Happy Thanksgiving

When I woke up on Thanksgiving, I wasn’t feeling particularly thankful. This was the third day without power, which also means no hot water and no shower. We do have a generator but only one apartment can have their water heater plugged in at time. And none of us had it plugged in since we kept expecting power to come back on any minute. The temperature reading on all four tanks was far away from any reading that resembled warmth and it would take a while for one to get warm.

We have been very fortunate and had power most days since I arrived. When we do lose it, it has only been for a few hours and at most over night. Not this time.

Since we don’t have central heat, when the power is out the electric heater in my bedroom doesn’t work. My other option for heat is the propane heater in my living room. Theoretically I could fall asleep with it on since it’s vented outside and not worry about carbon monoxide poisoning, but I’m not going to risk it. Between the lack of power, 3 days without a shower and my bones feeling cold, the homesickness hit with a hammer.

As I was lying in bed having a personal pity party and heard the rumble of the generator, my cell phone rang. Why is someone calling me at 8am? It was Rick and he wanted to see what time we could all have a pre-meeting about the project meeting we had later in the morning. All’s I was thinking was “great, a pre-meeting meeting on Thanksgiving.” I agreed to 9:30a and as we got off the phone thinking, well I was thankful for the generator but I’d rather be home.

Thankfully the day and my mood improved dramatically. Our actual meeting was at a military base and was followed by Thanksgiving dinner with the troops. As we waited in the chow line, the sun was out and the view of the snow-covered mountains was spectacular. The food inside was the biggest spread I have ever seen and had almost all the treats of home. As a bonus, they were replaying the UCONN men’s basketball game on TV.

On the ride home, we joked about how crabby all of us were in the morning and we realized how wonderfully we were provided for today, even the small ways. When we arrived at home, the electricity was on!!

Happy Thanksgiving!

A Wish

I celebrated my 35th birthday this week. I think being here distracted me from focusing on the actual number. The inauguration was Thursday and I was worried that would limit our plans for the weekend. Thankfully things were quiet on Thursday and by Friday afternoon we were allowed to travel.

The celebration on Friday started with a walk to a near by restaurant. The sun was out and it felt fantastic to be able to stretch my legs. Those opportunities to get out and walk are few and far between when you live here. Being able to go for a walk was such a nice present. After lunch I came home and took a nap, another treat. For dinner the whole gang went to a restaurant that serves one of my favorites; nachos! We had a great time, laughing, eating and drinking with no or very little talk about work. I haven't laughed that hard in a very long time. We spent a lot of time comparing those "not-in-Kansas-anymore" stories. These are the real stories and if we shared them people would really wonder why we are here.

Saturday the celebration was going to continue with brunch at a fancy hotel. Except last minute we were placed on travel restriction and couldn't go. I could slowly hear the air leaking out of my birthday balloon. We rallied, ordered pizza and watched a movie. Not a bad way to celebrate but I was disappointed. In hind-sight there was some divine intervention, later on Saturday that hotel was hit by a rocket. I don't know if we would have still been there. I didn't hear how bad the damages were and I'm not sure if there were any casualties. Either way, it helped put my disappointment over my birthday plans in perspective.

Today one of my nurses, her husband died and now she is a single mom. He was admitted over the weekend and had been chronically ill for a long time. Today I made time to stop by and check in. As the day progressed I could tell he was getting worse and it wouldn't be much longer. With my very limited language skills, I really had no idea what to say. All's I had to offer was a hug.

I'm not sure what the customs are for funerals but I can tell you that grief is the same. It was heartbreaking to see the family lamenting outside the hospital as he was placed in the car. The poor son, fell to his knees and sobbed in the grass. Back home, I'd bake something and bring it to her house. Maybe even a group of us would plan how many nights to bring meals over. I wonder what people do here to show their support. I'll ask some of the staff in the morning but for now, I wish/hope she has the support she needs.

Keep Smiling?

A Pep Rally

Last week was a busy week. We had a visit from Head Quarters and a team of five arrived. The team consisted of a Senior Vice President, a Board Member, the founder’s wife, a member of the development team and a radio talk show host. I wasn’t sure what to expect from the visit and had visions of it being like a giant inspection. Instead it was like a week long pep rally. It was a little chaotic and a little stressful at times but overall it was encouraging to have them out. The bonus about their visit was we went out to eat every night and I didn’t have to cook at all.

The team arrived on Sunday and that evening we had dinner and a team meeting. We made the introductions and each of us talked about how we ended up here. On Monday they arrived at the hospital, had meetings with the department heads, and were given a tour and a rough schedule was set for the week.

