Whew!

Hello All,

Well it's been a busy few days here at Camp Lemonnier (an aerial view of which appears above). It's a bit odd that, as time grows shorter, we seem to have accelerated our pace here at the best little EMF in Djibouti, but the additional work has been welcome. This is especially true as we had expected a bit of a lull while our point of contact at Hôpital Général Peltier - Dr. Elias - is away in Mecca on the Hajj. We've been preparing for some coalition military exercises, for which we will share medical duties with our French colleagues, so our drills have have taken on a new intensity (we've been working on our "walking" blood bank - that being the pool of folks walking around with blood of various types in their veins who might consent to bring it along to us in case we needed a bit extra in an emergency). The lab bit is a challenge, but it's really the administrative bit that's a nightmare - getting folks in, screened, and processed. Good practice though. Speaking of good practice, we've had a lot of practice with Medevacs and critical care patients. We've seen that big Air Force bird with a Critical Care Transport team in its belly touch down 3 times in the last week for a patient with heart trouble, a pharyngeal abcess and what we thought might be a case of acute meningitis. The former two were on ventilators, and as the de facto respiratory therapists my pal Herman and I spent a couple of long nights doing ventilator management. The weekend was dedicated to taking it easy and catching up on sleep.

Juxtaposed on all this is the ongoing H1N1 vaccination process. As an underemployed anesthesiologist, I ended up with "Public Health Emergency Officer", and as you can imagine I've been busy this past couple of months. With extremely able assistance (and extremely able assistants) however, we're almost done with the military folks here on Camp, and will start in on our contractors and other employees soon. We've been relatively spared so far, so that has been a blessing.

I did get my 11 mile run done this past Sunday though. My friend Kevin was kind enough to send along a book on treadmill training for runners, which has some helpful techniques, but most of the credit for not losing my mind must go to The Teaching Company, and to Professor J. Rufus Fears' absolutely engrossing series on Famous Romans. Having gotten to Marcus Aurelius, and the end of the series, I confess to being at a loss for next weekend's 12 miler.

Came back to a bit of sad news, as poor old Hektor, our long time patient Djiboutian military working dog, passed away. He had developed severe anemia and despite transfusions, and every other intervention we (and an international coalition of e-mail advisors) could think of, we could never get his bone marrow to restart production of blood cells. He had become a favorite of all of us at the EMF, and we were saddened to hear that he had passed on, albeit peacefully, last night. I will say that Hektor helped us all to become familiar with working around military dogs, and as that turns out to be part of the "expeditionary" mission, I would say he left us better than when we first met him - no mean accomplishment for anyone.

On a happier note, it now seems fairly certain that Mark, my replacement will arrive here on Thanksgiving day. It's an appropriate enough occasion: I shall of course be glad to see him, and - after a 30 hour flight - he'll be glad to get off the plane! Presuming that all then proceeds as scheduled, that'll put me home around the 14th of December - in plenty of time for Christmas, and with a bit of time to try to acclimatize in 70 degree San Diego before heading to Tahoe for our annual post-Christmas ski trip. I can't even imagine what 10 degrees is going to feel like on top of Heavenly. Brrrrr.

Other than that, not so much to report. With drills and critically ill patients we've been pretty close to base for the last couple of weeks. Weather is gorgeous, and it would be quite pleasant outdoors save for an explosion in the fly population - we're actually a few weeks into it now. The flies, which seem like ordinary house flies, have a discomforting tendency to land on one and ti refuse to take a hint. They aim for ears and eyes and noses and are thus a nuisance out of all proportion to their size or number. They also are sort of slow and not too agile, which doesn't work out that well for them - but it can make the outdoors a bit of a trial.

Anyway, reckon I'll sign off here. My CO pointed out to me the other day that Camp Lemonnier now has its own cool website. Should the mood take you, you can check it out at "https://www.cnic.navy.mil/cldj/index.htm"

Ciao!

A melancholy little week

Hello All (any?),

Well, another week's worth of days has vanished into the the vastness of the Horn of Africa. No spectacular triumphs or catastrophes to report, but instead a group of small enough events that have conspired to bring on a sourish sort of feeling.

Chief among them must be ranked the departure of my friend Jeff - off to future endeavors in Jacksonville. In my experience, one fairly rarely runs into folks with whom a wide ranging discussion is as possible as a comfortable, companionable silence. Jeff possesses both gifts in abundance, and I found him an immensely easy person to hang out with. It doubtless speaks of my many character flaws that I have found such people have been few and far between. I guess it makes me appreciate them all the more. A life in the Navy is all about wishing "fair winds and following seas" to one boon companion after another, but it always leaves one - or me anyway - a bit wistful.

