Tuesday, October 22, 2013

Toys

I arrived in Senegal at 5:30 am, exhausted, but scheduled for meetings at the hospital. I didn't sleep at all on the plane, and by 10 am my limbs were trembling from exhaustion, physical and emotional. The first day in Senegal is always the hardest for me. I got bad news about a week ago; a two year old who I had been trying to help get relocated to the US for a bone marrow transplant had passed away.

Of all the children who I was close to and worked with when I was here in 2012, only one is still alive. She is three years old, from Ziguinchor. Her name is *Aminata. She is so cute, and has a different hair style every time I see her, even though her hair is super short. Sometimes she has it in tiny braids, other times in an afro, and other times her mom puts something in it so that it looks more straight. I took an immediate liking to her because she is so cheerful and she'd try to talk to me in wolof. Every time I saw her she would have this huge smile. She liked to feed me things, but I knew her hands were really dirty (because I saw what and where she played) so I wouldn't eat them. She would peel an orange really messily, pulling off chunks of the fruit while leaving some peel on, and shove a wedge of that into my own germ ridden hands. Or she'd get a slice of apple, put it in her mouth and eat part of it, and then share it with me. I'd always pretend to eat it, but then I'd hide it and put it back on her plate. Not sure if 3 year olds are smart enough to know that trick or not.

I wasn't expecting to see her, since I thought she goes to the clinic on Wednesday. She has abdominal lymphoma, so her stomach is always swollen; she kind of looks like a tiny pregnant person. I was walking through the hallway with my supervisor when she ran out. When I saw her, the first thought that came into my head was, "thank God she's still alive." She was wearing a traditional Senegalese dress, and she smiled at me.  I was so happy to see her, I almost picked her up and gave her a hug. Instead, I took out a big box of M&Ms which I was supposed to share with the entire ward and I handed the entire thing to her. I'm not sure if she knew it was food, because she kept rattling it like it was a toy, so I explained to her mom that it was a candy.

I am worried though, because Aminata's arms and legs have become so skinny, and her stomach looks bigger than before. So much skinnier than before. It scares me because I saw a dying child last time, and he looked like that--swollen belly, and emaciated arms and legs. That child was also 3 years old. I didn't know him, because when I arrived he had been on his death bed. He lives 20 hours away from Dakar, and before they hooked him up to the respirator he kept saying that he just wanted to go home. Kids don't like the hospital. It's boring, and they get pricked with needles, and have to eat medicine. The doctors were debating whether to allow him to go home. They were going to pay for a cab to take them, but they concluded that he could not make the journey alive--and also there would be no morphine for him when he got there. He was in the hospital with only his father because his mother had just had a baby. Since they concluded he couldn't go home, she took the 20 hour car/bus ride to Dakar so she could say goodbye to him.

I feel more sad in Senegal because it's right in front of me. The kids that I became attached to were all in the intensive care unit. By logic, I guess I knew that they were the more severe cases; that's why they were at the hospital more often, and that's why I got to talk to them more. During my first trip, I thought all of them would survive. I thought it was sad that they had cancer, but I had a lot of hope for them, and the cure rate is supposedly 60%. By now I realize that the 40% is probably comprised mostly of the kids in the intensive ward, my ward.
 
I was stressed because I didn't bring enough stuffed toys for everyone. I only brought six. And on my way to the hospital, the doorman at the hotel commented that he has a 7 month old daughter who is very sick, and has a problem with her arm and her jaw and is pretty much handicapped. So I gave one to him and only had 5 for the hospital. I decided to let Aminata choose one, and then put the rest in the psychologist's office. That way, all the kids could take turns playing with them. When I gave her the toy, she smiled, but then seemed tired. She didn't react like how a normal 3 year old child reacts. She normally stays only for a few hours, but today she has to stay the entire night. I don't know if she has gotten worse, and I don't really want to ask.

