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November 22, 2007

Back in the U.S.

Thanks to those hwo have visited this blog and I'm sorry I haven't kept up well since I left Kenya...it was just a little harder to get to a computer. Now, I am back in the U.S., in Rhode Island for Thanksgiving. I am still on Africa time, so I'll try to use this time before everyone in the house wakes up, to fill you in on my last days in Africa and the journey home. Then I'll try to get some pictures organized back in Michigan for a final entry.

Uganda, including my visit to the Abayudaya community, was wonderful. It was a chance to be in a Jewish community that is living so close socially to one another and close to the earth. It reminded me so much of kibbutz life in Israel which I experienced in 1991, but even more rural and rustic.

The community works, lives, and teams up so closely for so many needs, and it seems so much easier to do this there than in the U.S., probably because most doors are open and everyone walks rather than uses cars. The food is fresh as it is grown right there, and the prayers sung on Shabbat for example giving thanks for bread carry so much meaning. For a nice blog about two Americans living in Mbale, visit the blog of Adam and Maital http://mulembeuganda.wordpress.com/ . We had dinner along with Samson at a great Indian restaurant at the Landmark Inn and had a great time talking about life in Africa.
There are many challenges for the Abayudaya, including health care. For a day and a half, we provided dental services, which consisted of extractions only. In fact, there is only one dentist in the closest town, Mbale, and that dentist does extractions only. There was dentist who did fillings, but he left. I spent a lot of time talking with Samson, the community physician, about how we can change this with the building of the new Health Center. We would like to put a dental clinic in the new Health Center, one which provides preventive care and restorative care, with the goal that extraction should be a last resort and not a first choice. I believe we can do it, but I think it will require teaming up with others in the U.S., including dentists and dental supply companies, for their support.
Transportation is also very difficult and costly. Gas is up to $6 per gallon (2400 Ugandan shillings per liter) and with a typical professional wage of $3 per day for a nurse that means that walking, bodas bodas (sit on a pillow on the back of a bicycle) and shared transport are the only viable alternatives for most.

The journey back to the U.S. was long. Matatu (shared minivan) ride from Mbale to Busia, which broke down along the way, then another from Busia to Kisumu. I am very greatful to Aura, a young nurse I met on the matatu to Busia, who helped me when the matatu broke down and then guided me to a matatu to Kisumu and made sure I was on the right bus and would not get a muzungu price. She is an example of how kind I found the people in Uganda and Kenya. I met many people who were eager to help when I was lost, confused, etc., and this I will remember just as well as the beautiful countryside and delicious food.

I will close now nd will try to put in another entry once I have processed some more photos. I hope everyone has a Happy Thanksgiving!

Posted by szwetch at 03:55 AM | Comments (0)

November 18, 2007

Hello from the Abayudaya community

I hate it when a long blog entry (like the one I just wrote) gets lost because of power difficulties. I'm now back in Mbale Town, but earlier I was up in the Abayudaya community, which is like a village. It is very rural and the roads to get up there are quite difficult. Yesterday I spent Shabbat there, which was really nice and interesting. Today, I provided some dental care, which around here consists of mainly extractions, unfortunately. We also talked about trying to improve the standard of dental care in the future.

I'll try to write more about this community and have some pictures in future blogs...but it is now 7 pm and this internet cafe is about to close!

Posted by szwetch at 10:59 AM | Comments (0)

November 17, 2007

Hello from Uganda

I left Kisumu for Uganda yesterday after the completion of the Operation Smile mission. Before leaving, I unloaded some of my "stuff" by giving some hats and scrubs to staff at the hotel. I gave the security guard a nice Michigan hat. Then my friend arrived with a car that he borrowed from a physician colleague. It was quite a journey. My friend, Omondi, was kind enough to drive me to Busia, which is the border town between Kenya and Uganda. Driving out of Kisumu was quite a chore...so much traffic. Unfortunately, I realized about 5 miles out of town that I had left my laptop computer sittig on the sidewalk outside the hotel.

So, we drove all the way back to the hotel, which was cutting into our time, and all the way I worried if the laptop was still there. Fortunately, the gentleman who had my M hat found it and kept it securely for me. I was so happy! One of my goals in coming to Uganda, was to bring the laptop computer to Samson, from the Abayudaya community which was donated by Sid from Rochester, NY. I would have felt so bad if it was lost or stolen.

