And that's a wrap!

This past week has flown by! Actually what am I saying.. this past month has flown by!! I can't believe that we just finished our last day in the OR as the first (of hopefully many!) Mercer PA students coming to do an international rotation. 

I'm proud to report that Meg and I stepped up to the plate for Mercer and gave it our all these past two weeks in the OR. We were up for anything, always wanting to learn more, offering our assistance in any capacity, and then also being very respectful of all of the OR surgeons, staff, and other students. 

We made friends to last us a lifetime and saying goodbye has been a two day struggle. The staff rotates one day on/one day off and so we had to say goodbye to one crew yesterday and do it all again today!! 

The surgeons have been amazing. They let us scrub in, explain what's going on in English (which is their third language!!), and allow us to learn hands on. They are patient with our suturing skills and even took an afternoon to teach us surgical knot tying and blood transfusion formulas. 

The nurse anesthetists have embraced us whole heartedly and were great at getting us involved. They taught us all of the (limited) medications they use and let us draw them up and administer. This week they also got us involved with intubation and epidurals. Both of us got great practice at doing these skills, which is rare to come across in the US. I don't think they quite understood there's a whole separate program for anesthesia assistants but we didn't want to burst the bubble! 

The OR staff and rotating nurses were fabulous as well! They accommodated for us being there, helped us maintain sterility and find supplies, and didn't mind us goofing off and taking pictures and videos while in the OR. 

And lastly the time spent with other students has been one of a kind. Elise, Ingrid, and Kamillanwere are the 3 Norwegian nursing students who were helping in the OR for the past two weeks. Lova (pronounced Luff aka "Ruth") is the Malagasy 4th year medicinal students on rotations at the hospital. She has been so kind to allow us to get in on the rotation for scrubbing in and then also helping us translate. We have been able to learn from her as well as teach her some medical knowledge we have already learned along the way. 

This rotation covered all the bases for global medicine. We spent a week in the field doing hands on clinical medicine with limited supplies and a huge language barrier thanks to Scarlet and Medical Mission Teams. 

And then we spent two weeks in the OR seeing everything from General surgery to speciality procedures to emergency medicine thanks to Dr Harison and the Antsirabe Lutheran Hospital. We saw/assisted with...

• GenSurg: open chole, lots of hernias, abscess debridement, and even acute septic abdomen
• Ortho: arm/leg fx, osteomyelitis, and amputation
• OBGYN: c-sections, D&C, ovarian cysts, and several hysterectomies
• Urology: urethral strictures and prostectomies
• ENT/Thyroid: GOITERS!! And a tonsillectomy. The cataract surgery for our clinic patient is scheduled for Monday after we leave. 
• Emergency: lacerations, I&D, and chest tube for a pleural effusion 

And it wouldn't be a true international rotation in Madagascar if we didn't lose power and run out of anesthesia supplies on the last day... the surgeries today were done using either local anesthesia or an epidural. And then during the last few cases the skies opened and it began to pour and about an hour later, the city lost power. The generator is unfortunately still broken despite several attempts to fix it and a new one costs $9000 so they will make do with candles and flashlights until it can be repaired. 

We have learned so much in our short time here and I'm forever grateful for all of the Mercer faculty and staff who put their faith and trust in us. Thank you to the one and only Dr JillRae Mattingly who traveled across the world with us to serve others and gave us the confidence to continue on after she went home. Thank you to Scarlet Holcomb who stayed behind for two additional weeks without her hubby to ensure our safety and help make this potential clinical site a reality. And THANK YOU to Dr Harison, Domoina, and Midera for taking us under their wings, hosting us so graciously and making this month abroad feel like home. It truly took an army to make our dream of an international rotation site a reality and I couldn't be more thankful to be given the opportunity to come here and be part of Mercer's future! 

Tomorrow we head to Johannesburg for a 27hr layover and then onto Atlanta on Sunday night. We will be back stateside on Monday so wish us safe travels as we journey back west this weekend!

Adventures with Domoina

Dr Harison went to Majunga on Monday for his conference so it's been a girls week this week! Domoina has been the ultimate hostess with the mostest. She has taken us to different craft markets and the gem market next to the hospital to find treasured items to bring home to family and friends. While at the gem market, Meg and I were recognized from TV!! The shop keeper watched the Pastor David's installation and was so excited when we she met us!! 

On Tuesday, the surgery schedule was very light so we hired Pastor Tantely (Pastor Honey) to drive the 4 girls to Ambrosita. It's a small artisan town about 1-2hrs south of Antsirabe. The town is known for its wood carving and cute markets. 

We went to Domoina's favorite lunch spot, Le Artisan, where they had live music and dancing. It was a total tourist spot but served good Malagasy food on a cute outdoor patio. We learned some more Malagasy words from Domoina and Tantely and had a great time just enjoying each other's company. 

