Monday, August 30, 2010
Saturday, August 28, 2010
MACRODYSTROPHIC LIPOMATOSIS: or focal giantism.
Dr. Provenchar, the orthopedic surgeon, said that only 20 cases are reported around the world at this time....and we just found two more in the same village on one tiny island. (Don't quote me on the statistic...I haven't looked it up to verify that it is accurate. In any case, it is rare.)
With sailors, soldiers and volunteers from Australia, Canada and Great Britain there has been a lot to learn.
fair dinkem: truth, or "seriously?!?" or "Are you for real?"
example: I just travelled to Timor Leste. Fair dinkem?
Tah: Thank you
up the duff: pregnant
Don't be a mug, mate: Don't do something stupid
Muster: show up at 6:30 AM to report for duty
Volun-told: no one volunteers, you're assigned as a volunteer
flight quarters: No one allowed on the deck while the helicopters are out flying, no flash photography, no smoking near the helo pad
Stand by to stand by: we have no clue what is going on but be prepared. Something will be soon
Mess Deck: cafeteria
State Room: officer rooming, as opposed to enlisted berthing
Berthing: pronounced birthing but not to be confused. This is the placed where you sleep.
Secured: has multiple definitions. I have obtained something, I have tied something down, you are free to go (secured for liberty), no allowed to go somewhere (secured for flight quarters)
Sweepers: as heard twice daily. "Sweepers, sweepers. Man your brooms." Clean the whole ship now.
BZ: short for bravo zulu or translated means good job.
Rack: bed or bunk
chips: french fries
crisps: potato chips
Nappy: diaper for a baby
Plaster: band aid
rubber: pencil eraser
As I was getting on a "band aid" boat the other morning, one of the Australians already on the boat turned and said to the people already sitting down, "if you all shuffle over, we can make room." I realized--it's not their accents that makes me smile. It is the unexpected phrases they use. In my mind I was getting ready to ask one of them to scoot over, but the sweet aussie said it way better, way funnier and way more memorably (if that is a proper english word).
I have a British roommate. I can't help but smile as she throws in terms like heaps, rubbish, bloke, fancy, and "brilliant!" The other day she was reporting on a patient and reported the child had a "nappy rash." It took me a few minutes to determine if she was refering to the type of rash (a diaper rash) or describing the ugliness of the rash.
Tuesday, August 24, 2010
The LDS charties pediatric day nurses (minus Kristen who had the day off). We are required to be in uniform at all times while away from our berthing areas just like the Navy and other military people. Our baby blue shirts (which you can't see the color by this photo) make us very easy to spot. I was walking down beach street in Dili toward the embassy to drop off a few items for the Crawfords and all of suddent someone is honking at us. Kelly Crawford was driving by and remarked that it is so easy to spot us in our shirts. We ended up getting a ride down the street and able to get out of the humid Dili air.
A few of these photos were taken on Monday when I visited a community health site that USAID is assisting with.
I took this photo thursday at sunset while on Liberty. Katie, MaryAnn and I spent the day with Kelly Crawford seeing some of the sites in Dili--Dili Rock, an Uma Luma (sp?), and hiking the Jesus statue. Sammy, Kelly's 4 year old, joined Mary Ann and I in our hike to the top...he got a pleasant ride on my back and I got an extra good work out while climbing 250 of the 500 plus stairs to the top with him on my back. This photo was taken right after that. The clouds have come in, but I think the only rain we got while in timor Leste was Monday afternoon and it didn't last very long.
This is an after photo of one of the kids who received a cleft lip repair while on the ship. I posted a before photo a few days ago. You canlook and compare the difference. He had a cleft lip and palate repair with dental restoration and tubes placed in his ear. Wow--quite a lot for one little guy to deal with AND for his father to assist with care post surgery. He had one of the worst cleft lips/palate that I saw while here in Timor Leste. He is still pretty young and was such an energetic little guy. He didn't seem ashamed or aware of his deformity prior to surgery as he interacted with all the other children. I can't help but think what a blessing this surgery will be for him. Operation Smile was also doing surgeries on the ship and had some of their pre-op patients in our unit. There were a number of adults who were on board to repair thier lips. Cleft lips/palates seem to be more common in South east Asia than in other parts of the world, according to one of the doctors I spoke with, though they are unable to determine the reason.
