Clinic in SNOW

And here is the clinic!

Just trying to see how easy it is to post pictures in here from Picassa - it's pretty easy!

New Picture

So here is our crew at Commonwealth!

Friday

Today is Friday - and today Emma went home. :) She had a good night at the emergency clinic and ate well for me this morning - she peed and went number two - all that was required of her. So, I sent her home with tail wagging and proud papa smiling. :)

I'm pretty sure that her vet was smiling a little bit, too. :)

amazing. :)

Emma

Today is one of those days I want to remember. And due to the requests that I keep blogging - I thought this venue would do just fine for recording today's events. Actually, today started yesterday....

I saw a patient named Emma - she's an 8 year old female chocolate lab. She was injured in an accident (HBC - Hit By Car) the last week of January. She had some bumps and bruises, but recovered fine. But over the last 2 weeks or so, she's been losing weight, losing her energy, not eating with Gusto. According to her owner: "she's just not Emma." I examined her yesterday and knew pretty quickly what was going on. When she was bumped back in January - it was most likely with some force. Sometimes, a large amount of force in the abdominal cavity can cause a rip to occur in the diaphragm. This poses no immediate risk (usually) but over time things start to migrate into the chest that don't belong there. When I took an x-ray of her yesterday, I could see that her liver and a good portion of her small intestines were in fact in her chest. The liver gets mad being out of place like that, and oozes lots of fluid. This fluid eventually leads to the lungs not having enough room to expand - hence why Emma didn't feel up to snuff. This can be surgically corrected - but it is a risky surgery. Dr. Woolsey - the vet I worked for during high school and college did several while I worked with him. The prognosis was always 50/50. Dr. Bowman has done two in his career - one lived, one died - again, 50/50. I, of course, have not done a procedure like this before - and I really wanted to send Emma to a board certified surgeon in Richmond to provide her the best chance possible. I gave the options to the owner - and he said that he'd talk to his wife and call me back. I ended up calling him back, and when he answered the phone he said: "Doc, I have one question for you - are you a believer in Jesus Christ?" I answered, "of course!" - he said "then you are doing the surgery. We know this is new for you - and we know it's risky - but we trust God for the results." wow. So, ok, here I go. Try to prepare as much as possible. Read all my books. Call Dr. Woolsey - he gave me great advice! Talked with my tech who would be doing anesthesia - we both knew that this was going to be a large endeavor. It was that, indeed.

Dr. Bowman had today off - so I had arranged it so that Dr. Nice would be assisting me in the surgery. (He's never done one of these either....) Both of my tech's and both of us docs were very somber as we got started - but I told them I had been praying for Emma all morning (and most of the night, as I didn't sleep all that well!) We got started and there was so much fluid everywhere! (Dr. Woolsey warned me of that!) We couldn't see a thing. We suctioned and suctioned and I was finally able to see where the hole in the diaphragm was - we actually had to make the hole larger in order to get the liver back through it. Once the hole was unplugged, things started getting tense. She stopped breathing - but this is normal and expected as the normal negative pressure zone of the chest is now open to the world (no more negative pressure.) No prob - my tech was breathing for her (bagging her.) But then the heart started getting mad because I had disrupted it - no prob - "Jenny, give the lidocaine." This made it not so angry - but it still decided to give us probs and beat really, really slow. "Jenny - give the epinephrine." I placed my hand on her heart (THAT is a really STRANGE feeling!) and I immediately felt: thump.... thump..... thump, thump, thump, thump - all was well. Now, back to our hole. Dr. Nice had the better angle for making the first, very difficult, suture placement. Unfortunately, he nicked the vena cava with the needle (this is a large blood vessel going straight to the heart, just so you know) as he made his first pass. Lots of blood. No worries, deep breath, put a clamp on it. No more blood. Go Dr. Brown. I tried to put a suture over it, but Emma was trying so hard to breathe that there was too much motion for me to tie anything. Ok, leave clamp on, close hole, then come back to the vena cava. Dr. Nice did a great job of closing it up - I added a few stitches to close a few gaps - then we had Jenny bag her - no leaks. "Ok, Jenny, give the Dopram and let's see if she breathes on her own." This is where she lives or dies - this is where it's out of my hands. We wait. It seems like a long time. The carbon dioxide has to build up in her blood to signal to her brain to breathe. We wait. She starts breathing. We start breathing again. :)