So I am here now in Uganda and will be going to visit the Abayudaya community, a Jewish community here near Mbale. I hope to talk with their medical director about establishing some future for dental care here. More in the next entry...

Posted by szwetch at 12:17 AM | Comments (0)

November 14, 2007

It's Wednesday...is that a goat following me?

It's Wednesday and I'm submitting this blog and pictures from an internet cafe in "Mega Plaza" (an indoor shopping center)...which, in case you're wondering, in on Ogingo Odinga St. in
Kisumu, Kenya. I walked here, and shared the sidewalk with a goat. The power has gone out in this mall twice. First time I had just logged on so I didn't care, and left for a few minutes to buy something at the supermarket next door. For some reason,
they had power. The supermarket was really crampmed, but modern. It reminded me of a grocery store in Manhatten. Then, I returned to the internet cafe and it takes forever for things to load on websites at the internet cafe. It is not dial-up, but worse!
It is yet another example of the really bad infrastructure in Kenya...roads, plumbing, sewage, electricity, etc. Well, after finally logging in and beginning to load pictures, the power went out again. Oh boy.

Monday we began working on the patients who had been selected for care after screening. There were many, many, primary lip repairs, and to be honest, very few obturators and
not many extractions that needed to be done. So this means I don't have as much to do as I anticipated. Monday was fairly busy, though, but Tuesday was less so.

Click below to read more of the blog....

There are three operating rooms...two of them each have two general anesthesia cases goin at a time, and one of them is for local anesthesia cases. Here are
Rose, a nurse anesthetist from Chicago, and Joana, a nurse from Richmond, VA, prepping a patient with a cleft lip for repair.

And here is a one-year old boy with unilateral cleft intubated and ready for surgery.

As you can see, there is a rotated and labially displaced tooth "E" and we have some discussions about whether these primary teeth
should be removed. On the on hand, leaving the tooth could irritate the wound and delay healing. On the other hand, if the lip is well sutured (which it usually is), then it could serve as an orthodontic force and lead to
improved contouring of the alveolus for the future. I tend to believe it's better to leave the tooth, and perhaps take it out down the road if
there's a problem. Don't throw the baby out with the bathwater, they say.

One interesting patient is Prisca, a 15 year old girl from Luanda, Kenya, which is about 40 kilometers from Kisumu. She lost the left ala of her nose in an altercation. Surgical reconstruction is n option,
but the ability to peform that is limited during an Operation Smile mission...so, we are making her a prosthetic partial nose. We took an impression and made a cast. Here is the cast:

And here is the sculpting that we came up with, first on the cast:

And on the patient:

Now, I will take this back to the U.S., process it, and mail it to my friend, Dr. Ben Omondi, for delivery.

Take a look at the burner I have to work with...it's a lamp that people use for readin who don't have electricity.

I'm also making an obturator for a 9-year-old boy who will not be scheduled for surgery for various reasons. He has a small fistula behing the premaxilla, and a soft palate defect. Here is the cast with block out wax and design,
however the cleft soft palate os not really visible.

And here is the obturator.

Tomorrow I will add the bulb for the soft palate and I hope it works out for him!

Last night we had Chinese food for dinner. Can you imagine, Chinese food in Africa?! Well, to be honest,
even though I'm enjoying the typical African cuisine, it does get a bit tiring to have it every meal! Typically the meals we have have a meat, either chicken (which is really good), tilapia (a fish), or beef stew, then there is a starch, either
rice, or ugali, which is like polenta, but made of a white maize. Popular vegetables include kale, cabbage, and other greens. I've learned to take relatively small portions, basically because I really would feel awkward throwing out any food around here. Well, you're probably wondering how African Chinese food is...it was really good! I totally recommend
the "Chinese Oriental Resturant", located on the ian drag here, Ogingo Odinga Street. Ogingo Odinga was the first Vice President of Kenya and was from Kisumu. His son, Raila Odinga is running for President. Elections are next month and people are there are rallies all over.

Here's another nice sunset picture, looking out over Lake Victoria.

