing or number of breaths or anything really about basic life support). i could feel that his neck and face were quite cold, and couldn't feel a carotid pulse. we tried to inject him with adrenaline, but after a few minutes of chest compressions dr. n said that he was dead.
a few minutes after that, we walked back to where the tutorial was (just 10 meters away in our very open ward) and the family of the man who had passed started wailing
that was the first time anyone has died right in front of me
i was quite sad and started tearing when the family started wailing. dr. n just went right ahead and did the tutorial with no apparent emotions. he must have seen hundreds of patients die like that
Tuesday 2 June 2009
age
yesterday night we celebrated the 30th birthday of one of our expat friends here in zambia. it was somewhat of a gongshow, and amongst over things i discovered that ethiopian food may just be my least favorite genre of all foods
i'm 23 now, and i can still quite clearly remember what happened last year, 5 years ago, even 10 years ago. 10 years ago, when i was in grade nine, i thought that 23 was a dreadfully old age, a distant specter aeons away from where i was. well, here i am. it seems that life accelerates the older we get. haha! i know i'm quite young still, but it's true that the decades will only keep piling up.
on the topic of growing old, i was watching the notebook the other day, and at the end of the movie a couple very old and very much in love die in their sleep. sorry for spoiling that ending.
i swear one of the two main reasons i am christian is that i just can't stand the idea of a love like that dying after just 80 or so years. that would be just too sad. better there is a heaven where love can continue to bloom.
in other news today i was drawing blood for some electrolytes/creatinine for an HIV patient and splashed a load on my hand. i'm glad i had my gloves on, but often i don't. better safe than sorry, though the rate of transmission from blood to unbroke skin for hiv is ridiculously low
i'm 23 now, and i can still quite clearly remember what happened last year, 5 years ago, even 10 years ago. 10 years ago, when i was in grade nine, i thought that 23 was a dreadfully old age, a distant specter aeons away from where i was. well, here i am. it seems that life accelerates the older we get. haha! i know i'm quite young still, but it's true that the decades will only keep piling up.
on the topic of growing old, i was watching the notebook the other day, and at the end of the movie a couple very old and very much in love die in their sleep. sorry for spoiling that ending.
i swear one of the two main reasons i am christian is that i just can't stand the idea of a love like that dying after just 80 or so years. that would be just too sad. better there is a heaven where love can continue to bloom.
in other news today i was drawing blood for some electrolytes/creatinine for an HIV patient and splashed a load on my hand. i'm glad i had my gloves on, but often i don't. better safe than sorry, though the rate of transmission from blood to unbroke skin for hiv is ridiculously low
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