So we use a syringe and needle to suck as much air as we can out of the chest to create the happy negative pressure zone again. Now, back to the hole in the very large blood vessel. I place an 'x' type suture over my clamp and as I tighten it, I ask Dr. Nice to remove the clamp. I tell him that whatever oozing we are left with - we are left with - I don't think I can place another suture. (This was VERY difficult!) As he pulls out the clamp, I see a stream of blood about the size of a coffee stirrer shooting out of the vessel (which is the diameter of a hot dog) - before I can even get my needle back into position to make another pass, the front part of the abdomen is full of blood. I can't see anything. I can't see where to clamp. Dr. Nice tried to swab away the blood but it was coming out too fast for me to have a visible window. I make a blind stick into the puddle and pull tight - we both watch - the puddle isn't growing. (!) We swab out the blood and look - a little bit of oozing - but nothing more! Oh, my goodness, I just closed a hole I could not see! WOO HOOO!!! Quit celebrating! Get out of there! We look through all the intestines to make sure everyone is happy, then we stitch her up. Dr. Nice starts on one end - I on the other. We meet in the middle and we are done. She's breathing! She's alive!

Then we hear a very sobering question. "Dr. Brown, I only have 5 lap sponges (large cotton sponges for wiping up blood, fluid, etc.) - how many did you start with?" I look at Jenny - "6." "Are you sure?" "Maybe." We look everywhere. No way - we did NOT leave one in her. No way. We take an x-ray of a sponge to see if it shows up - it does. Fortunately, M.D.'s have been sued many times for leaving sponges in people - so they added a little metal material to them so they show up on x-ray. We took an x-ray of Emma - there it was - glaring at me as if to say "you didn't think it would be THAT easy, did you?" Back to the table - open her up - take out the sponge - close her back up. She was still under anesthesia during all this - no worries. It's so fortunate that we found this now, and not 3 days from now. It would have been better, of course, to have found it was missing BEFORE we closed her up - but this is what we call a learning curve. :)

2 hours later Emma is up and wagging her tail. I tear up. She's alive. She got heads when the world called tails. God was involved - and he decided that Emma needed to be around for a few more years.

And I am overwhelmed that I got to be the instrument by which that happened. wow.

She's not out of the woods yet - but hopefully over the next 24-48 hours she'll continue her recovery. Stay tuned....

This is Holly and I in our Sharees! 

Last Days and summary

Loving the USA ...And all of it's technical wonders. I can't BELIEVE how FAST this computer works. It has been an extreme lesson in patience waiting to use the computers in Bangladesh - you just have no idea how long it took to get to this page so I could write to you all! But, it was so worth it to have you along on the journey - thanks so much for staying with me - reading everyday and praying for us! We certainly were beneficiaries of your faithfulness, for we feel that we were used by God - both in a physical and spiritual way. Since the jet lag is decreasing, I'm going to attempt to write a coherent summary of those last few days - and of my feelings about the whole experience that was 3 1/2 weeks in Bangladesh. :)

Ok, so actually it's now Monday - I have been a delinquent blogger - just trying to catch up with folks and adjust back to this time zone. Haven't been able to sleep well through the night (though did pretty good last night) - my body still thinks that night time is day time - but it's getting better. I was advised yesterday at church that coming home is harder to adjust to than the going over is. It's my first day back at work, and due to a snowstorm - things are slow. They are easing me back into work gently. :)

I've had several requests to finish (or re-create) my missing blog. I'm not sure I can do it justice, but I will certainly try. Those last few days were precious - very sentimental in allowing us to feel like we had an impact on the Bangladeshi people that we were priviledged to work with.

Our trip to the Bangladeshi national museum: a very nice museum, nothing like our Smithsonian, but very informative. It had displays covering the national wildlife and plants, to local art, to the history of the birth of the nation that is now Bangladesh. We saw a carpet stained in blood - this carpet was from the teachers' lounge at Dhaka University - and many teachers were killed in that room by Pakistani soldiers during a raid. We saw a torture chair - and I will leave the details out for your sake. The fight for independence for them was not unlike most wars of it's kind. The Bangladeshi people are very proud of their country. I never once heard a negative word from a Bangladeshi about the country or the people - only the government. It really strikes me that if they had honest people in power, the country could really rise above it's current state. But as things are now, it seems almost impossible... it has, afterall, been declared to be the most corrupt government in the world.

