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Tim’s Daily Nigerian Times (Day 14)

March 6, 2008 – Day 14

After enjoying the last breakfast at the guesthouse (warm biscuits and jam) we set off to the hospital to perform a last minute cysto and tie up a lot of loose ends. The cysto patient was a no show and that allowed for us to split up all the jobs – paying multiple bills, picking up some finished sewing, giving out some donations and gifts, handing over the numerous patients that we had operated on over the last couple of weeks. On a personal note, it was interesting to see how our urethroplasty patient with buccal graft did over the 2 weeks. We never see those patients every day and I think it was interesting to see him each day and the course of his convalescence (the patients in Nigeria don’t believe they are getting their money’s worth if they are sent home “prematurely”) and he’ll stay until his foley comes out 3 weeks postop.

We then had enough time to dart out to the HIV widows quilting shop and got some last minute shopping. Many spent more than they planned when we saw the wares and it couldn’t go to a better cause. The beautiful fabrics of the region were on display in a traditional art form (apparently they do American style quilting….whatever that means) J…

We popped back to the VVF clinic and the OR for a final lunch of rice/pounded yam and the red stew. It was nice to have the time today to say a proper goodbye to all the new friends that we had made. Many nice and thoughtful words were shared on both sides. Lots of “Kodak moments”. With a tear in our eye we set off back to the guesthouse to pack up for Abuja.

After bringing out the baggage we realized that there was no way we were going to fit all the baggage in the back of the Peugeot station wagon. Fortunately Sunday and Chima arrived with the upgrade – Land Cruiser. Despite the upgrade we still ended up sitting four in the back seat…with Pauletta on the floor behind Tom’s seat. With knees and elbows everywhere, backs cramped and everyone hot (and most of us smelly), we set off. Another truly Nigerian experience. The trip was as harrowing as I remembered from the arrival, with multiple passing attempts being “white knuckle” moments, although Ezekil did an excellent job of avoiding other cars/potholes/bikes/motorbikes/people/goats/roosters thanks to his trusty car horn. With bags all around (and on top) of us we pulled into the Abuja airport….

The Abuja airport (aka Danté’s Inferno) was as hot as I remember. I was the only one in shorts and I was sweating buckets. The long lines and cramped quarters made me glad that we had come several hours early….After negotiating security, check-in, 2 surveys, and emigration we sat down for quick and well-deserved beer in front of the only (and small) air conditioner. The ice cold Heineken and Pringles were a very satisfying dinner. We then had to say goodbye to Tom and Susan as they were taking an earlier flight to Amsterdam. I am sure that we’ll sit down for a dinner/drink at the AUA. After seeing them off, we waited for our flight – basking in the glow of the icy cold A/C. We were called in a couple of hours prior to our departure into the preboarding lounge (after another security check). Even though I didn’t believe it, it was true….this room was even hotter.

Equipped with bright lights that were blinding if viewed from the proper angle in addition to the 110+ heat, I felt like I was in an interrogation room from the former Soviet Union. After an unending session in the hot box, I was ready to give up any of the classified information I was privy to…fortunately they called us to board just as I was about to break down. Realistically, how much information can you give up as a Canadian? The specs on the 6 helicopters we have available for military service? J

We got aboard and fell asleep quickly. Economy class seating seemed like first class when compared the car ride down….

Tim’s Lesson of the Day:
“Traffic rules aren’t a bad idea”

Tim “Blogman” Davies

~Catherine deVries

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Tim’s Daily Nigerian Times (Day 13)

March 5, 2008 – Day 13

As we wind down the last full day in Jos, I’m realizing a couple of things, one of which I will miss the breakfasts in the morning (French toast again this morning). Another epiphany was the fact that I have really grown comfortable here in Jos. It was a seamless transition from anxiety about going to and performing surgery in Nigeria, to now comfort in a new location/OR. It is amazing to see what these surgeons can do with very little in the way of instrumentation and equipment. The term general surgeon definitely means something here. It really tests what a new grad like me has learned about urology. I have learned much from the more senior urologists on the trip and from the local surgeons as well.

