Goodbye Afghanistan

Well, I thought I'd write one last blog from here in Kabul. It is about 9:30 Wednesday morning, and I leave the hospital at 10:30. My flight leaves at 2 and makes a quick stop for more passengers in Qandahar (be praying for that). Actually, the airport there is under US control.
In case any of you heard about the suicide bomb here in Kabul yesterday, I am fine. The blast was heard here at the hospital, though. Please continue to pray for the people here as they live in almost daily fear of something like this happening.
I just wanted to say thank you to all of you for your love and support. I have felt it while I've been here. I look forward to seeing you all and sharing my experiences with you.
Until then, take care and God Bless!

Happy (belated) Thanksgiving

Let me just start by saying that I hope you all had a wonderful Thanksgiving. It's never fun being away for Thanksgiving, but I was able to have a wonderful Thanksgiving feast even here in Kabul. There was a large meal and Thanksgiving service at the UN guest house here and we went to that on Thursday. I had turkey, mashed potatoes, corn, stuffing and pumpkin pie - just like home! It was wonderful and the atmosphere was very festive. Although, Dad, I must say that their stuffing didn't hold a candle to yours :)

I had another exciting night of call on Thursday night. A lady came in with twins and complaining that her water had broke and was now having regular contractions. She was preterm and both babies were breech and her cervix was 6cm dilated. In the States, we would have headed back for an emergent C-section, but after discussing it with Dr. Jacqui, it was decided to do a vaginal delivery. You see, the survival rate for preterm infants (she was approximately 29wks) is very low here and they just don't like to put mom through a surgery for babies that may or may not survive. I went through a myriad of emotions. First, I was angry. Why shouldn't we give these babies their best shot at survival? What if we do permanent damage by delivering them breech? But then I had to take a step back and realize that she was speaking from years of experience here in this country and that my American ideals don't always make sense here. After I had worked through that, I felt pure fear. What if I did something wrong (Dr. Jacqui wasn't at the hospital)? I just started praying that the Lord would give me wisdom. So, we went back and had a successful double breech delivery with breech extraction of the 2nd twin. It was scary and exhilerating all at the same time. So far, both babies (a boy and a girl) are doing well. Mom went home the next day. Oh, and did I mention all of this was done with NO anesthesia? Women here are tough!

After all that excitement, I needed a break. So, today we went to a beautiful lake on the edge of town that is surrounded by mountains. It is a popular picnic spot during the summer I hear. It was great to get away from the hustle and bustle as well as the overhwhelming dust and smog and just be out in peaceful nature. It was great to see a beautiful part of the city. I've put a picture below.

Thanks everyone for all your prayers and support. I have found out that I have to land in Qandahar on the way home, but have been assured I won't have to get off the plane. So, you can pray for that. Also, we heard today that there was a suicide bomber in Gazni (about 2 hours from here). Please continue to pray that this nation would know peace.

Also, I just found out that my sister took a nasty fall this week at school due to a janitor not properly marking a very wet floor. From what I understand, she fell and hit her head hard, but Xrays are okay. Please pray that Bethany will heal from this and praise God with me that nothing serious happened.

This may be my last post from here. If it is I will be sure to post when I get home. Thanks again for all your support! You have no idea how much it means.

Me with "my" twins

Lake Qargha

No longer culturally sensitive

Ok - today's blog is going to be full of venting. I'm so frustrated with this culture right now. Although it has many beneficial features - they are very hospitable, they value family to a fault, they are kind - I have to say that I am so tired of men who know nothing medical dictating (and I mean dictating) the medical care of their wives. I saw a woman in clinic today who has lost 2 babies previously, both of which she delivered at home because her husband refused to allow her to go to a hospital. Now, she presented for her first visit at around 34 weeks. She was complaining of itching all over, including her palms and soles. She said that this happened with her last pregnancy as well. So, I started thinking that she probably has something called cholestasis of pregnancy, which is a problem with the liver that can lead to sudden death of the baby. We sent her for some tests and her liver enzymes were extremely elevated. So, the recommendation from me and Dr. Jacqui as well was to be admitted immediately, given steroids to help the baby's lungs mature, and deliver soon as her infant is at high risk for sudden death. Her and her mother-in-law both said that her husband would not allow that and that they needed to go home. We explained over and over and in the end, they agreed to go home and talk to the husband. They thought that he would agree to bring her back tonight. So, hopefully she'll show up with a live baby.
Other than that, I had a good day. I gave another lecture. Things are going well here. I'm finally feeling back to normal. I have one more week here, and as the time to leave approaches, I must say that I have mixed feelings. I'm definitely ready to go home, which is a strange feeling for me. Not that I don't always miss people back home, but in the past, when I've been in Romania and Myanmar, I just feel so drawn to the place that I'm resistant to return to the States. That, for whatever reason, is missing this time. I have enjoyed my time here, and I feel a burden for this country and these people. But, it just doesn't seem the same. I guess I'm not meant to feel called to every country, right? That always makes leaving difficult, though, because everyone wants to know when you'll be back. So, I guess I'll need to work through that.
I hope you all are doing well.