A sign going into the museum posed the following restrictions: No bombs, grenades, or weapons allowed. Kindly refrain from spitting. Talk noislessly. No running. No food. Important things, first. No bombs. :)

I also had to check my camera at the desk when I went in to the museum - this did not make me comfortable. I had not let that camera out of my sight since arriving - and here I was, at the end of the trip - with ALL our pictures on that camera (it's digital) - and I have to hand it over to someone who works for the most corrupt govt on the planet?!? I was anxious - but recovered it, none-the-less. :)

Anyway, we did have to hurry through the museum - to arrive back for lunch. We went on our last (very sad) client visit to re-check a cow to see if she was pregnant. She was not. :( She looked great on the outside, felt fine on the inside - we could find no reason to explain her infertility. The farmer was going to try fresh semen on the next breeding instead of frozen to see if that made any difference - we also suggested some vitamin supplements. Hopefully, she will be able to get pregnant and maintain it. The people's faces were so bright as they saw us again! Our Bangla lessons impressed them as we were able to have a small conversation with them - whereas the first time we met these folks, we couldn't even say 'hi.' :)

Have I mentioned how that everytime we said something in Bangla we got laughed at? It wasn't rude laughter, just pleasant amusement - I guess we sounded funny. :) Can't imagine that a girl from TN would sound funny trying to speak an asian language. ;)

The visit to the Fort was really very cool - they had a huge tomb and mosque and a living quarters building. The tomb was for the 'favorite' daughter of some really important person (didn't think you were supposed to have favorites?) It was beautiful. Finely decorated with hand-made ceramic tiles and marble. It was amazing to me that this place was built in the 1600's - made to last, indeed. The mosque is pretty famous - it appears on their 10 taka note. We did not go inside of it, though. Inside the living quarters there is now a musuem with quite a collection of memorabilia from the Monghuls - spears, sheilds made of elephant skin, some very old guns, books, paintings, etc. I was quite fascinated. There was a very large bathroom, complete with a hot water system (heated by fire.) The fort itself was made of an outer wall, a large moat, and an interior wall. There is a large pond for keeping fish - and now the grounds are all flowers and grass. In a very crowded city, this place is a bit of a haven. We spotted many couples there - probably getting to know each other following their engagement - with a wedding coming up VERY soon. :) Getting to and leaving the fort was a challenge. The streets are just soooo narrow!!! We got tangled up with a rickshaw and had to ask constantly which route was the best way out. It seemed like a maze. We also drove past a tannery - a place where leather is made. Now, I have a strong stomach - but the smell from this place was overwhelming!!! It was cool how they had so many hides laid out on the ground - they stretch and nail them out in order to dry them. We also saw large pieces of fabric laid out with some kind of powder (?) on them - when we asked Lawrence what that was, he commented it was for color. Possibly blood meal, possibly herbs and things used to color the leather. We never were quite sure.

Our last day at the office started with my leading Devotions. I was completely unprepared - for we had stayed up late sorting out our gifts for the staff (the M&M's were a HUGE hit!)and writing thank you cards. We had to say good-bye's in the morning to some of the YWCA staff - and then stop by the head office to get our printed out addresses that we had made. We sang "Victory Chant" one last time, then they sang a Bangla song - and I opened my Bible - still unsure of what I wanted to say. I opened to John 15 - the passage talking about Jesus being the vine, and us the branches - and how if we remain in Him, THEN we will bear much fruit. I told them the story of the starfish (I have this poster in my office and read it often) - I'll write it for you just in case you've never heard it:

While walking along a beach, a man saw someone in the distance leaning down, picking something up and throwing it into the ocean. As he came closer, he saw thousands of starfish the tide had thrown onto the beach. Unable to return to the ocean during low tide, the starfish were dying. He observed a young man picking up the starfish one by one and throwing them back into the water. After watching the seemingly futile effort, the observer said, "There must be thousands of starfish on this beach. It would be impossible for you to get to all of them. There are simply too many. You can't possibly save enough to make a difference." The young man smiled as he continued to pick up another starfish and toss it back into the ocean. "It made a difference to that one," he replied.

I asked these field officers if they ever felt overwhelmed doing the work they do. They all replied, 'yes.' Maybe I should do a better job explaining what they do, first. World Concern is a development organization - it is know as a 'NGO' - a 'non-government organization.' They have many projects in many countries - in Bangladesh they have a free school - where children from the slums can come and have a free breakfast and lunch, as well as a free education. They have a school for the deaf and the blind. They have a hospital. And they have the Women's Small Business Assitance Center - the WSBAC - and this is what I refer to as 'the office.' This is a team of people, mostly women, who provide small loans to women to start their own business. This could include making handi-crafts, jewelry, starting a grocery store, or buying a milking cow. The women are approved by loan officers - and it is the loan officers job to make regular visits to the client to make sure that all is going well, provide training and assistance when necessary, and collect their monthly repayment installment. The field officers go out every day - sometimes traveling very far to see their clients. Every field officer has 60-90 clients - and there are 49 (give or take) field officers currently. We were present during one collection from a 'problem client' and I watched as the field officer carefully inspected each bill - to make sure there were no counterfeit! There was!!! I know that I wouldn't be able to spot a fake bill - but this is their job. Most clients love their field officer - but some are not so kind. They are very brave to travel out to people's homes to collect money - they usually go alone. So, I asked if they were ever overwhelmed...