The best "market" we went to was up above the town. Pastor David (aka the new Lutheran president) found this place on one of his trips and we honestly have no idea how! We drove up the hill above the city and turned onto a dirt road. The dirt road took us past small houses and a church. Pastor Tantely stopped right after the church and said we were here... looking around I saw one unfinished house, a gravel path behind the church, and a couple small houses on the other side of the road... 

Scarlet took us across the street and behind one of those small houses to a bench and told us to sit. We heard a lot of whistling and then people began appearing out of no where. A couple guys started up their hand powered carving table while the women and children set up the booth with lots of hand made wood carvings. We watched the guy turn a block of wood into a little flower vase. Megan and I then took turns learning how to carve and spin the wheel. 

Once the demo was over, the women had set up their booths and it was time to shop! The wood carvings were less ornate than the ones in town but it's because they make them behind this little house!! We didn't even want to barter bc the prices were already low! This money went straight to the people without a middle man to mark up or take a percentage!! What an awesome find! 

Then today (Thursday), Domoina took Scarlet and I to the "big market". We have been to the small market before to get Megan and Scarlet's dresses and that was totally manageable. The big market should be renamed the ultimate SuperWalmart market. It has everything and was Yugggggeeeee!! We walked in came upon the kitchen stuff and the fabric. We continued on until we found the fruits, then veggies, then meat, then live animals, and finally clothing. Each area was so widespread that you couldn't see where it ended. The fruits spread out in all directions!! 

     

At the market Domoina helped us purchase lychee fruit. It's a type of berry that is mostly produced in China but they also grow here in Madagascar. However lychee cannot be sold until Nov 12th. I still don't exactly know why there is a strict date for "lychee season" but it is a big export so everyone gets excited when they can start selling them!

We had so much fun exploring the market and Madagascar in general with Domoina and Dr Harison! They are the most amazing hosts and I couldn't imagine a better family to stay with for a month while abroad! 

Celeb Status

The first week we were here Domoina told us we had been invited to the installation of the president of Madagascar's Lutheran Church. She said it was a big deal and we needed to wear something nice. Seeing as neither Megan nor I are Lutheran we didn't really understand what this event was or what his position entailed. All that was relayed to us was "it's like he's the pope of the Lutheran Church of Madagascar". Um okay?

So fast forward a little... a family friend named Pastor David and his wife came in town to stay with Dr Harison and Domoina this past week. Scarlet has met both of them before bc he used to be the Bishop of Antsirabe so it was fun to have a mini reunion every morning at the kitchen table! We slowly put two and two together that Pastor David was the one who was being installed as the new president this weekend. He seemed totally normal and we frequently saw him lounging in his PJs so I didn't think that he was too big of a deal.

 The installation was in Tana so Domoina helped Meg, Scarlet and I get everything ready last week. We bought Meg and Scarlet dresses at the local market and then the three of us all borrowed shoes from Domoina and her mom. Somehow we all found shoes that fit perfectly!! We were packed and ready to head to the capital on Sunday. The event started at 10am and it's a 3-4hr drive so we left Antsirabe at 5am so that we would buffer any potential problems! 

As we got into the city, it started to become apparent that this was a bigger event than I expected. Domoina told us we would be sitting up front as guests of honor "bc we are white" and there were two other US pastors coming in town for the event. Pastor Jeff and his wife recently moved to Kenya for mission work and then Pastor Albert lives in the US and travels to events like these to show support. 

**side note: her comment about why we are guests of honor was translated wrong and we later found out it was bc we are foreigners and so our attendance would elevate the event and make it more important in the minds of the Malagasy**

We arrived outside a large outdoor amphitheater where people were swarming in and we were told to walk down the road to the side entrance. There were lots of Boy and Girl Scouts helping to direct traffic and I found out that this was how Domoina and Dr Harison met back in the day! They were both Scouts! We walked down the road to the other entrance and that's when I realized it was the VIP entrance...

The stairs were lined with Scouts staring at the vazahas and when we got to the bottom we were escorted into the amphitheater by ladies dressed in very fancy dresses. As we turned the corner and saw the crowd I knew this was much bigger than I ever imagined. There were at least 6000 people or more filling into the seats. 

We were escorted to our seats which were literally front row center. Our posse included Midera and his girlfriend, Dr Harison, Pastor Al, Pastor Jeff and his wife Michele, Domoina, myself, Eleanor (here to translate), Scarlet and Meg. The installation started promptly at 10am and lasted a mere 4.5 hours.... 

The service began with a long explanation of the voting process bc there is so much corruption in politics here and the vote was a close one. You have to have a 2/3 majority to win and it took 4 times before Pastor David finally came away with the victory. Then they also spent a while justifying the secretary position bc a women had been elected. She was the first women ever elected to be in the governing board and it was clearly a hot topic. 