So much to blog, so little time

Wow, have I got a lot to blog about. I think a day-by-day approach would be the easiest. Let me just first say that I am well and continuing to see the beautiful as well as the harsh aspects of this country.

So, last I wrote, I was excited about getting to operate. On Thursday, I spent the whole day in the operating room (or operating theater as they call it here). I watched a vesicovaginal fistula repair, which was very interesting. For those of you not in the know, that is an abnormal communication between the bladder and the vagina, leading to constant leakage of urine. Hers was caused by a very traumatic delivery out in a village with no repair of the damages. It went well, and it was amazing to think that such a simple procedure will make such a dramatic impact on her life. Then, I was able to do a hysterectomy with one of the fellows and even taught her a few things, I think. It was great. As we were finishing up, we heard that a patient who had been hospitalized for about 1-2weeks was hemorrhaging. The kicker is that she also has severe heart disease. So, she came back for an emergent C-section. I have grown close to her over the last couple of weeks, and I was able to sit next to her and hold her hand and comfort her throughout the procedure. I also was able to show her her healthy baby boy for the first time. What a joy!

Then, Thursday night, I did my first night of call. It was definitely much less busy than what I am used to at home. I did a couple of routine deliveries and then got called to come do my third - when I got there, I found out that the baby was breech and this was her first! When she got to the hospital, she was completely dilated, so they decided to let her delivery naturally. Needless to say, I was excited and scared to death all at the same time. You see, this would be my first breech delivery and the risk of the baby's head getting stuck with this being her first baby was pretty high. And, we had no idea how big this baby would be. So, with the wonderful coaching of the OB fellow and a wonderful midwife, I completed my first breech delivery! It was great, and the baby did wonderfully. Praise God for that!

On Friday, one of the long-termers here decided to take us around the city. We went to a beautiful hotel in the city center and ate at an Indian restaurant inside the hotel. The food tasted wonderful, but even before we left the restaurant, I had a glimpse of what was to come as I started to fell "not quite right". We went up to the roof, though, and got some beautiful shots of the city. By the time we got back to the van, I knew that I needed to go home. Let's just say that for the next 2 days, I saw the bathroom about every 30 minutes and my stomach made noises that were not human. My internist friend here said that it sounded like Giardia (an amoeba) and since I've started antibiotics, I have felt much better.

On Saturday, I got a call from a midwife at the hospital saying that Malalai had come in in labor and was asking for me. Unfortunately, I could not get off the couch. I asked her to give my apologies and reiterated that I was praying for her. Dr. Dee, the internist friend of mine, went in that day and was able to go see her and tell her that she was my friend. She delivered shortly and Dee was able to get pictures of the baby and the placenta. Still no answers as to why, but I pray that she knows that she is loved and that she is being bathed in prayer.

So, that just about catches you up. Are you sick of reading yet? Here are some pictures. Look forward to seeing everyone when I get home!

A delivery bed

Me with 2 of the midwives (Victoria and Najeeba)

Malalai

Well, I know a lot of people were wanting an update on this precious lady. I spoke with her today and she says she is doing well. She still has not delivered. I couldn't talk long as my phone was about to die, but she said that she was doing well and thanked me for praying for her. Please continue to keep her in your thoughts and prayers.
I don't have much to blog about today. My lecture today went well. I just found out that I will get to operate tomorrow, so I'm very glad about that!
Keep the comments coming. Tim and Christy - can you please send me your email address? It was so great to hear from you. Amanda - more blogs please :)