There are over 15 million people living in Dhaka. It is the most densely populated city in the world. It is the most polluted. It is the most corrupt. It is one of the poorest. So, yes, they feel overwhelmed. So, I told them the story of the starfish - to remember that they ARE changing lives, one by one, in Dhaka. And I reminded them that the energy comes from the vine - and He is the giver of fruit. Through very teary eyes I told them how I prayed that one day they would have the chance to see the fruit of their labor - that they would see the difference they have made. I was so blessed by thier attitudes - their courage and their compassion. And their friendship! In such a short time, so many of these women drew so close to us - saying to us upon our departure that they felt such 'deep sorrow in their hearts' because we were leaving.....

One very special friend - Rupali (which means silver) even came into work that morning to see us off - she had the day off, for she was studying for a large exam for her masters program - they just loved us. Instantly. We were sisters. And we were, in Christ.

We gave out our gifts after that, took tea, then traveled to the head office to talk with Prodip about our time, about Lawrence, our recommendations, etc. Prodip had actually been out of the country since Feb 8th - only returning on the 22nd. A World Concern meeting that was supposed to happen in Bangladesh got moved at the last minute to Uzbekistan due to all the strikes. So, he had to be filled in on all the things we had done. He read over our mastitis and stall design things - and we made our recommendations that the livestock program be enlarged - for it is a very profitable venture - and that Lawrence be given a cell phone so that clients can actually contact him when there is a problem. (They currently can't really get in touch with him.) Lippy (the WSBAC program director) and Lawrence and us talked for a good while - and we all were very pleased with how things went. We had lunch, then I typed that one blog.... I thought we were through. However, we headed back to the WSBAC for a farewell for Holly and I. They gave us roses and a picture and they stood up one-by-one and said something about our visit with them. Holly and I were so moved. They sang our song one more time - and they sang a special song for us - a traditional Bangla farewell song (apparently they had a poet from Bangladesh who won the Nobel Prize - his poems and songs are very famous throughout the country.) We took tea (no surprise!) and then gave lots of hugs and handshakes. We got several small gifts from some individuals - and 3 of the ladies stayed until everyone else was gone. They were Diba (who is a Christian), Teetu and Parvin - our muslim friends. For being so reserved at first - these two sure took to us at the end. We were so blessed to have that happen. Thanks again for praying for them.

Lawrence told us that he had a gift for us - but that he would bring it to the YWCA later. At this point, Holly and I were a little drained from all the good-bye's but knew that Lawrence's would be special. Sure enough, he came by with his wife and daughter - with shirts from Grameen bank. (Grameen bank is where the micro-credit loan originated - there was a special on it on National Geographic just last week.) Holly got a shirt, as did.... Matt. I didn't get a gift - my boyfriend did!!! :) I wasn't quite sure how to take that - but was very appreciative none-the-less. We said our good-bye's - though I know I'll be in touch with him - and then we went and packed up to leave.

Up and at em bright and early Thursday morning - at the airport at 6am for our 8:20 flight. We go to the end of the line - and for the next 4 hours we stayed at the back of the line. Americans are just not pushy enough. :) The delay was brought about because the security guy from British Airways was not satisfied with the scanners, so he ordered a hand search of all bags. This was a FULL flight on a 777 - and ONE security guy checking the bags!!!! I'm quite surprised that we made it out of there at 11 like we did! But, we missed our connections, and like I wrote, I caught a flight to D.C. while Holly stayed in London. I have heard from her - she is home safe. I have only received one of my bags - but they have the other one, and it's supposed to be here tomorrow. :)

There are some things about the culture that I wanted to write. First, I never explained the strike thing. There are two main political parties in Bangladesh - the BNP (Bangladesh National Party) who is currently in power, and there is the opposition party, the Awami league. In August of last year and then in the end January, two Awami league officers were assassinated - with no arrests being made. In protest, the Awami league called for country-wide strikes - stopping all commerce. By crippling the already broken economy, they hope to force the current govt out of office. They will attack any business that is open or any vehicle that is on the road that is private. Foreigners are a great target - for the object is to rattle people's cages to try and force a change. Hence Prodip's warning to us to stay indoors.