Another photo from the USAID trip to a community center. The average age in Timor Leste is under 20 years of age. As I have written in a previous blog, this is because so many were killed during their fight for independence a little over 10 years ago. We didn't see people in the older generation very often and I loved seeing these 3 little ladies. I'm not sure if they were there seeking health education or if this is the place to hang out and get a little shade for the day. Seemed like most of the town had shown up for the event.
Me playing in the pediatrics unit. As a side note--as you can see, the garbages are all labeled. We are required to separate food, paper, plastic, and metal garbage into different bags. The capcity of these bags is obviously huge.
If the baby can cry, why can't I? Gotta love that hat
My last day in Timor Leste (Monday) was a day off from the pediatric unit. I was forunate to hear about a small group of preventative health representatives meeting up with a USAID employee to visit a district about an hour away from Dili. We visited a community health center with actual buildings/rooms for visits with doctors and pharmacy pick ups. There is also a birthing center. This is a 3 room building for women to come for delivery. I learned that less than 30% of women go to facilities for births and the mortality rate is very high at the time for women and babies during child birth. There are also no Timorese doctors at this time. There was a Cuban doctor at this clinic, otherwise it was run by nurses and midwives. Many of the women who deliver have a neighbor come to assist with the delivery. We met a woman who delivered her 4th child the previous night.
I love the photo below of this sweet elderly gentleman. He saw the photo taken of him on my camera and got such a kick out. Katie snapped this photo of him with a smile on his face. The other pictures I have of him, he has a very serious face. You can't see his teeth, but if you could they would be stained red. Many of the adults chew on a red root called beetle root (not sure if that is how you spell it, but is how it sounds). The first time I saw it, I thought someone mouth/gums/lips were bleeding all over the place. I quickly learned that was not the case.
Sunday, August 22, 2010
Poor little guy had a surgery that required him to have a catheter for a week. I guess I might cry too if I had to endure that for so long. For the first few days he refused to get out of bed. I was the lucky nurse that took care of him the day the doctor said he must ambulate. Shown below attempt #1 of getting him to walk. My solution: I carried him upstairs to the flight deck to entice him to walk. Instead of using a ball like you would to get a baby to take his first steps, I had something even better--boats and helicopters. It worked. He took about 20 steps up on the flight deck toward the "helo" but every step was a fight. As you can see from the picture, he had a pretty good melt down back on the unit because I tried to make him walk back to bed. He slid across the linoleum floor while mom and I pulled.
I took care of little mr. stubborn for 3 long, consecutive days. On the third day, Dr. Auge took out Jebanio's catheter! Glorious day for the kid. He was out of bed, running circles around the nursing station, kicking a big blue exercise ball, having the time of his life. All until he needed to go PEE (excuse my improper medical terminology for urinate). Once the little guy peed, he could take a bandaid boat back to shore and go home after spending 8 or 9 days on the ship. I thought it would be SO easy. I gave him water to drink, tried giving him bubbles to blow to bear down, etc. No, No, NO. It didn't work. He started screaming around lunch time and doing the potty dance. I put him in a warm shower-3 different times, tried putting him in a bucket of warm water, tried placing a warm rag over his bladder, and pushed on his bladder. The screaming only got worse. I called a different department of nurses-ones who have actually been moms to see if they had other suggestions. It was an international survey as we had suggestions from Americans, Canadaians, Britians, and a nurse born in Trinadad. I had run out of ideas. After 3 hours and attempting to place another catheter in the child while he was screaming/kicking (no luck there), Dr. Auge decided to take him back to sugery.
Photo #1 was a 16 year old girl. She only had the second toe debulked and shortened. Sorry I don't have any pre-op photos of her foot.
These next two photos are of the 16 year old boy that I posted photos and explained about the other day. His surgery was much more complicated. The orthopedic surgeon removed the second toe, straightened the big toe and debulked the excess fatty tissue from the bottom of his foot.
I'm not sure what you think. As nurses we were debating on whether this really was an improvement from his pre-procedure foot or not. You can be the judge of that. He seemed happy with the outcome and had tossed his crutches aside and was hopping around the unit for the 3 days he stayed.
He and 3 other patients from the unit flew home by helicopter to a remote village called Same (pronounced Saw-May) Monday morning.
We currently have one patient left on the unit. He will be transferred to the national hospital this morning and we will depart for Guam last this afternoon.