Crash

Well, the IT guy says my computer is hopeless. Either the hard drive is crashed or my operating system has some fatal flaw. Very frustrating considering I have a presentation tomorrow and everything for it was on my computer. But, I was able to look up the articles again, and I think I will have it done in time. Thankfully, I have some very nice roommates here who are willing to let me use their computers. So, I guess I will be getting a new computer when I get home. The only thing I'm really worried about is getting my pictures from the last 3 years off of that hard drive. If anyone has any suggestions, I'd love to hear them.
Things here are going well. Since I blogged last, I've seen lots of patients in the clinic. It continues to amaze me how people will travel days just to get her to be seen. In many of the villages throughout Afghanistan, there is no health care at all. So, people travel for days, some on foot, to come here and wait for hours to be seen. How lucky we are - and to think that people throw a fit if their doctor is an hour behind!
I had a good day today with the OB/GYN fellows here. There was a urogynecologist from Eggers military base that came and gave a very good lecture. It was fun talking to him and he even had an Indianapolis connection. Then, I did a journal club with the fellows. Dr. Minor, if you're reading this, you would have been proud. The purpose was to help them learn how to clinically evaluate medical articles that are published. They all said that they learned a lot, so that's good.
Also, last night, I had dinner with the doctor and his wife who started this hospital. It was a wonderful time and it was great to hear their stories of how things have changed in the last few years.
So, that's all the new news I have from here. No word on Malalai yet. I will try and call her this week.
Take care and God Bless!

(p.s. - For my fellow residents, please let me know how interviews went)

An unfair world

Hello all. Sorry for the delay in between blogs, but internet access is difficult. Now, my computer has decided to stop working all together, so I'm having to bum other people's computers now as well. Such is life overseas! Actually, there's an IT guy here, so I'm going to take it to him to see what he can do with it.
Yesterday was tough. I was working in the OB outpatient clinic, and I saw a woman I had seen last week. She is currently pregnant with her 5th pregnancy and has no living children. She has made it to full-term with all of her previous pregnancies and has had deaths of her children either prior to, during, or immediately following labor. So, when I saw her on Wednesday, I was determined that we would get her a successful outcome. We sent her for testing of the baby, which looked good. She was only 35weeks at the time, and here, they cannot do much for premature babies. So, we decided to do close testing and instructed her well on monitoring her babies movements. We decided we would electively deliver her once she reached 37wks. Turns out, we should have just delivered her that day. She came back yesterday for her testing and the baby was dead. I sat there dumbfounded when the midwife handed me the ultrasound report. Did I miss something? Should I have done something different? More importantly, how is this poor woman going to deal with this in a culture where women's only worth is found in their children? My heart broke for her as before my eyes she went through the stages of grief - denial, wanting a 2nd opinion, and then finally it hit her. As she sat there crying, I just wondered "Why Lord?" I know that He has a reason for everything, but sometimes I just don't understand. We are not allowed to pray with the patients at the hospital, so in my heart I said a prayer for her and I got her phone number so that I can call her. Her name is Malalai - please remember her and her family in your prayers as they go through this difficult time.
Now that you're thoroughly depressed - I did have a bright moment this morning. I was checking email and I found out that my "nieces" who are 2 1/2 and 1 1/2 were both asking about me last night. What a joy to hear! By the way, for those of you who were following Anara's story through her surgery, she is doing great and now home. You can go the Hubartt family link on my blog to read more.
Hope you are all well. I'm about halfway through my time here - look forward to seeing you all when I get home.

My First Delivery

OK - I finally have time to blog. Today was a good day! I spent the whole day in the OR (operating room) with the GYN team. I didn't scrub, as they don't get to do many cases. But, it was good to observe and be able to give suggestions here and there. I also was able to see my first delivery - I just haven't been in the right place at the right time so far. It was a lady that I had seen a couple of times in the outpatient clinic and had sent in for induction yesterday. So, it was nice to see her deliver a healthy, and very large, baby boy. All of the routine deliveries here are done by the midwives, so it was interesting to see how they do it - not too different from how we do it. The only stressful thing for me is that there is no monitoring of the baby during labor. I just kept thinking - wouldn't my call be easier if I didn't have to worry about whether or not a baby was crashing? :) The other thing I realized, as I went back in later to see mom and baby, is how alone women are here. No men are allowed on the maternity ward at all, not even during the postpartum period. Besides a midwife being present for the delivery, no one was there to be with her, to comfort her, to rejoice with her over the life of her new child. She just looked so alone - not quite the joyous scene you usually find in a delivery room. I'm sure that they are used to it, but it sure did make me sad.
I've seen other interesting things here as well. A lady was transferred in from a province about 4 hours away in a semi-comatose state. Two days after she delivered, she complained of a severe headache and then had a seizure. Following that, she couldn't move the right side of her body. She was supposed to come here that day. Instead, her family took her to a mullah (an Islamic holy man), who beat her to try and beat the evil spirits out of her. She is now clinging to life and almost completely unresponsive. It just breaks my heart that if these people would have better access to care, things like this could be avoided.
So, things have been busy. The OB fellows here (have finished residency, getting one year of extra training) are full of questions and eager to learn. They want me to give lectures on all kinds of things, most of which I can't give off the top of my head. So, this weekend (Friday and Saturday), I will be working on lectures. I am forming good relationships with them, though, and hope that I am more a help than a hinderance.
It is starting to get cold here now. At night it is in the 30's and during the day in the 60's. Thankfully, we just had heaters installed in our rooms yesterday.
So, that's what's going on with me. I hope everyone is doing well. Keep the comments coming - it makes my day when I read them.