We set off to finish up the remaining cases. A couple of PV Slings, 2 more injections for bulking agents and we managed to fit in a couple of last minute cystos. As usual a lot of pathology was around. 2 obliterated bladder necks and a couple of bad strictures were seen on the cystos. But a failed catheterization from another hospital resulted in the worst urethral perforations Tom has seen in 32 years in practice(fat all around the membranous and bulbar urethra). Throughout the day in the OR a plethora of interesting cases rolled through the door – a fungating axillary carcinoma, myelomeningocele, open tibial fracture, flexor tendon repair, all in one day. Wow!

As we winding off the trip, the paperwork has really picked up and last minute consults have really come up today. We do the best we can in the short time that we have remaining. We returned to the guesthouse for a quick Sloppy Joe dinner and more paperwork. We were bid adieu with another sing along from the other group staying with us which thankfully stopped just before 10pm. We gratefully fell asleep in silence….

Tim’s Fact of the Day:
The city of Jos is actually the initials for “Jesus our Savior”

Tim “Blogman” Davies

~Catherine deVries

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Tim’s Daily Nigerian Times (Day 12)

March 4, 2008 – Day 12

Another All-American (or in my case – Canadian) breakfast of eggs and toast. We spied the “Quick and Easy Cookbook” in the kitchen this morning – one quick glance told us this was the secret to the meals we had been receiving.

We started off the day with a couple of cystocele repairs with PV Slings with fascia lata. We were able to harvest plenty of fascia with 2 pretty small incisions over the lateral thigh in the first case. In the second case, the fascia was harvested in 1 incision for both the sling and the cystocele repair. The second case was performed by Dr. Sunday Lengmang, with Susan assisting. They both went well. Tom chipped in with the general surgeons as they perfomed a suprapubic prostatectomy and a cysto that revealed a large stone in the proximal bulbar urethra. We looked at our limited options and decided that an open urethretomy was his best option. I certainly haven’t seen one of those in my residencies!

*During the day, I had the unexpected pleasure of having my wife call to see how we were making out. It was very sweet of her. I can’t believe she was able to get a call through to be honest. She reached the VVF ward office and Pauletta was right there, she checked to make sure that it was my wife and ran the 500m to the OR to get me. When she arrived she could only say 2 words breathlessly: “Wife” and “Phone”. She then collapsed to the ground unconscious….disaster was averted when Simon the local anaesthetist began to perform CPR. A few cracked ribs later we had her back performing urodynamics.and I was on the phone with my wife.

We finished off the day with a couple of PV slings, and all the procedures went well. We had another long day with our arrival back to the guesthouse at 830PM. A quick burger and fries (although not sure if it was hamburger), although not exactly like home, prior to sitting down to do some

Tim’s Lesson of the Day:
“Check with your physician before starting an exercise program (or run to give someone a message)”

Tim “Blogman” Davies

*Portions of this paragraph may have been fabricated/exaggerated for effect (Don’t worry Paul, Pauletta is just fine)

~Catherine deVries

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Tim’s Daily Nigerian Times (Day 11)

March 3, 2008 – Day 11

Awoke with the sweet smell of pancakes and syrup making its way through my Sahara sand filled nose to my smell receptors…..

After a lovely weekend we are back to the daily grind. We have really settled into a groove here. We have been splitting up rounds to be efficient prior to the OR getting started (although there is no rush as the 8AM start is Nigerian time). We have been reviewing the patients the night prior, with Susan cranking out the paperwork like a champ. The patients undergoing UDS have their results reviewed and plan outlined the day after the testing.

We performed 2 more PV Slings today and 2 bulking agent injections in the OR. Thankfully all were uncomplicated. We have started the transition from teaching the procedures to having the local surgeons performing the operations with our guidance. I feel (as a recent resident) that I can relate to their process pretty well.

These days have been pretty long as we return back to the guesthouse after dark every night, eat dinner and sit down to do paperwork/review patients until we are all pretty sleepy. This definitely isn’t a vacation…..

Tim’s Lesson of the Day:
“Monday’s come early in Nigeria too”

Tim “Blogman” Davies

~Catherine deVries

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Tim’s Daily Nigerian Times (Day 10)

March 2, 2008 – Day 10

We ate, we napped, we did paperwork and blogged. Nothing interesting happened.