There were lots of speeches to congratulate the new board and then the Lutheran church service began. In Madagascar, the typical Sunday service lasts 3hrs so fortunately they modified it so the event didn't last too long... but they didn't cut back on the singing! There were probably 600 choir members who were behind us and did a fantastic job with the hymns and songs. Eleanor and I used Domoinas hymnal to sing along and I was able to practice my Malagasy!

The event ended with the benediction of Pastor David and his wife. They received metals and certificates while paparazzi snapped all of the pictures. 

Which reminds me... the entire service was broadcast live nationwide. So every time the press would run up to the front to snap a pic of the action on stage, they would also turn around and snap a picture of us! We're waiting to see if we make it into the local newspaper but Domoina got lots of texts saying we were on TV several times during the live broadcast!! 

Since we are VIP and now apparently famous, we loaded up in the cars and drove across town to the reception. WHOA SO FANCY! This place looked like it belonged in a country club in the US. The building itself was beautiful and it overlooked the city. 

The reception was catered with a delicious 4 course meal and we were entertained by the full choir. They sang traditions Lutheran songs in Malagasy and then all of the sudden turned it up and sang gospel music the rest of the night.

About midway through the reception, Pastor David got up to make a speech and to introduce the two visiting US pastors. After he introduced them, he also decided to introduce Scarlet, Meg and I BY NAME! He knew our names!! I'm shocked bc we his English is limited and we maybe spoke a handful of times, mostly about food! He explained we are students working in Antsirabe and providing free healthcare to the Malagasy people.

Pastor David is the man and I can't wait to hear all about what he does these next few years! He has such an amazing sense of humor and is very humble so I pray good things come his way! (PS- pic is from brunch Monday AM when he joined us at a local cafe before his flight) 

 

Daily devotion: Isaiah 51:16

 “And I have put my words in thy mouth, and have covered thee in the shadow of my hand, that I may plant the heavens, and lay the foundations of the earth, and say unto Zion, Thou art my people.” -Isaiah 51:16

This was one of the scriptures read during the inauguration. It was meant as encouragement for Pastor David as he takes office. "Don't be afraid, God is with you and will be there the whole time. Rely on Him when the going gets hard." I thought it rang true not only for his next journey but also for anyone headed to an unknown future. Prayers go to Pastor David and his wife as they take on this major responsibility.       

Malagasy Wedding

Weddings are a special occasion that take lots of planning so that the couple can be surrounded by friends and family... and random vazahas (foreigners/white people).   Tahiri is one of the nurse anesthetist in the OR and his brother Njaka (who also works at the hospital) is getting married today. The custom for weddings and other special occasions here in Madagascar is to invite visitors to said events. Now in America I'm pretty sure most brides would turn into bridezilla if they were told to add an entire table to the reception to accommodate random visitors from another country. But here, apparently it's customary!

Food preparation began yesterday at the guest house and continued this morning. The hospital staff were in charge of the food and were cooking all kinds of meat and veggies and other delicious looking food out in the open on the big silver pots. Also FYI to the mission trip people who were staying in the guest house... we should've come this next week bc there wouldn't be any more geese to attack you/wake you up in the morning. That's bc we're apparently eating 16 of them at the reception tonight!!!

The wedding ceremony started at 12p so Megan and I spent the morning in the OR with Dr Harison to soak up every chance we get! We scrubbed in on an open cholecystectomy (gallstone was the size of a prune) and then also a c-section. It's interesting to see the surgeries we did laparoscopically in the US done open here. I'm starting to better understand the pros and cons to both!

The wedding ceremony was held at the big Lutheran church downtown. We met the 3 Norwegian nursing students at the church and had our own vazaha pew. The service started at noon, which means people were showing up from 11:45 until right before it was over. We showed up about 30min late with Domoina and her mom and no rude stares were thrown our way (mostly just confused glances on who we are).  The ceremony lasted a mere 2 hours and there was a lot of stand up/sit down and singing. The bride was absolutely beautiful and the church was decorated nicely. 

Malagasy weddings all have color themes and so whatever color the bride picks is what all the guests wear. The bride and her bridesmaids all wear white. This bride (Stella) chose a rainbow theme so we were able to wear any color and the church, car, and reception was decorated in rainbow colors. 

After the wedding, the bride and groom hop in their decorated car and everyone caravans behind them in a parade. We parade through grassy mall downtown where everyone hangs out and then also parade the newlyweds past their homes. Njaka grew up in Antsirabe so that was easy but Stella grew up in the next town so we drove an extra 20min to get to this other town. Scarlet made the comment about how did they meet bc it was a pretty far way to walk and most people stay in meet someone in their same village/town.

