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Final Pics

OR Team: Local anesthesiologist (forgot name); me; Soheir, scrub tech; Angele, scrub tech; Carlos; Fady, House officer at American Hospital
Nile View at Night

Nile view during the day

Pyramids of Giza (more interesting view from the outside than inside)

~Croth
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Blog like an Egyptian

Puns aside, Egyptians do things on there own schedule and I guess I’ve picked up the habit. Actually it has been a whirlwind few days and I actually just now have time to make my last post. I’m sitting in the Cairo airport with my flight to Paris leaving at 1:35 am on Sunday. I’ll make it back to Oklahoma City via Houston around 7:30 tonight. Needless to say, Monday will be a challenge.

We had a really good day on Friday considering the relative urgency to get things wrapped in time for the first round of departing guests to make their flights. We did another 9 cases utilizing our two bed OR as well as rotating cases in another room. Our plastic surgery friends had finished their cases earlier than we did and they actually helped us out by closing skin incisions. We had a great week given the number of cases we were able to get done and the number of kids we were able to help out.

I expected that the operative experience would be different than anything I had done before, and indeed it was. Typical challenges to any given case would be flies in the OR, dim lights, rolling OR tables, multiple Arabic conversations going while you operated (even if they weren’t talking about you, you’d never know), so-so surgical instruments, etc. Despite all this I feel like I was able to hold my own and realized how lucky I am to work in conditions that are optimized for good outcomes.

The entire staff of the hospital was great to us all week. I could sense they were very proud of their hospital and they did everything they could to make us feel like we were part of their team. The hospitality was not limited to the hospital but extended into pretty much everything we did all week. One of the former house officers was visiting the hospital on Friday prior to our departure and was a huge help in arranging for my trip back to Cairo. He took Joseph, an anesthesia resident from New York, and me to the train station and even tried to pay for our train tickets himself. Just before boarding he brought us to a neighboring market so we could be some local confections to bring back home. I can’t say enough about how hospitable our hosts and, in fact, all Egyptians were to us throughout our stay.

The train ride to Cairo was the first time I really felt like I was on vacation. I was able to get a room in Cairo overlooking the Nile and was impressed with the enormity of the city. I walked to a local restaurant and feasted on grilled pigeon which tasted great though consisted of about 3 ounces of actual meat. It was worth the try. Today I did a Griswald-paced tour of the Cairo museum and the pyramids of Giza. I get the sense that you really need 3-4 days to get the real feel of Cairo. It was a great conclusion to my week abroad.

I hope these posts gave a good sense of what we were up to while we were on the mission trip. As designed, these trips truly benefit the patients and the medical team to an equal degree. Thanks for reading.

Chip

~Croth

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Too Late for Real Blog

We had a long day which didn’t wrap up until after nine. We did make it back to the rooftop restaurant in time to catch a wedding party. This entry will be the visual variety.


Cornerstone at Hospital, View from Hotel Room, Two Tables in One OR, Rooftop Wedding Bash.

~Croth

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Groundhog Day

Everyone is settled into their roles here and we are definitely more efficient. We have a particular routine to our day (breakfast in the same restaurant, bus ride to work, fast-paced day, bus back to hotel, dinner at rooftop) that would make Bill Murray jealous. Tonight we are going out for a party at one of the hospital administrator’s house and we are look forward to mixing it up a little bit.

Today in the OR we did another seven cases. We did 3 redo hypospadias and 2 urethrocutaneous fistulae following hypo repair. The frequency of complex cases is unlike anything I’ve experienced in the course of my training. I guess that speaks well for the quality of urology we are practicing back home. We had more visitors in the OR today – a plastic surgeon from Cairo came to visit (he was also interested in the craniofacial cases that the plastic surgeons with us were doing). He states that his service in Cairo does over 300 cases a year. It nice to see so many people interested in hypospadias surgery. It is disconcerting that at the same time we will probably operate on over 30 kids who have either not had access to someone who can provide the operation they need or have complications following surgery. I’m obviously not informed enough to dwell on the issue too much and it may simply be an issue of surgical volume. Regardless, I do feel better about healthcare in America.

I will get off the soapbox now and get freshened up for our night out. I will attach some more pics since it now seems to work. We again had lunch in the OR hallway (notice the food on stretcher).

~Croth

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Tuesdays in Tanta

We had a regular day at work today. Today was the first day back in school for the local kids so traffic this morning was terrible. We started rounds around 8:30 and our first cases at 9:00. Hospitalizations here are a family affair and it’s not unusual that each patient was 3-4 family members with them at the hospital. There are few private rooms and most kids are in common wards. On rounds the entire room full of people, relatives or just onlookers, gather around the patient of interest. It seems they all have something to say, of course only a fraction makes it through the interpreter. We eventually make it through.