Posted by szwetch at 11:10 AM | Comments (0)

November 12, 2007

Screening patients

Hello from Kisumu. I'm going to bring you up to date on things. Last Thursday and Friday, we began
performing screenings of patients. We are at the New Nyanza Provincial Hospital, which is the main referral area
of the province. First thing you see as you park is a mssion statement of the hospital painted on the outisde wall.
The hospital was built in 1969 and funded by the Russian government, as an effort by the communists to bring Kenya into the eastern bloc.
It feels like a hospital that might be found in the former Societ Union (not that I have any idea what I'm talking about!)
The locals refer to the hospital as "Russia"

There is an interesting poster as you enter the hospital, listing the services, charges, and waiting time! In case you're wondering, we don't have
this type of poster at the University of Michigan Medical Center!

As you can see below, the hospital has covered pathways and outdoor waiting area. There is no air conditioning, but decent airflow and some fans.
When we arrived towards the Operation Smile screening area, we couldn't believe the large numbers of people waiting.
There were infants with their parents with cleft lip, there were adolescents with cleft palates, and many others with a variety of problems,
including keloids, burn injuries, and some very interesting pathology. I saw some things that I
had never seen before.

Here are some pictures of the waiting area...

Each service had their own room...one for the speech pathologists (see below)

That's Erika from Sterling Heights, Mich. and Kristin from Kansas City...both speech pathologists.

Also ones for dentistry, surgery, anesthesia, pediatrician, and a lab. To be honest, if I had to make a recommendation
for the future, I would have liked for dentistry to be with the surgeons so that we could have seen the patients together and discussed their treament.
It didn't really happen that way. The patients were first seen by the surgeons, and then they went to different areas, and the last was dentistry. (Click the link for more)

We didn't have a great idea of what the surgeons had planned before we brought the patient for an exam,
and by that time we were backed up signficantly. Okay, I won't bother you with the problems, but let's just say
Thursday was VERY busy. We performed dental exams for 200 patients! Fortunately my new friend, Dr. Ben Omondi of Nairobi and Kisumu,
arrived to help. I couldn't do it all by myself. Below is a picture of Omondi examining a very cute boy named "Washington".

Speaking of really cute kids, have you ever known anyone by the name of "Loveline"?

If you look closely, you can see Loveline is holding a stuffed Mr. Potatohead. These were donated by Hasbro, which is
based in Pawtucket, RI, right near my hometown of Providence. I made sure to point out to the Kenyans that these toys came all
the way from Rhode Island. (But actually, I looked at the label and saw that they were all made in China (oops).

I mentioned that there was a great deal of interesting non-cleft related pathology. I'm not going to show these pictures, for privacy reasons, but if you are
interested, be sure to get in touch with me and I'll be happy to share these with you.

Here was the chair I had for sitting when I examined patients.

This really reflects much of what you see in Kenya. If items are in disrepair and there are no materials to fix them, they will continue to be in
bad shape. This is a poor country...no doubt, and this is a government hospital. There is not much money for repairs or new equipment. On the other hand, there is
plenty of labor, albeit low paid. I understand the nurses are paid $3 per day on average! The housekeeping staff is paid
even less. The housekeeping staff is very active. Even though the hospital is
low on equipment and repairs, there was not a speck of dirt or stains to be found anywhere. The
floors are swept and mopped, as well as the walls on a daily basis.

At the end of Thursday, the screening area emptied out. We were all exhausted.
I mentioned that the clinics were not airconditioned. We were also pretty hot.

When Friday morning came, as we ate breakfast we had no idea what to expect for screening that day. Would there be fewer patients,
because most people had sought to be first on Thursday, believing "first-come, first-served", or would there be more, because people
may contact their neighbors to tell them that we really were there and they should come. Well, the
former was true. We had a much smaller crew on Friday, and were even able to leave a bit before 5 pm.

Tomorrow is Monday, and we will start procedures for patients. I will be helping with extractions and making some prostheses. Of note, there
is a twelve-year old girl who lost part of her nose when there was a cooking fire in her home. As I mentione dpreviously, there are many, many poor people
in Kisumu who are living in small, shanty-like dwellings and very cramped quarters. They use the cheapest means possible to cook and fires are very
common, unfortunately.

I'll end again with the beautiful side of Kenya. It is now Sunday night as I write this, and today we went hiking through the jungles of
the Kakamega Forest, which is one of the last surviving forests in Kenya, and much of Africa. We saw monkeys playing in the trees and learned some interesting
things about the "social structure" of monkey families from our very knowledgable guide. When we reached the top of the hill, we had some nice views.

