Well, another interesting week here on the Horn. Weather continues to moderate, with relatively cool mornings and evenings, and even mid-days that are not blisteringly hot, or oppressively humid. That said, as I was thinking how pleasant the temperaure was yesterday around 5 pm, I happened to glance at a thermometer which read about 90 degrees Fahrenheit. "Ah", thinks I, "maybe that's part of what has changed". I've turned into a desert creature. It makes me wonder how San Diego and the low 70's will feel on my return.
I must apologize again for the all too obvious decreasing frequency of these
missives. I'm essentially a lazy creature of course, so that is likely the
root of the explanation, but I must admit to a certain sympathy with those
Europeans - mostly notably Colonial Service employees working in British
East Africa - who during the first quarter of the last century were
diagnosed with "tropical neurasthenia". This was thought to be "not
psychosis or madness, but was rather an ennui or loss of "edge" brought
about by the strains of tropical life...". I reckon I'd much rather be another
tragic victim of Tropical Neurasthenia, then a lazy sod! Many thanks to
friend Red for sending along the excellent article "What Was Tropical about
Tropical Neurasthenia? The Utility of the Diagnosis in the Management of
British East Africa" from the Journal of the History of Medicine and Allied
At the root of it all I reckon is a growing sense of "being done". It is
not that the work is any less abundant, or the days any less interesting,
but instead that I grow increasingly impatient to be home. My days here
interest me less and less as that day grows closer, and they are
commensurately less appealing to write about. But today I've had an extra
cup of strong coffee and shall endeavor to catch you all up.
As you'll recall from the last entry (you can go back and read it...I'll
wait), we have only recently become aware of the existence of a Chinese-run
MRI scanner here in the city of Djibouti. We had a chance to go visit it a
couple of weeks ago, and found it just outside the Chinese embassy building
(which is a gorgeous new building near the French Naval base on Islet de
Heron, at the very tip of the peninsula). The scanner itself is a small 0.4
Tesla, open design unit. It is located in a small purpose-built
construction, in front of what will ultimately be an office and reception
area, but is now a two storey cement and rebar skeleton. We were able to
tour the facility, see some of the images, and meet the folks in charge.
Now, as I'm informed by my more imaging savvy colleagues, more powerful
units of different design will provide clearer, more detailed pictures - but
it was obvious even to me that we have just seen at a stroke, a quantum leap
in the availability of high quality diagnostic capability here in Djibouti.
Prices were pretty good too - about 300 USD for a head MRI ( and a discount
on your 2nd study!). We're pursuing some arrangement to allow the folks
here at the EMF to order studies, which will hopefully allow us to avoid a
couple of unnecessary and expensive medevacs here and there.
The scanner is run by Dr. Fong, a Chinese trained urologist and his wife -
also Dr. Fong - who is a radiologist. They have an administrator whose
anglicized name is Lydia ( I can't think of that name without hearing
Groucho singing "Lydia The Tattooed Lady".) They all speak tolerably good
English, although Lydia's is the most fluent. They were very pleasant and
accommodating, even inviting us to try out the scanner. Sadly, I couldn't
think of anything I needed scanned at that exact moment. Anyway, we made
plans to come back with all of our providers (the first visit was just Bill
and I), and did so one evening about a week ago. While the scanner was the
main reason for the visit, the highlight had to be dinner afterwards.
After our colleagues had toured the tiny building, and asked polite questions about the MRI, we hopped in our car and followed the staff to a nearby Chinese restaurant. I must admit to having some misgivings about Chinese food in Djibouti, having become something of a Chinese food snob after growing up close to Vancouver's large and thriving Chinese community and dining well there many a time. My worries were somewhat allayed when the owners of the tiny place proved to be expatriate Chinese, and were further assuaged when the next patrons of the place to walk in turned out to be guards from the Chinese Embassy. Dr. Fong and Lydia did all the ordering from a fairly extensive menu, and shortly thereafter dishes began to arrive at table. I couldn't possibly describe them all, but there was crab in black bean sauce, a steamed fish in ginger, spicy beef and spicy shrimp, dumplings, and about half a dozen other superbly prepared dishes. The company was delightful, and the meal was simply one of the best Chinese feasts I've had the good fortune to stuff myself on (you know that sensation when you're full, but you squeeze one more bite in 'cause it's so good?). Dr. Fong told us that he had first come to Africa as a volunteer - sort of a Chinese version of our Peace Corps - and had felt that there was a need for a few centers with MRI capability. He has set one up in Ethiopia, and is now establishing a site in Djibouti. His wife was a bit quieter, but was clearly excited about the prospects of their new endeavor. The only time the Drs. Fong seemed a bit less than enthusiastic about their work on the Horn of Africa was when the conversation turned to families, and they spoke about their 4 year old daughter, at home in China - Mandarin language education being scarce in these parts. We all sympathized and raised glasses of beer or tea to those left at home. Djibouti is certainly a place full of unlooked-for gratifications, and this night was another such. Anyway, we've invited them (the folks from the MRI center) over to Camp Lemonnier for a visit, and shall hope to hear more of them.
Later that week, we had a chance to help out our local veterinarian, and the Djiboutian police by assisting with surgery on a couple of Djiboutian military working dogs. Tona and Hektor stopped by for some x-rays, a few lab tests and a bit of surgery. Tona - an older German shepard female - needed an abdominal mass removed, and a couple of superficial lumps excised. Hektor, a younger male, needed some, um, boy surgery. Anyway, I got a chance to place the endotracheal tubes, and run the anesthetics, while Bill and Heather (the vet) set our two canine customers to rights. It was both comfortably familiar and pleasingly different. Although many of the medications are used in different ways or amounts, the anesthesia volatile agents have similar effects in most all creatures and were easy to titrate to the appropriate level. Surprisingly, temperature control proved to be a bit of work. The OR's (we used the second, back-up OR at the EMF) are fairly cool, and despite their fur the dog's body temperatures seemed to drop more quickly than I would have thought. Nothing a little forced air warmer and a warming blanket couldn't fix though.
Both dogs did well initially, and were returned to their Djiboutian handlers with antibiotics, pain killers and instructions to watch them closely (apparently those cone-head collars are just not available here to stop the dogs from worrying at their incisions). We saw Tona back today for a small wound breakdown, and little dental work, but she's a tough old girl who we think will do fine.
Beyond that, not so much to talk about. We did have an interesting symposium of the various expatriate medical services here in Djibouti at the French Naval base in mid-week. We met with our French, German, Norwegian, British and Belgian colleagues to discuss our respective capabilities, and to work out areas for mutual support. The officers of the latter three countries were here as representatives of the EU's Operation Atalanta (no that's how they spell it), which is an anti-piracy mission out of Europe. Discussions were warm and friendly, and I'm optimistic that much good will come of them. (Now that sounded like a diplomatic press release, eh?) If nothing else it's just nice to have faces to put with the names one sees on e-mails. We've agreed to a monthly informal dinner meeting, and a quarterly official get together.
Whale shark diving plans for this weekend got scrubbed for one reason and another, so it's been a fairly quiet one. And...you're caught up! Plans for the upcoming week include surgery at Peltier (it's like a box of chocolates - we never know what we'll get), a trip to the Cheetah refuge, and of course Taco Tuesday, which will leave 5 more to go. I'll try to keep you updated.
Picture is of me, Bill and Tona. She's the furry one.