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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 November 14, 2007 11:10 AM


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