The population of the U.S. is around 300 million. The pop of Bangladesh is 150 million. The size of Bangladesh is around the size of Iowa. COZY!!! I spoke with one man who had visited the states - he commented that he felt lonely and scared because there were so few people around. Holly and I felt scared because there were so many people around!!! When I told people how that sometimes I go hiking and go an entire day without seeing a single other person, they literally could NOT imagine such a thing. People are everywhere to them. Most of them want to live with their parents - and the family connection is very strong. There are nursing homes, but most aged people are taken care of by their children.

The men of Bangladesh wear skirts - thin cotton that is tied together in a bunch at the waist. This is very convenient - for urinating (and defecating) on the side of the road or sidewalk is VERY common. :(

One day we passed a dead body on the side of the road - it was in a plastic bag and people were collecting money for it. We asked Lawrence about this - and he explained that he was most likely a poor man and they were collecting money to bury him. A word about burials... in a country with lots of people and little land, I inquired to Lawrence about how they do bury people there. He said most people are buried in a wooden box - and a new person in buried in the same spot after 5-7 years. They are not wasteful people - they even recycle gravesites.

I don't think I mentioned our visit to a Buddhist temple. It was a lovely place - but as we stood in that place full of literal idols, I couldn't help but be so sad - people actually do bow down and worship things made of wood and gold. It's quite an eye-opener to see that first hand. You hear of it - but to see it is just so stark. How blessed I am to know and worship the one true God - the One who exists, though is not seen. How grateful I am that I don't have to be bound by lies....

One thing I forgot to mention - everywhere we went we were offered chairs to sit on. Along with the command 'sit down!' We would be looking at cows and they wanted us to sit down! Sometimes they would go to their neighbors house to get a chair for us! And when we were offered food - they never ate with us. They always just watched us. This made us uncomfortable - but it is their way of showing honor to guests.

Several people have asked what I missed about home the most - I have a couple of answers. The first being space to breathe and move in. The second is music! I'm so accustomed to having music on during work (there is a radio in every room of the clinic!), listening to the radio in the car, and when I'm home, I almost always have music on. So, for a month I had hardly any exposure to music!!! Sometimes they would have music playing at the YWCA on the computer - but it was usually Hindi (from India) and occasionally some Celine Dion or Madonna. I was grateful to hear some Caedmon's Call again - as well as good ol country music!

And for those of you wondering - I did NOT lose weight while in a foreign land. Turns out that white rice, tea, and lots of sugar and fried foods are good for gaining weight. I gained 5 pounds! :)

Ok. I think this one is done. I've been told that I need to keep blogging - but I'm not sure that my ordinary life is much to read about.... :)

It's been a blast - thanks for coming along!

Dr. Brown - the 'poshu doctor'

"Pray for the homeless and the hungry - then pray for hearts that will do something about it." You can make donations to World Concern - just look them up on the web.

:)

Home Safe

Just wanted to say that I'm in the U.S. - after a very, very, very long day. 36 hours. I am still functioning to some extent, too. :)

We had a major delay in Dhaka - so our flight left THREE HOURS late - making it impossible for Holly and I to make our connection in London to fly to Chicago. I begged and pleaded and batted my eyelashes and got a flight to D.C. tonight. Matt picked me up at Dulles - Holly is still in London. :( But she'll fly out in the morning. All is well. I have cereal. :)

Shower and sleep. I'll write tomorrow.

Final Day

So we just had lunch with Prodip and the WC staff - it was our last lunch here. They made us a special meal - shrimp. :( I'm allergic to shrimp and Holly doesn't like it. Oh, well! We also had Mutton and veggies and rice and the usual Bangla food. Everything is fried in oil - they don't have ovens - I can't WAIT for raw veggies and baked food!!! (Remember how I commented that I liked the veggies here? That's because they are fried!!!)

We are wearing our Sharees today - we did manage to get them on ourselves - but as soon as we got to the office we got 'adjusted.' :) Prodip loves us in them!!!

We went to a Monghul fort built in the 1600's yesterday - built by a guy named Shasta Kahn - made me think of Disney's 'Mulan.' Very interesting stuff - I wrote you all about it - but it went 'poof.'

We also visited the Bangladesh National Museum yesterday - it was very good. Wrote lots about that too....

I made a HUGE list of odds-n-ends about Dhaka - but that is lost forever....

I'll make a shorter version once I get home. It won't be the same without Holly sitting beside me laughing, though. (Can you tell how SAD I am about losing my blog yesterday?)

We leave tomorrow at 6 am - I'll probably blog on Friday morning when I eventually get up. 30 hours of traveling is probably going to leave me a little tired.

It's been so good..... thanks for being a part of this with me by reading and praying for me.

sadness

I just typed the same blog - twice - 45 minutes of typing EACH - and they are BOTH gone. Power failures are bad things.

I don't have the heart to do it again.

It was really good, too!

so sad....