The hospital staff was really interested in meeting the “American Visitors.” We held a mini-all staff meeting and provided everyone an opportunity to introduce themselves and ask questions. About 25 staff attended the meeting and it was a good representation of all the departments, both clinical and non-clinical. I was a little nervous about what questions the staff might ask but overall it went really well. Staff was mostly concerned about how the current economic situation in the States will impact our funding and ability to raise support for the hospital. They asked a lot of questions about long term plans and if we were going to open more clinics around the country.

My favorite part of the week was when we took some of the graduates from our Residency program, who are now Attending’s and working at the hospital out to dinner. It was great to see the Doctors outside of work and get to know them better. The conversations were fun and light hearted. I think the visiting team and the doc’s really enjoyed themselves. I know I did.
Overall the week was great, exhausting but great.
Keep Smiling!!

Training Day

Last week I had an opportunity to visit two of the villages near our out-patient clinic. The clinic is about a kilometer from the hospital. We are in the process of starting a community health worker (CHW) program. The purpose of the program is to train volunteers from the surrounding communities to be health educators for their villages. These volunteers will be our eyes and hears in the community and help us better meet the physical needs of our community. In graduate school I read a lot of articles about using CHW’s in international settings and I am so excited to be a part of rolling out this program.

We have already met several times with the village elders to explain the purpose of the program and what we expect from the CHW’s. Most of the elders seemed really excited about it and were eager to be involved. It was up to the elders to select the volunteers, based on certain criteria. The elders also provided us with some topics and programs that they thought were the biggest health needs for their villages.

The first village we went to is a Tajik village and we met with 12 women in the house of one of the women. The education we will do in this community will occur after their religious studies at the mosque. It was exciting to hear that they have already identified a time and a place that we can meet with a large group of women. During the meeting the women had a lot of questions about the H1N1 flu. An interesting question they asked was if swine flu was a real disease or just some political agenda item. I was able to explain it is a real disease and I also took the opportunity to tell them a few key ways to prevent the spread; i.e. hand washing and covering your mouth when you cough or sneeze. I felt a little silly talking about the importance of eating right and getting a good night sleep when the poverty in this village really limits what they have available to eat.

The second village we went to is a Hazara village. Here we met in the education building which is next to the mosque and we met with 8 about men. The topics they are most interested in are hypertension and respiratory illnesses (asthma and COPD). H1N1 was never mentioned. Air pollution is a huge problem here and many adults have chronic respiratory issues.

Later that afternoon the 14 trainee’s arrived for their first session. The goal was to again explain the expectations and determine how many times a week they would be able to attend class. It was exciting to me that the majority of the trainee’s are female and that one of the village elders wants to be a trainee. The part that was funny was that the only thing they seemed interested in was when they would learn how to start IV’s and give injections. We spent a lot of time explaining that we aren’t going to teach those skills, at least not yet. I don’t think I have ever seen such enthusiasm around “poking” people.
This week we have had 2 training sessions, the attendance and level of interest seems to be holding even if they can't "poke" people.
Keep Smiling!

Be careful what you wish for

I confess that there was a part me, the infectious disease/infection prevention side that was slightly envious of the H1N1 (swine flu) situation back home. I felt like we had been talking about the big outbreak of bird flu for years, so what if we confused the animal, bird, pig whatever. I wanted to see how it all played out. I spent a lot of time reading about influenza, learned about how the vaccine is made, how effective it is, wrote a paper on it for school, studied how it’s transmitted, the incubation period, and tried to lay the ground work for encouraging behaviors that would prevent the spread of flu before the big outbreak hit. And finally when it hits, I’m not there.

I suspect you are reading this and thinking I’m a nut case. And foolish of me to think I wouldn’t be involved if/when it here. The difference, I felt slightly more prepared to handle it back home. I’m less sure about how things will play out here.

We had our first emergency preparedness meeting about this yesterday. The Ministry of Public Health (MOPH) announced the night before that they were closing ALL the schools in the country for the next 3 weeks. I don’t know what the absentee rate has been or even how many confirmed cases we have. I think it’s some where between 250-300. We have seen a few outpatient suspected cases. No staff has been out with influenza like symptoms. Not yet at least –thank goodness. But each day, more and more people are seen in the community wearing masks. Women are wrapping their headscarf’s around their nose and mouth. I am giving my elevator speech on hand washing but I think the next few weeks are going to be really interesting on a lot of different fronts.

Keep Smiling!!