The reception was at a pavilion near the center of town and was decorated in rainbow colors! There was a live band, 4-course meal (including the geese...) and lots and lots of dancing! 

The surgeons and OR staff were there and they helped teach us the Malagasy dances including the Afindrafindrao (opening dance) where you dance with your partner behind you and shuffle around in a circle. There were lots of circle dances, line dances, and then just regular fun dancing! 

As expected our table was the vazahas plus Dr Harison, Domoina, Midera, and gma. Kamilla, Ingrid and Elise (the Norwegian nursing students) also had a blast and it was fun to be surrounded by 3 fellow blondes! 

 

TGIF

Friday 11/4 - There were only a handful of cases on the board today so we were expecting a slow Friday. Boy we're we wrong! The first surgery was a tonsillectomy secondary to persistent rheumatic fever (a complication of untreated strep throat). We also had a couple abscess debridements. But the big case was a young guy who came in with peritoneal signs (acute abdomen) from a stabbing that happened last night. He was very out of it and had rigidity, guarding, and diffuse tenderness. We got him back to the OR for an exploratory laparotomy and right after he was intubated, the patient coded on the table. 

The OR monitors are older and so they sometimes show an error in heart rate and O2 sat. So when the monitor started beeping and showing a flatline it wasn't too concerning bc normally the vital signs will pop back up in a minute or two. Around the same time the anesthesiologist was listening for breath sounds to indicate a good intubation but looked up concerned bc he didn't hear the heartbeat. That's when everyone stepped into action. Lots of Malagasy was being spoken but everyone remained calm. They started chest compressions, kept continuous breaths and pushed epi. I have no idea how much time passed but it felt like an eternity and I really thought we lost the patient. The staff started relaxing a little bit and we later found out it's bc the patient was back with us but with weak vitals that weren't registered on the monitor yet. Slowly the vitals came back to normal and the patient was starting to stabilize. It became a high risk surgery due to an unstable patient but once we opened him up we knew that continuing with the surgery was the right call. The stabbing had punctured the patients stomach and he had rice and other stomach contents floating free in his abdomen. The patient was very close to becoming septic so they cleaned out the free fluid and sewed up hole in his stomach. The surgery went smooth and we checked on the patient later that afternoon to find a very alert and oriented 20yo who was shocked to hear he almost died. 

Everyday the hospital takes a 2hr lunch break from 12-2p to go home, eat, and rejuvenate for the afternoon. We took advantage of the lunch break and headed into town to Antsena Kely ("small market"). This weekend we have two very exciting events we got invited to (stay tuned!) but needed proper attire. So off we went to go find Megan a dress and possibly shoes for me! 

We walked to the front gates and hailed 2 pus-pus to take us to the market. A pus-pus is like a chariot where you sit in cubby and a man (usually barefoot) lifts up the other side and starts running/pulling you towards your destination. Very strange concept at first but man was it fun! The men are so strong and can run so fast! The other type of transportation they have is a bike-pus which has a guy peddling a tricycle of sorts with you sitting behind. And to be honest, I think the running pus-pus actually get there faster! 

The afternoon was super quiet in the OR so the surgeons decided to practice knot tying with us and then Dali (nurse anesthetist) taught us blood replacement formulas. We had asked him about it a few days ago and he apparently went home to look up everything and came back in today to teach us! We are so fortunate to be surrounded by people who truly care about our education and want to help us learn! 

Right as we decided to head home for dinner, a young boy came in with a pleural effusion from falling(?) that needed a chest tube stat. We had been waiting on him to be NPO but his family kept feeding him water or soup. This means he couldn't be put under general anesthesia for the procedure and we could only use local lidocaine. It took a couple tries but Dr Harison got the tube into his lung and started draining blood. Before the boy left the OR, he had already drained 65cc and Dr Harison said he drained over 3L of fluid over the next day from his lung!! Poor boy could hardly breath before the chest tube!

Julie and Domoina cooked tacos for dinner to celebrate Domoina's moms birthday. It was a seasoning packet that scarlet brought from the US on her last trip and Domoina has been holding onto it for a special occasion!! Tacos have never tasted so good with all the fresh produce and meat!

As if today/this post isn't long enough, there is one more thing that must be mentioned! Midera promised to take us out on the town tonight and it just so happened one of this friends was throwing a Halloween party at a bar called Code Le 110. So even though I escaped Halloween in America, it still found me here and we celebrated big! We were given masks at the door and we walked into a fully decorated Halloween bash. The Norwegian girls met up with us a little later that night and we danced the night away! It was so much fun!! Oh and Midera introduced us to a local celebrity who is in town to perform a concert on Saturday. So if you ever hear about an artists named Rak Roots, just know that he's from Antsirabe Madagascar!