Friday, August 17, 2018

IEP Medical Mission in Namibia: Day 4 in Surgery

We started off the second week of surgery with a very aggressive schedule. We planned 13 cases and completed 10. One was canceled because the patient had a fever and another moved to Wednesday. Sadly, they had to cancel a procedure for a seven-year-old boy because we couldn’t get parental consent. His family is in the Okongo region, which is very far north near the Angolan border. His uncles had brought him to screening, but the hospital needs actual parental consent. It’s sometimes hard to explain to the families. Culturally, uncles are like fathers and aunts are like mothers. Legally, it’s just not the same.

Just to keep things hopping, we screened several more patients in between cases while the operating rooms were being turned over for the next surgeries. We also reviewed the x-rays and CT scans of patients we screened last week to make final decisions on whether they should receive surgery.

The team completed nine surgeries on Tuesday, our busiest day yet:
  1. 8-year-old girl – tendon transfer and plantar fasciotomy 
  2. 10-year-old girl – bilateral clubfoot repair
  3. 12-year-old boy – Achilles tendon lengthening, tendon recession, and plantar fascial release
  4. 29-year-old woman – triple arthrodesis 
  5. 32-year-old woman – ankle fracture repair
  6. 44-year-old woman – ankle fracture repair 
  7. 50-year-old woman – ankle fracture repair
  8. 54-year-old woman – bilateral metatarsal cuneiform exostosis
  9. 63-year-old man – ankle fracture repair
We’ve seen a lot of ankle fractures referred from the local orthopedic departments. The doctors here say they see a lot of trauma, largely from car accidents. Our team really specializes in deformities like clubfoot that are often not treated as quickly as trauma cases.

It was a long day, but very satisfying. We spent nearly 12 hours at the hospital, which meant the van was particularly quiet on the way home. One of the things I appreciate most about this group is that it really is a team. We eat breakfast together, work together, and usually eat dinner together. There's plenty of work, but plenty of good humor as well. While we're here, we're definitely family -- which makes being half a world away from my own family much easier.

IEP Medical Mission in Namibia: Day 3 in Surgery

Our first week of surgery finished with a full schedule in both operating rooms. Because Dr. Kao and Dr. Oloff were only able to join us for one week, it was also the last day for arthroscopy cases. But it wasn't the last use of the arthroscopy equipment. We're donating it to the Namibian Ministry of Health so that the local surgeons have the latest equipment to treat more patients.

The team completed seven surgeries on our third day in the operating theaters:
  1. 11-year-old girl – bilateral Achilles tendon lengthening
  2. 21-year-old woman – repair of meniscus tear in knee
  3. 22-year-old man – repair of Achilles tendon rupture
  4. 23-year-old man – tendon repair in hand
  5. 28-year-old woman – removal of bone fragments from foot
  6. 33-year-old man – shoulder stabilization to prevent repeated dislocations
  7. 47-year-old woman – scar revision from previous surgery
Meanwhile, part of the team traveled north to Angola with Dr. Haifuku, the Namibian Minister of Health. Dr. Nyska, Henry Duvalsaint, and Flecher Fleudujon joined Dr. Haifuku to share information about our project, evaluate more patients, and tour the medical facilities at multiple hospitals.

Dr. Nyska was very impressed with the facilities and equipment in the Angolan hospitals, much of which is very new. He shared information with the orthopedic doctors from Angola, who planned to visit our team in Windhoek the following week.

Although Namibia and Angola share a border, there are significant differences between the two countries. Namibia has a population of about 2.5 million, while Angola has more than 28 million. One of the biggest challenges for healthcare delivery in Namibia is the population density. The population is spread broadly across the country with 55% of people living in rural areas. Many of our patients traveled several hours by bus from the north to see our team for screening.

Dr. Haifuku has been very supportive of our mission and spent time with members of the team to talk about what we can all do to improve healthcare through efforts like public and private partnerships.

Friday, August 10, 2018

IEP Medical Mission in Namibia: Day 2 in Surgery

We saved Day 1’s expected chaos for Day 2. The changes we made to the surgical schedule on Tuesday afternoon didn’t quite make it all the way through the system, so we had a few surprises this morning. The theme of flexibility came up again as we shifted patients between operating rooms and doctors to account for the schedule changes.

The person who had the most trouble with the schedule changes was a 5-year-old boy. Because patients cannot eat for several hours before surgery, we like to put the youngest children earliest in the day. The shift in the schedule put him a bit later and he needed some extra mom time – and two teddy bears – to get through the wait. The bears definitely helped comfort him, but with the language barrier, I was unable to reassure him with any kind words. It’s one of the times when I feel most helpless.   

Wednesday, August 8, 2018

IEP Medical Mission in Namibia: First Day of Surgery

We always expect a bit of chaos on the first day of surgery as everyone gets their bearings in a new place with new people.

Dr. Helena, our main liaison, has worked incredibly hard to make sure everyone at the hospital was prepared for our arrival. This time, everyone dove right into the work and our first day of surgery went very smoothly.

The Windhoek Central Hospital facilities are much more modern than those we used at Katatura in 2016. The nursing staff was well-prepared and has been an important part of our team.

We completed seven cases on Tuesday, six children and one adult:

Tuesday, August 7, 2018

IEP in Namibia, Day 1: Patient Screening

Our first day was very busy. We started the morning taking most of our equipment to Central Hospital, where we’ll be doing all the surgeries. There we met the matrons (head nurses) of the operating theater and the equipment sterilization departments. We bring most of our own instruments, so we worked with the department to organize everything for sterilization in preparation for Tuesday’s surgeries.

By 11a we were on to Katatura Hospital, where we worked in 2016, to do the patient screening. There were quite a few patients ready to be seen, so we quickly got moving. The team usually focuses on foot and ankle deformities but based on the specialties of people on this mission team we were also seeing patients with knee, shoulder, and arm injuries.

I’m their first stop. I check in the patients and create an information sheet (chart). I gather their basic personal information – name, birth date, contact information. Then I gather details about why they’ve come to see the team for evaluation. There are many languages spoken in Namibia, so I often run into communication challenges. But it’s rarely a major issue because the other patients are quick to help translate.

Sunday, August 5, 2018

Adventures in Travel with IEP

Lehnerts and luggage left behind...
We’re here in Windhoek – all 16 of us! But it was a bit of an adventure to get here.

Traveling internationally is almost always an adventure. Add to the equation a large group with a lot of medical equipment along for the ride and it’s a lot to manage. Even so, the biggest challenge is usually making sure we get everything at the baggage carousel when we reach our destination.

Namibia gets a little more challenging because we also have an overnight stop-over in Frankfurt, Germany before our flight to Namibia the next day. That means getting all of our gear through customs and into taxis to the hotel – and back again the next day. Twelve of us arrived in Frankfurt on Thursday, where we met up with another two team members before our flight on Friday.

Everything went smoothly at check-in – 14 people, 14 suitcases, and 14 boxes of equipment. We went through passport control and security with no problems. And then, we discovered an interesting challenge at the gate. It turns out that Namibia had enacted a new law shortly after our last trip. Unfortunately, we weren’t aware of it. Out travel guidance didn’t flag it and the airline didn’t have any information about it during ticketing or even the check-in process.