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)