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Dr. Geelhoed journal entry 10 Feb 2011

Series: 11-FEB-B-8

A DAY BEGUN ON THE RUN AND BEGINNING TO OPERATE AS AJAK IS STILL HELD UP IN BOR WITH THE RESIDUAL OF THE FAILED AFFAIRS OF THE HEART AND CURRENT DEGENERATION INTO LEGAL BREACHES OF CONTRACT

February 10, 2011

Two things noted on the run this morning—not the usual reportable events of wildlife spotted or distance gone or encounters along the way, but a note about two visceral functions which I almost never report. First, I had told the team to report to me on how often and how much they peed  “Oh, yes, I was going to mention that since it seemed unusual!”  On the run I realized I had taken off from the pre-dawn start without the need to stop to void after the night. My own calculations are that I have done this twice per day at about one fourth the amount despite  several liters of fluid taken in with the addition of ORS (Oral Rehydration Salts” we have in abundance.  The second function which has been rare in this environment, only slightly less frequent than that of urinating, is comes with a word of caution. Even in the dry season bush, try to look for leaves rather than the dry and brittle straw of the dead grasslands so that no slivers are carried along on the run.

I saw what appeared to be a civet cat scooting along in the bush on the run at the junction of the dawn and the night.  I saw a flotilla of four cranes overhead as they drafted each other, and all else was silent and alone.  I encountered no one along the run until I was back after dawn and running by the Werkok—the pond of Kok.  There a young man approached my running route with curiosity and asked in stilted but understandable English in bafflement: What are you doing?”  I thought the activity might be self-explanatory, and simply said “running” but he shook his head convinced that I am up to some nefarious purposes  And there may be a fair amount of the head shaking going on during the first ever Jonglei Marathon on Saturday two days away with a starting time of nine o’clock AM already too hot.  Ajak has been to see the Governors and MOH and invited them to participate—which I consider a fat chance.  I also am sure that there may be a few folk who are interested in starting—after all I believe you get the tee shirt up front—but have no intention of finishing.  But it will be scenic, through the musty and dusty town (there are no paved roads in Bor—or for that matter the whole of the new state of GOSS.  We will go to the hotel which is run by a Lost Boy entrepreneur who was with them in Canada who is banking on a growth in the Bor Jonglei capital with the new state’s secession.  We will stop at the Police Station—each of these bottled water stops.  And we will probably drop off supplies for the alter trip to PiBor since they cannot be carried out of Werkok as a full load on the aircraft.  It will also be a  good idea to pick up a few patients particularly the pre-ops since it is true that the transport from Bor to Werkok is Thirty Sudanese pounds (the New State is too new to have its own currency as yet) which is almost ten dollars, and their MCH consultation is only one pound (thirty cents.)  So that may be one of the reasons we are still a long way from over busy here due to its geographic isolation.

We saw patients in the clinic including one small girl with a burn flexion contracture of a ring finger which did not interfere with her grasp but only prevented her extension of her fingers of the non-dominant hand.  They were keen on seeing how I might operate on this but it would require a full thickness skin graft and a several week hospitalization since a split graft would contract giving her a bigger contraction problem that she had from the burn.

We have had our tutorial’s based on a few of the patients who were in clinic but mostly on the basis of pre-assigned topics and John Jack has been a champ discussing pneumonias from his carefully prepared notes just as he had done for malaria last year.  I am assigning both John Mchol and Juma topics for tonight and hope Ajak will return for the quick course on sonography, now that we have our InterSon probe returned.  I had loaded the program on the laptop of both John Mchol and on Juma’s so they are each hopeful to get the new probe later—a $2500 donation.

I had to pin out that a couple of “slam dunk” lesions that should have been easy pickings for operations—such as the ventral hernias of a young man with abdominal distension secondary to a bellyful of ascites following chronic active hepatitis B.  Of course if these hernias were repaired without the underlying pressure form the ascites relieved, they would recur immediately and not before the constant leak of the sticky colloid of albumin weeping into his belly from portal hypertension.  Besides, a closed abdomen would not be a source of the peritonitis that would surely result if it were opened leaking he rich culture medium.  So, judgment is necessary as well as technique—much as my interception of an older man who was about to have a parotid tumor removed as a “lipoma”” in the ER at LHMRRH in Philippine.

Late word is that the container is in Juba awaiting “clearance.”  But it should not need that with its exemption papers, so if it shows these it should be here tomorrow.  There may be a point to having the Governors and all the MOH and other eager owners come by so as not to be sneaking things in so that no one can try to get sole ownership.  But those invitations are extended by Ajak today and he will return to report on the events of his day in court and his further plans for our week and the weekend Jonglei Marathon for which he was considering having the runners overnight in Bor so as to get the nine o’clock starting line, when I have been vernally on the run by 6::30 each morning here in Werkok with just light enough to see and before it got so sticky and bracingly hot.  I will learn more at our tutorials tonight after we repair a re.  current ventral hernia done two years ago somewhere else and an older woman who is telling me “her whole body pins here” due to what appear to be subcutaneous OV nodules  Onchocercus volvuli was the filarial subject of one of our conferences last two days and was discussed as the source of River Blindness.  I told them to look for guinea worm and for OV nodules and here this older woman had beaten them to the diagnostic punch.  I also heard that a Samaritans Purse team is coming to do a trachoma prevention program across the road at Werkok this week by giving all the young kids an annual dose of azithromycin.  We may be trying to gain on the entropic collapse of this corner of the world a little bit at each effort.

A major accomplishment of today was an interview on videotape and then the request by Brittany was for a complete history and current status of the intertribal conflicts and what we are doing here in our peace imitative.  I gave as much as she could stand in sitting and then squatting and wore her out in her arm holding the video camera but I did a rather completer run down of how we came to be here and what we hope to accomplish using the macrocosm of the Big Picture of the cattle culture conflicts and the microcosm of the Ajak marriage proposal and its defrauding as the kind of instigating event that has had people warring for time immemorial each with good cause, since it is to their advantage to grab all they can get over and above their reward for legitimate efforts and if no reaction to that egregious gouging to repeat it at a higher level of plunder.  At the same time, considering all the people around one to be resources to be milked for one’s own advantage and aggrandizement—where do these people think they are—New York?

Oh, and one more thing.  As has happened three times in our daily morning circle under the acacia shade as a morning report/devotions/plan of the day is delivered (and usually a very formal repeat re-presentations of each member of the team in case anyone new has shown up that has not participated in this ritual before today—run for your lives if you are a cute little kid waging its tail and bleating cheerfully.  It seems nothing good can happen from your nosing into our inner circle since this is a group of high calorie consumers from the Western World and they need a carnivorous diet to stay docile.  So, as each of the kids has nosed into our circle each has been led only twenty meters away to the side of the cook’s tukul and there as the kid is prancing and bleating in utter joy at the attention being paid to him, abruptly he finds himself hoisted up with one leg tied to the fence post as he bleeds out on the ground along with the last echo of his bleating. He will be joining us for lunch.

Care to come along and participate with us?

Oh, remember I had reminded you to pack dental TAPE not floss! You’re going to need it!