In the distance are the Nandi Hills. It is from here that come the great runners of Kenya. They live
at high elevations and have developed with higher hemoglobin levels, which allow them to run long distances with less fatigue.

Good night from Kisumu.

Posted by szwetch at 12:11 PM | Comments (0)

November 09, 2007

Day 2 in Kisumu

Day 2 here in Kisumu, and my eyes still bulge with all that I see. It is incredible.

By the way, the food is very good here for the most part. I know I have to be careful and avoid potentially dangerous foods, but so far I have found things to be tasty. The other day, I enjoyed for dinner fried tilapia in a spicy butter sauce. Delicious. And some friends had the chicken masala, which was equally good.

The Kenyans on the mission are very friendly and outgoing. There is Lois, the head surgeon, who has done Operation Smile for the past 20 years! And Stanley, the post-op nurse who is always asking me people’s names. I’ve told him five times that I am just as bad and can’t remember people’s names, either. We have a lot of blonde women in our crew, and I think he has a lot of trouble telling them apart!

Here are some pictures, for as you know, pictures speak a thousand words!
Below is the airplane we took from Nairobi to Kisumu. It was a short, 45 minute flight. But it sure beats driving…they say the roads are so bad, that it would have taken about 8.5 hours to go the 300 mile distance!

We arrived at Kisumu Airport. It’s pretty small.

But as you can see, even at Kisumu Airport you can find people text-messaging while they wait for their luggage!

Some schoolchildren watching planes take off…

I must admit, that the ride from the airport was an amazing culture shock for me. The streets are filled with people, and everywhere you look there is a makeshift stall where somebody is selling “whatever”. These stalls may be made from tree branches, from metal scraps pieced together, cinderblocks, etc. Or sometimes no stall is even needed…just sell! One woman is selling tomatos and plantain, while next to her a gentleman has shoes…and next to them is a “hotel” where you can stop and get a snack. Here are a few pictures…

Need your bike repaired??? There’s a place to stop for that, too!

Tomorrow I hope to share pictures from our first day of screening. Needless to say, it was a very busy day, and the amount of pathology is enormous. I wish I had brought my oral pathology textbook.
Best wishes from Kisumu, Kenya, and the nice view from my room at the Sunset Hotel.

Posted by szwetch at 09:09 AM | Comments (1)

November 07, 2007

Hello from Kisumu!

Our team arrived in Kisumu this morning. There are about 20 people from North America, and 20 from the local Kenya group. This includes surgeons, anesthesiologists and anesthetists, operating room nurses, pre- and post-op nurses, child-life specialists, speech pathologists, photographers, and a dentist!

We visited the hospital today and it is a bit on the old side, and quite sad walking through the wards. We definitely take our health care system in the U.S. for granted...we pay a lot, but we get a lot. (sorry...not going to get too public healthy...)

Africa is pretty amazing. There are many, many people and there is significant poverty. Streets in the towns look like one big flea market as everything is sold on the sidewalks. Boda-bodas are bicycles with seat on the back behind the driver fgor paying customers. I haven't ridden on yet! Oh...there are monkeys playing outside the hotel and I heard some growls from hippopotami in the lake behind the hotel.

Tomorrow we perform screening examinations for those patients who are coming for evaluations. Different stations for screening...by the surgeons, speech pathologists, anesthesiologis, and the dentist (me!). I'm hoping another dentist from Nairobi will join me but so far there have been logistical issues. You have to be really, really patient here in Africa. Things go at a snails paste. I've found that out and I've only been here a day!

Thanks for reading this blog and if you have any questions about Operation Smile and/or Africa, fire away...I'll try to answer.

"Dr. Z"

Posted by szwetch at 01:28 PM | Comments (1)

November 01, 2007

Leaving next week!

Next week I'm off to Kenya for Operation Smile, and as a new added twist, I'll be going to Mbale, Uganda, to visit the abayudaya community and talk about their dental issues. I've been really impressed by the generosity of so many who I have asked to help me bring things. Example: Uhler Dental Supply in chicago sent me 1000 sets of denture teeth! I asked them for 12, but now I have enough not only for this mission, but probably for all future Operation smile missions for the next 20 years!

So be sure to visit in the weeks ahaead...I hope to have some interesting stories and pictures. Feel free to post comments and ask questions.

Posted by szwetch at 10:25 AM | Comments (0)