It was in this frame of mind then that I went to visit the nearby cheetah refuge. It's a place I'd intended to visit for some time, but as the afternoons and evenings are no longer poisonously hot this seemed an ideal time to check it out. We piled on the MWR bus one late afternoon and bumped and jounced about 4 miles down the road toward Somalia. Having cleared the village of Douda (for which the nearby dump is named) we came to the entrance to the refuge. It is a property of some dozens of acres that is a lovely, peaceful green(ish) spot in an area that is otherwise dotted with rubble, refuse and signs of hard scrabble existence.

The refuge is the result of the work of Dr. Bertrand LaFrance, a French veterinarian who has worked with the Djiboutian government to establish a spot for captive cheetahs confiscated by the authorities. The refuge currently has six of the cats, along with miscellaneous other African animals (gazelles, ostriches, caracals, tortoises, etc.), some of whom are destined for reintroduction to the wild. The "green" of the acres of enclosures is provided by scrubby acacia trees, extravagantly festooned with needle sharp thorns. The red sand and dust make these stubborn survivors appear an intense green, especially in the slanting light of the early evening. We strolled around the dusty paths, enjoying the soughing of the wind in the trees, the warbling of song birds - the environs of Camp Lemonnier being the near exclusive preserve of crows and pigeons, neither of whom produce much in the way of melody - and the absence of industrial noise.

The cheetahs were in generously sized enclosures, separated from the walking trails, so the viewing wasn't ideal (although I'm sure this is actually better from the cat's point of view). The place is as nice as it could well be, given the constraints of location and finance. I guess I couldn't get past the contrast of even a large enclosure with the vast sweep of the Masai Mara, and the contrast of the pacing of the cheetahs back and forth along the fenced perimeters with the sinuous grace they display stalking through the tall grass of the African plains. For all that though, there are less than ten thousand cheetahs left in all of Africa, a tenth of the population just decades ago. I'm sure these caged carnivores don't feel all that lucky, but lucky they are in point of fact. It was a pleasant enough afternoon, but suffused all through with just a hint of sadness at the thought of these graceful cats relegated to life "inside the wire". Anyway, soon enough we piled back on our bus and headed back inside our own wire.

Later that week, we saw one of our canine patients from a week ago. Back then, he had just needed an adjustment of his boy parts, but this time he presented gravely ill. For reasons that are still unclear, all of his blood cell lines had taken dramatic drops, leaving him severely anemic and and low on platelets - the little clotting cells that keep us from bleeding and bruising at trivial trauma. We tried one transfusion from a brave "donor" dog, but nothing seemed to improve. Best bet seemed to be related to his massively enlarged spleen filtering out the blood elements , and after some debate we decided to attempt a splenectomy - a risky business in a critter with low blood count to start with and the inability to clot properly. Thanks in large part to Bill's meticulous technique, the procedure went well enough, and our shaggy patient made it through. He was still desperately short of blood cells though, and another transfusion the next night didn't really seem to help. Suggestions for treatments poured in from all of our email contacts around the globe - special kudos to friend Mitzi for sending some of the most helpful - and by dint of much effort and many medications, he has hung on - to this point at least. He's a sweet natured Shepherd, who will need to be retired from life as a Djiboutian working dog, and who already has multiple volunteers to take him home. I hope he makes it, and I hope any future owner knows how to say "sit" in Somali.

The week ended on a bit brighter note, as the crew from Norwegian Frigate Fridtjofnansen pulled in for a port visit. They toured the EMF and we met them for dinner at The Melting Pot, a French/Greek/Japanese restaurant located not so far from their hotel. They were a congenial bunch, who spoke English very well and had a gift for humor and lively conversation. It was a very pleasant evening, and we are promised a visit to the ship's sickbay when next they pull in.

Beyond that not too much. A quiet weekend and a short week ahead, given the Veteran's day holiday. Might head out to Moucha island again, as chances to enjoy the beaches and reefs will diminish rapidly as the month goes on. My replacement reported to Fort Jackson this past Sunday, and while I still don't know exactly when I'll depart, the prospect is becoming more substantial.

Reckon that'll do for a bit. Take care all.

Pictures are of Cheetah refuge.