When the other parents walked in and saw that I gave something to Aminata, they began asking for toys for their own children. There is no privacy in the hospital because there is not enough space. I had to apologize and say that I couldn't because I didn't have enough for everyone. I had a certain number of toys for the people I knew--but they had all passed away. I felt bad because there were kids looking at me because they wanted a toy too. They have IVs in their arms, and they walk towards me, rolling their IV bag with them. I felt so awful, like a toy nazi who gave only to one and not the others. I tried to explain that I knew Fatima and she was special to me, which might have made it worse because that implies that the others aren't special. I should have just packed more toys, although I wouldn't have had room in my suitcase. In the end I said I'd put them in the psychologists office and they could all take turns playing with them.

Tuesday, October 1, 2013

Surgery and Recovery

I've done so much work on health care in Senegal, so here is a chance for me to write about health care in the US, specifically New York. Of course I thought it was pretty awesome, since all I've really seen are cancer wards in Dakar and geriatrics in Taiwan.

On September 25th, I went in for surgery. I had to push back my plans to go to Africa due to a sudden and urgent medical issue with some ovarian cysts. While I had had cysts for some months, normally they would go away on their own. This time however, I had two abnormal cysts that grew significantly larger over time--one was a cyst with septations, the other was a dermoid. I began having more pain, and other symptoms like nausea and occasional vomiting. Smells on the street, especially in the morning, would make me dizzy. The week before I was supposed to fly to South Africa, I found out that the cysts had grown to 7.5 cm and 3 cm. Considering that I am a fairly small person (5'3" and 120 pounds), they were taking up a lot of space in my body and were in danger of causing my ovaries to twist--in which case I would lose my ovaries unless I got to an ER in time.

As a result, my doctor advised me to cancel my trip to South Africa and postpone my work in Senegal so we could remove the cysts. I was really sad because I have never been to South Africa before, and am always excited to add a new country to by blog. However, I have first hand knowledge of how bad hospitals in Senegal are, and could not risk having an emergency while in Dakar, or during the long flights.

My mother flew in to help me out. Before the surgery, I had to drink this awful beverage that cleans out the body by inducing massive diarrhea. It tasted so bad, even with the flavor packages. I guess my stomach is not so big, so I ended up feeling too full and being unable to drink it--the instructions said to drink a half gallon every hour and a half. However, I missed the part about not eating any solid food 4 hours before taking it, so I got a really bad stomach ache. I drank about 3/4 of it and then poured away the rest, while my mother squawked and swore that she too would throw her medication away later just to spite me and make me worry.

On the day of the surgery, some emergency happened at the hospital, so everything was moved back significantly. My surgery, which I thought would be at 12, was going to be moved to 9:00 pm. As we were in the waiting room, I started to feel dizzy because I hadn't been allowed to eat or drink anything since taking the diuretic at 6:00 pm the day before--there had been nothing in my system for almost 24 hours. Luckily, a girl who had a surgery for the 6:00 pm slot was willing to switch with me since my case was more severe than hers. I went in at 6:00.

I was a bit nervous since the room was cold, and there were bright lights over head. However, I lay down on the table and a large, friendly eastern European doctor grabbed my arm and jabbed a needle into it. "Now you fill nothing more," he announced. Sure enough, I passed out.

When I woke up, I was in the recovery room. I had a panic attack because I was in more pain than I had expected to be in, and was still really cold. The nurses wrapped me up in heated blankets, and allowed my mom and friend to come in and see me. The surgeon had made four incisions in my belly to remove both cysts. I ended up having two more panic attacks, which is strange for me since I've never had any. In general, my pulse is low, but my blood pressure dropped to the 40s and my heart rate was in the 50s, and I began thinking I was having an asthma attack. I ended up being perfectly fine.

I got excellent palliative care in the hospital, with fentanyl and oral opiates to take home. I think I am now in a place to better appreciate palliative care, even more than I did before, simply because I was in so much pain even with my medication, to go through the process without pain relief would have been gruesome.

Today I went to have my stitches taken out, and am recovering at home; my mom has been helping me out a lot. Will go to Senegal in late October!