The Horn of Africa

I went to Group Hospital this morning and, after two previous strike-outs there, spent the better part of four hours in the operating theatre with the Chief of Surgery, Dr. Sulaimon. (My favorite Neil Diamond song too. Double trouble!)

 

Our first case of the day was a thyroid adenomectomy. We used local anesthesia (lidocaine) and spent an hour digging our way down, easing the gland up out of the fascia, and then cauterizing off the vast majority of it. Zzt, zzt. I quite like the electro-cautery pen. As we closed things up, we put in a tiny tube for drainage. I've written "we" here, but I was only observing on this case.

 

Dr. Sulaimon invited me to assist on the second case. It was a prostate gland removal -- open prostatectomy. We cut into his abdomen first, then slowly cut our way down to his bladder. There we aspirated fluid with a needle to make sure we were in the bladder, not the intestine. Everything looked good, so we cut into the bladder and then had another assistant insert a finger into the patients rectum and push the prostate up toward our incision. Once we were certain of the positioning, we cut into the floor of the bladder and Dr. Sulaimon used his fingers to excise the prostate. After that, it was catheters in, suturing, a drainage tube, yadda yadda. Today's procedure was fairly simple really. It's the follow-up, recovery, complications, etc, that're potentially difficult.

 

Our last case was the removal of dead tissue surrounding an ulcer on the bottom of the foot. Our patient was young, strong, not diabetic, and had the ulcer for 12 years. When we removed the bandages from around it, the room was filled with an intense smell of BBQ. The ulcer itself was approximately an inch and a half in diameter, and necrotic, rotting tissue puffed out a good half inch for the inner 85% of that diameter. Dr. Sulaimon used the cauterizer to cut the tissue off, leaving a large hole.

 

As he worked, smoke curled up from the wound, filling the room with the smell of burning flesh. I was thankful for this. It smelled bad, sure, but it was expected bad -- the "cost of doing business" as it were. The BBQ smell was bringing back memories of cooking on the patio at work, the delicious BBQ restaurant in Oakland, etc. I was consciously trying to prevent myself from making the associations but as I smelled the meat cooked for dinner tonight, it seemed to smell exactly like that man's foot.

 

 

The hole will be packed with betadine-soaked sterile gauze for months, I think, as they hope the tissue granulates and starts healing. It's possible that it could heal and fully close and he'd be able to walk normally for the first time in over a decade. Judging from some of the slides shown at the "Advanced Wound Healing" presentation at this years AAPA conference, I'm not especially optimistic. They don't use silver nitrate here and they certainly don't use advanced techniques like applying vacuum pressure to the surface of the wound.

 

We had two more surgeries scheduled but they were both cancelled. The first, a hernia repair patient, had a terrible cough. The other scheduled surgery was for a man who fell off a wall, catching his crotch on the way down, who had "urethra damage." For whatever reason he ended up eating breakfast that morning so we couldn't operate.

 

I'll be returning to Group Hospital on Tuesday morning for more surgeries with Dr. Sulaimon. For those of you keeping score: I wasn't even a smidge queasy during any of the stuff.

 

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After lunch, I hopped a taxi over to Diana's office today. She works for EDC, the Education Development Center, on a project called SIRIP: Somali Interactive Radio Instruction Program. They're writing scripts and producing radio shows to help educate the populace. Teachers, even in rural areas, will be able to tune in and listen to the program and guide students through exercises, stories, etc. Diana is a school teacher from Houston.

 

A few days ago, her husband, who's a concrete contractor with KBR in Iraq, came in to town and I joined them both for dinner two nights ago. Diana made Louisiana gumbo and it was delicious. Afterward, we played Monopoly. I thoroughly trounced them, taking early risks that paid off big-time later, trying not to snicker as I mercilessly drove them into the ground. The Monopoly set they had was Houston-themed. Boardwalk was NASA, one of the orange properties was the Astrodome, etc. My player token was an armadillo.

 

Afterward, we talked about education in the country, the dangers of travelling, etc, and I mentioned my upcoming Daallo flight. Diana mentioned that one of EDC's staff members was recently ambushed on a road outside Mogadishu. She was robbed and her driver nearly died from gunshot wounds to his legs. In the last few years, she's worked on contract, usually for a year at a time, as a teacher in China, Abu Dhabi (UAE), etc.

 

When I went and saw her today, she'd printed out a funny joke one of her staff had found. I've copied it below.

 

One of her co-workers is a Somali who grew up in the US from age 12 on. He's in his early 40s now, with a PhD, and has returned to Somaliland to coordinate this project. His name is Said. He and I spent a few hours talking, covering everything from George Bush to female genital mutilation to chewing khat to promiscuous Somali girls (!) to raising quadralingual (or pentalingual?) kids. I'd met him at the "ex-pat party" previously (it was at his house), but hadn't spoken about anything of consequence. This afternoon, I greatly enjoyed his company.

 

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Diana's gift was a sheet of paper. She handed it to me with a big grin.

 

It read, "Welcome to Daallo Airlines! Good morning, ladies and gentlemen. This is Captain Sharmaarke welcoming both seated and standing passengers on board Daallo Airlines.

 

- We apologize for the four day delay in taking off. It was due to bad weather and some overtime I had to put in at the bakery.

 

- This is flight 126 to Hargeisa. Landing there is not guaranteed, but we will end up somewhere in Somalia. If luck is in our favor, we may even be landing on your village!

 

- Daallo Airlines has an excellent safety record. In fact, our safety standards are so high that even terrorists are afraid to fly with us!

 

- It is with pleasure that I announce that starting this year over 30% of our passengers have reached their destination!

 

- If our engines are too noisy for you, we can, on passenger request, arrange to turn them off.

 

- To make your free fall to earth pleasant and memorable, we have complimentary tea and laxoox!

 

- For our not-so-religious passengers, we are the only airline who can help you find out if there really is a god!

 

- We regret to inform you that today's in-flight movie will not be shown as we forgot to record it from the television. But, for our movie buffs, we will be flying right next to British Airways and their movie will be visible from the right side of the cabin.

 

- There is no smoking allowed in this airplane. Any smoke you see in the cabin is simply the early warning system on the engines telling us to slow down!

 

- In order to catch important landmarks, we try to fly as close as possible for the best view. If, however, we get a little too close, do let us know. Our enthusiastic co-pilot sometimes flies right through the landmark!

 

- Kindly be seated, keep your seat in an upright position for take-off, and fast your seatbelt. For those of you who can't find a seatbelt, kindly fasten your own belt to the arm of your seat. For those of you who can't find a seat, do not hesitate to get in touch with a stewardess who will be happy to explain how to fasten yourself to a suitcase."