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17 February 2015
Surgeries started today! I tried staying up as late as I could, but I only lasted until about midnight. The other gals were up early to get to the hospital but I’m covering the night shifts. I got up at 7:30 to stash some of the hostel’s free breakfast away for later, then slept until 13:00. It was cloudy in the morning and I didn’t feel bad sleeping but when I got up at 13:00 the glorious sun was shining, the birds were singing, and Addis was calling me outside. I should’ve just loaded up on sunscreen and slept outside every day. Really regretted not bringing my sleeping pad.
I told the girls to send someone around 15:00 to get me, but not to hesitate to send someone later if I wasn’t needed. But the internet was down at the hostel and I didn’t know if anyone had tried to get ahold of me so around 16:00 I just took a taxi to the hospital. As I was walking in our driver was walking out to get me. Adessa was covering the ICU and gave me the rundown on our only valve replacement of the day- the 20 yo female, A. who is 5’2″ (157 cm) and weighs 79 lbs (36 kg). These kids are tiny. During her screening she told us she wanted to have babies one day so there was some debate about repair vs. replacement, and mechanical vs. tissue. She needed both mitral and aortic valves but in the end only got a new mechanical On-X mitral valve because there wasn’t an aortic valve available that was small enough for her. Again, these kids are tiny.
A. came back from surgery with a peripheral IV, an arterial line, and a RIJ central line with CVP, but the accuracy of the CVP was questionable so I ignored it as best I could. Boy are we spoiled at home with our continuous cardiac output monitoring. Try remembering the Fick formula in a pinch. Or how to calculate a BSA. Luckily one of the docs had internet on his phone so we could google it. The IV pumps here are just mls/hr and only run with 50 ml syringes so with IV fluids I didn’t even try to calculate how many drips in a ml, and therefore how many mls in an hour- I just left that to the local girls. A. initially came back on neosynephrine which I’m used to running at mcg/min but anesthesia runs it at mcg/kg/min, and none of the drug info we brought showed it in mcg/kg/min so it was like relearning pharmacology and algebra trying to run that drip. I’m a simpleton so in the end I just found out what my max dose was in mls and stayed below it. I felt like I was back in nursing school.
The night nurses, Meron and Nitshu, were sweet as could be and I had plenty of questions for them about Addis and nursing and their personal lives (neither married, no babies). They only come to work when there are missions, otherwise Nitshu has a bracelet shop and Meron works at another hospital. Nitshu asked me what the average monthly salary was for a nurse in the States. I estimated $25/hour x 12 hours/shift x 12 shifts/month = $3600 x 20 = 72,000 birr. She just shook her head. They maybe make 2500 birr/month here and according to her the cost of living is atrocious. 2500 birr is about $125. I asked if either of them lived on their own and they both just laughed. To buy a small home here is about 500,000 birr ($25,000) and to rent a tin shanty with a living room and bedroom is about 2000 birr/month, or $100. $125/month salary and $100 of that goes toward rent. They both said they might live with their families forever.
Nitshu’s brother got a visa to move to the States six years ago and through she’s tried three times she’s never been approved for one herself. I asked where he lived. She said “Maryland. Have you heard of Johns Hopkins? He’s a scientist there.” I just laughed. Yes, I’ve heard of it. She says her brother in a genius. Nitshu’s boyfriend lives in Australia but she hasn’t been approved for a visa to go there either and hasn’t seen him in 18 months. A CV surgeon here has a wife in California he hasn’t seen in three years. Can you imagine? Are we spoiled or what? I’ll tell you what, mister; Greg can leave the lights on and flush the toilet while I’m showering every day if it means I get to keep him in the same country. Only kidding. As if I shower that often. Being here sure makes me realize how good I’ve got it at home. How good we’ve all got it.
An uneventful night with A. and after weaning the Neo off I went home around midnight. Our driver had left for the night so I was going to take a taxi but after conversing amongst themselves Meron, Nitshu, and Fekede the CV surgeon decided it wasn’t safe for me to take a taxi so Fekede offered to take me home. A 45 minute drive during the day took 10 minutes at night.
p.s. Nitshu told me that even if you’re approved for a US visa, it still costs about one million birr to go. That’s around $50,000. Most Americans don’t have that kind of dough lying around, not to mention Ethiopians. I’m not sure if that’s from the Ethiopian or American government but either way it’s outrageous.
Important unrelated side note: Homosexuality is illegal here and you can face jail time or even death if you’re busted. I don’t know how they bust people, aside from speculation, but if you’re going to visit Ethiopia and you bat for the other team (and not that there’s anything wrong with that), maybe just keep it under wraps until you get home.