Towards the end of our third case I started to smell food in the OR. Sure enough, lunch was being served in the hall outside of the OR. We had a nice traditional Egyptian meal which consisted of various pastas, beans, and vegetables which you top with fried onions and a spicy tomato sauce. It was great.
We made it home around 6:30 this evening and had a nice dinner at the rooftop restaurant which has turned out to a nice surprise. Overall, work is work and Tuesdays are Tuesdays, even in Egypt

~Croth

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Back to Work

We left the hotel for the hospital at 7:30 this morning. We should have probably left at 6:30 but I guess the OR starts later here. We quickly got settled in. We were given sandals to wear with our scrubs. I was wearing white socks as opposed to the locals who wear just sandals in the OR. After feeling out of place for a while, I scratched the whole thing and went back to my Nikes. We had two OR tables in one room which was very efficient. My last patient was 11. I walked him into the OR and he didn’t bat an eye and the redo hypospadias patient laid out on the neighboring table. He never asked for his mom and didn’t even need root beer flavor in his facemask. Expectations are just different I guess.

We did have a productive day. We got eight cases done though were at the hospital until 7:30 this evening. Today was an Egyptian national holiday, Oct. 6th fittingly enough (to commemorate victory over Israel in the 1973(?) war), so we had a number of local urologists and residents who came by to watch us operate. I did one case with a peds surgery fellow and another with a local urology resident. It was nice to get to work with people from such different backgrounds.

Tomorrow calls for more of the same. I will eventually post some pics, hopefully before I return to the states.
Chip

~Croth

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Day Trip to Alexandria

Today we left Tanta around 9 to head up to Alexandria. I’ve learned more about the police escort which we always have. Realizing the importance of tourism to the national economy, Egypt now has a special Tourism and Antiquities police force. Any groups of foreigners traveling by bus has to be escorted. Each state has their own division of police which escorts you through their state. Our trip to Alexandria required at least 4 changes of escorts which could take up to 20 minutes. So the 1.5 hour trip took us 2.5 hours.

Once we got there we went to the new Alexandria library which is meant emphasize Alexandria’s prominent place in the ancient world just like the original one did centuries ago. Alexandria was been ruled by the Greeks, Romans, Turks, French, and British though, due to a tumultuous political climate and the occasional earthquake, very little evidence of the previous occupants remain. Archeologic efforts are underway to help preserve as many sites as possible. We had a great local lunch at a restaurant overlooking the east harbor and finished up by Montazah, a former summer retreat of the Egyptian kings.

Tomorrow we have a full OR day. I’ll let you know how it goes.

~Croth

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Screening Day

Following a long couple of days of traveling, we finally arrived in Tanta around 10 pm last night. We are staying at the Panorama hotel in Tanta which is very comfortable. Typical of a nice hotel, clocks with the current time in various international cities are displayed behind the front desk. It is currently the same time in New York as London, though you get the point. They do in fact have wi-fi which makes this blogging much easier.

Our group is complete and our IVU group, me and Dr. Angel, are joined by Surgical Volunteers International run by Tom Flood. SVI largely focuses on craniofacial defects and there are two pediatric craniofacial surgeons in our group. To coordinate all the surgical activities we have a pediatrician, two peds anesthesiologists, an anesthesia resident, a peds anesthesia fellow, two OR nurses, three recovery nurses, and some additional support staff. It takes a while for our group to get moving and to compound the issue we never go anywhere without a police escort.

Today we had our clinic to screen and prioritize patients for the upcoming week of surgery. We will be working at the American Mission Hospital in Tanta. The hospital was founded in the early 20th century and is devoted to treating citizens of Tanta and the surrounding communities. Since the last trip here one year ago, the medical staff, including the pediatricians and surgery residents, have been keeping a running list of patients to see. In addition, word that we are coming has spread and a number of patients just show-up at the clinic.

Dr Angel and I saw approximately 45 patients today of which close to 40 are scheduled for surgery. We saw a lot of hypospadias with about have of these patients presenting with urethrocutaneous fistulae following repair. I got a little frustrated with the lack of any medical records for the patients. We saw one kid with a pfannensteil incision scar, non-palpable testes, and a somewhat repaired proximal hypospadias (i.e intersex until proven otherwise). Mom thinks her kid has testes and the surgery was an attempted orchiopexy. We’re going to take a look and see what we find. This is just an example of how you make do and treat the patients as well as you can in the given situation. Our last patient of the day was a bed wetter; the only bed wetter I’ve ever been glad to see.

Anyway, we have tonight on our own though can’t go anywhere without our guards. Maybe we will check out the views from the rooftop bar of the panorama hotel. Tomorrow we have a day off and most of us are going to check out Alexandria for the day.

Later,
Chip
Uploading pics is going really slow, i’ll try to work on it later.

~Croth

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Rainy day in Paris

The trip is uneventful so far. We are currently at Charles DeGualle airport in Paris. We have a 5 hour layover; too long to sit in an airport, not long enough to go do anything. The view from the airport window is European, overcast with lots of very economic-looking small cars and trucks on the tarmac. Our group now consists of about 11 with a few more people still to meet us. Once we arrive in Cairo we have an hour-long bus ride to Tanta which puts us getting there around 7pm local time. I’m told we have an internet café at our hotel in Tanta so I’m hopeful I’ll be able to get the posts out on time.

~Croth

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