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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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Tim’s Daily Nigerian Times (Day 7)

Feb 28, 2008 – Day 7

We scarfed down a quick breakfast of hot biscuits with jam… there is something very comforting about warm carb-filled food. Suprisingly we didn’t fall asleep on the ride to the hospital. We got there early to start a pediatric laparoscopy for bilateral undescended testes at 8AM, but we didn’t get going ‘til about 10AM. Here in Nigeria they are on Africa time and things happen at a certain pace, so it is best to relax and go with the flow…

We assisted with multiple VVF and vesico-uterine fistula repairs (all secondary to obstetrical complications). It was very interesting to see the techniques used by Drs. Langmeng and Chima to repair these so called straight forward cases. I would hate to see the complicated cases!!

We also watched a couple of vaginoplasties for FGM. We put our heads together and thought that a buccal graft to augment the dilated vagina might be helpful so we will perform one tomorrow. One of the local gynecologists had a case of a mullerian abnormaility with a shortened vagina which we all agreed likely needed an intrabdominal procedure to bring down the uterus (after some vaginal dilation).

We left the OR well after dark and were back to the guesthouse by around 845 PM. We settled down to a Mexican feast. Sherri was especially excited by the tacos, as she had made the request the previous day. We were tired, so no chichat or Sodoku, and we were off to bed (to the sweet melodies of the local dogs).

Lesson of the Day:
When the OR lighting is dependant on the daylight from the windows, try to finish before dark.

Tim “Blogman” Davies

~Catherine deVries

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Tim’s Daily Nigerian Times (Day 6)

Feb 27, 2008 – Day 6

Awoke with French toast and syrup on the table, we were all ready for a hearty breakfast knowing that another long day lay ahead….

The majority of the physicians’ time was now being spent at the OR, with Pauletta slaving away at the urodynamics and Sherri trying desperately to keep us all organized. We started the day off with a mid-shaft hypospadias for which we performed a TIP repair with Bill Ardill, the general surgeon missionary from California, looking on. We carried out another PV sling (thankfully more straightforward), and a urethral dilation to finish off the shorter day in the OR than yesterday.

After dinner we were serenaded with music at a loud volume until about 10pm by the other group staying at the guesthouse. Sherri, 10th degree black belt in Soduku, challenged Tom (a lowly green belt) to winner takes all, battle royal, soduku cage match. It really ended up in a nasty way with pencils being thrown and bloody paper cuts on both sides. We managed to pull them both apart and send to their rooms for a timeout. We all fell asleep exhausted after a full day and evening activities.

Lesson of the Day:
Use C Batteries wisely, misuse may cause shocking and corrosive results!

Tim “Blogman” Davies

~Catherine deVries

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Tim’s Daily Nigerian Times (Day 5)

Feb 26, 2008 – Day 5

We started off the day with a hearty pancake breakfast. It is surprising how easily Rachel and Helen (our hosts here at the Baptist guesthouse) manage to put together authentic American cuisine each and every day for us. We packed down a couple of flapjacks and caught a ride with trusty Ezekil to the Evangel hospital.

We broke up into a couple of groups with Pauletta , aka Jummai(which is her Hausa name) carrying on with the urodynamics. She keeps telling us Jummai means Friday, but we are all pretty sure there is a more ominous meaning….

Sherri, Susan and Catherine carried on with seeing some patients who were not seen the previous day. They were again quite busy – the bature doctors are very popular here.

We were segregated along gender lines as the boyz(Tim, Tom and Kurt) went to the OR to start the first case of our trip – a urethroplasty. We managed to provide excellent exposure of the urethra prior to the placing the buccal graft in an onlay fashion that was a new technique to the surgeons here. Susan joined us for a couple of very difficult PV slings using fascia lata in women who had numerous VVF repairs. It was a reminder that operating on patients who have undergone multiple procedures is a humbling experience.

We returned to the guesthouse with one less team member, as Kurt had to return to the US for a conference. He will be missed by many, but not me. We learned over dinner that the constant sand in the air (causing dust and dirt to accumulate quite quickly on everything), is actually sand from the Sahara known as Harmatan. We with our brains full to the brim with all the information we can handle as we drop off to a restful sleep thinking of…………

Tim’s Lesson of the Day:
No matter how good the tissue looks, always remember the patient has had 3 previous repairs…

Tim “Blogman” Davies

~Catherine deVries

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Tim’s Daily Nigerian Times (Day 4)

Tim’s Daily Nigerian Times
Feb 25, 2008 – Day 4

We were up early enough this morning to eat and be off to the VVF center just after 8AM. Again another enthusiastic greeting from the patients at the center. We got off to a slow start, blowing dust off the UDS machine and setting up the area/corner of the office where we would be examining the women. We did have some difficulty with the UDS pump and blowing from fuses. After we had abandoned the pump and attempted to set up a system to document the patients, we began to examine the patients…

Despite some more hiccups in the system and some other changes we managed to see approximately 60 VVF patients in about 5 hours…not bad! During that time, we also saw 6 male patients. We booked a full OR day for tomorrow in the first 2 hours of seeing patients.

Lunch provided us with our first taste of pounded yam – the local staple. It is pretty bland, but they put a sauce on it to spice it up. It was served with an unknown meat and we didn’t ask. Everyone is so nice and accommodating, we really feel appreciated.

We returned to the guesthouse for a quick meal (including the last of the yummy chocolate cake), and we were off to the internet café. We were all suffering from a bad case of internet withdrawal and thought we should take care of the tremors prior to operating on anyone tomorrow. We all pitched in and helped Pauletta with her algebra, probably driving down her average. What do you get when you have 5 MDs doing algebra homework? Probably a D+….

We retired to the guesthouse and dropped into bed…. And thought of the first of a regular series…..“Tim’s Lesson of the Day”:

Dogs that look unhappy about your arrival during the day, like to bark all night (and by all night I mean from 9pm until 7am).

Tim “Blogman” Davies

~Catherine deVries

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