Tim’s Lesson of the Day:
“Sleep when you can”

Tim “Blogman” Davies

~Catherine deVries

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Tim’s Daily Nigerian Times (Day 9)

March 1, 2008 – Day 9

We were all looking forward to a well deserved weekend away from the hospital. Again we started the day with a French toast breakfast with warm syrup. Kingsford (Bill’s driver), came by to pick us up for a day of local shopping.

We dropped into an art shop and some fabric shops prior to lunch. Kingsford was a masterful shopper providing us with much needed savings. The shop owners didn’t have a chance when he started in with his strong-armed negotiation tactics. They have the brightest fabrics with the most vibrant colours here. All the local women wear them fabulously. After spending our cash, we managed to save enough for lunch at the Net Café. Not surprisingly, the internet connection was down again and Pauletta’s academic prowess was slowed by the lack of communication. We made a couple of other quick purchases prior to heading back to the guesthouse.

We had to say farewell to our fearless IVU leader Catherine as she had to return to the U.S. Again, Ezekil was kind enough to drive one of us back to Abuja to catch her return flights. And then there were five…

Bill returned to the guesthouse to take us to the local school’s carnival for the elementary students. Hillcrest School has approximately 250 students(K through 12) and the grounds were impressive for such a small number of students. They follow the California curriculum and many of the students (both missionary and local) carry on to college – either Nigerian, American or European. This private school certainly provides a good education and multicultural experience for all who attend. The carnival, put on by the high schoolers, seemed to hit the mark with all.

We then returned to Bill’s house (on the Evangel Hospital grounds) for another meal. We were very happy to spend the afternoon and evening meal with his 4 kids and his wife Dorothy. After some chili, we had a pleasant conversation with the 2 of them. Bill had told us a little of his surgical experience, but we were all impressed by Dorothy’s good work. There isn’t room here to explain all of her exploits, but her most recent projects – Seeds of Life(to feed the widows and orphans) and recycling wedding dresses(including hers) to give the widows a chance to get back on their feet are worth mentioning. After a fascinating and insightful evening with Jos’ “power couple”J, Bill was kind enough to return us back to the guesthouse.
Tim’s Lesson of the Day:
“It’s true that one person can change the world”

Tim “Blogman” Davies

~Catherine deVries

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Tim’s Daily Nigerian Times (Day 8)

Feb 29, 2008 – Day 8

I have never eaten as many hearty breakfasts as I have on this trip….again with a large serving of scrambled eggs and toast. We can’t seem to get away from eating big meals at each sitting. We have a large lunch each day served by the staff at the hospital. All of us feel guilty if we don’t have it, not that Simon gives us a choice : ). I suspect that we will all put on a couple of pounds over these 2 weeks….when we return everyone will ask – did you leave any for the starving children? Obviously not.

We started the list as Tom joined Bill for his cysto list. He performed a cysto with dilation and DVIU for a proximal bulbar stricture. One of our VVF patients required a cysto for what we thought might be an ectopic ureter but it turned out to be a severe case of schistosomiasis. She had a large inflammatory mass in her bladder, with punctuate calcifications and a golf hole ureteric orifice. Very interesting!!!

We also performed our planned buccal mucosal augmented vaginoplasty without any problems. The harvested graft was a reasonable size and the graft looked good after being laid into place. We also performed a few more PV slings with facia lata which we demonstrated for the VVF team.

Continuing with the theme of overeating, we went out for a dinner with the VVF team. This was traditionally done towards the end of the trip, but with Catherine leaving tomorrow we decided to have it tonight. We went to the Elysar restaurant for a traditional Lebanese-Chinese fusion meal. It was a great meal (filled with kibbe, spring rolls, beef, shrimp, chicken) with the food seeming to go on and on. The company was very pleasant and we were sad for it to come to an end (although we were tired from the week’s work). We said farewell to the VVF team and retired to the guesthouse.

Tim’s Lesson of the Day:
“When you come to Africa, bring pants with elastic waistbands”

Tim “Blogman” Davies

~Catherine deVries

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