Quick Note

Hello all! This will be very quick as I'm about to miss my bus. Just wanted to let you all know I'm alive and well (in case you heard about the bomb about 45 minutes north of here). We didn't even know about it here except through the news. Things are going well. There's just very little time to be on the internet as I can only be on it here at the hospital. I'm planning on writing a blog tonight and posting it tomorrow, though (it will be tonight for all of you). Thanks for all the prayers - keep 'em comin'!

A little overwhelmed

Hello everyone. Well, I have survived my first day of work at the hospital. It really wasn't that bad except for not being able to communicate and trying to learn a new system.
Backing up a little bit, the team flew out on Friday, after multiple mishaps trying to figure out when their flight actually left. I moved into the CURE guesthouse - where I have my own room with a double bed and a balcony. Some of the comforts we had at the other guesthouse, however, are missing here. No one to do my laundry, electricity only a few hours/day, and lukewarm showers with no water pressure. But, I have certainly survived worse and I know that it is still leaps and bounds better than what most people deal with on a daily base here. The house is pretty full right now - 2 family medicine residents from Oklahoma, an orthopedic surgeon and his wife who came here from spending 6 weeks in Africa, a Brazilian pathologist and a nurse who is half German and half Afghani. Oh, and a pulmonologist from New York who is originally from here. What a melting pot!
On Saturday, I went with the Afghan doctor to a teaching hospital that is associated with the medical school where he trained. He gave a lecture there (slides in English, but he spoke in the local language), and I was able to pick up some things. After that, I was invited to his niece's home, who is a FM intern at CURE, for lunch. It was wonderful! I got to experience home life in Afghanistan and we were served a feast, which we ate sitting Indian style on the floor. It was wonderful to really experience the culture.
Which brings us to today. The work week here is Sunday through Thursday. I spent all morning in the prenatal clinic. It was very busy and I saw lots of new patients. I had an "interpreter" who could speak only a few words of English for the majority of the morning. So, it was just a little bit frustrating. By the end of the day, though, everyone was asking to see the foreign doctor. I'm sure this was very frustrating for the locals, who are just as qualified, if not more, than I am.
I think it will take some getting used to schedules, etc, but I am really looking forward to the next few weeks. I must admit, though, I am a little homesick. I'm hoping that getting into a routine will help that.
I love and miss you all. Keep praying!

All by my lonesome

Good morning from Afghanistan! Yesterday was a good day. Our Afghan friend got us into Rabia Balkhi which is the largest maternity hospital in Afghanistan. It has received US support in the past. They were very welcoming and answered all of our questions. We are looking into starting a midwife training program, as midwives are key in this country to taking care of women and babies. They were very helpful for us. We asked about their needs and they have a lot. Their support pretty much just comes from the government and it is minimal. They need anesthesia machines, mammogram machines, pap smear supplies, probes for vaginal ultrasounds, laparoscopy equipment. So, if there's anyone out there who knows how to get their hands on some of these things, please let me know.
Then we go to tour the hospital. I was once again humbled as I saw protocols hanging on the walls that were right on with what we do in America. They really are trying to provide good health care, they just lack the resources they need. We saw 3 women who had just delivered. The midwives told us that it was a slow day, as they usually deliver 1500-1700 babies/month (not including operative deliveries)! We hope to establish a relationship with this hospital as well.
For lunch, we took all the teachers from the school up to the Intercontinental Hotel for a beautiful lunch buffet. They really enjoyed it and we spent a lot of time talking with them and learning more about their lives. Then, in the afternoon, we took all of the medical supplies we had brought over to CURE. They were so excited about them and were impressed at the amount (we pulled out some to give to Rabia Balkhi hospital). I'm really looking forward to getting started there.
But, there is one sad thing about today - the group from my church is leaving. It has been great reconnecting with them and it will be hard to see them go. I am thankful, though, that I have had this week with them.
One other piece of news - an internist that I know from home (Dr. Dee) was planning on coming over for 3 weeks and flying back with me. I found out the day I left that she was no longer coming, and I was pretty bummed about this. But, not to worry, I got an email today that her trip is back on. So, that's something to be happy about!
Hope everyone at home is well. Amanda, it was great to talk to you last night. Mom - try answering your phone!