Work Week 2 – Aug 13

This has been a busy week, a week of interesting cases and unusual conversations. Many things considered mandatory in London, Ontario seem almost frivolous here. Things like a sheet to cover the patient’s exposed body, blankets, bedsheets on the patient’s bed, pillows, alcohol wipes, paper towels, labour epidurals, screens to keep patients’ privacy, informed consents, safe sharps management, anaesthesia machine checks, the help of an RT, availability of blood for transfusion. Oh, I could go on forever!

Beth and I have decided that we are going to kiss our anaesthesia machine and glidescope when we return! She has also said that she is looking forward to her OB call. This one I am not too sure about and I will have to see if she changes her mind!!!

Here is a patient who very kindly allowed us to photograph her for teaching purposes. She came in for a mandibular tumour excision. We did promise her that her face would have a black stripe over her eyes. A very pleasant woman who lives in a remote area of Guyana and came in for surgery as she could not eat anymore.

Kaieteur falls weekend trip – Aug 13

We had an amazing weekend. We were invited to a Guyanese wedding on Saturday. An anaesthesia resident was getting married (to an OB resident!) and we were last minute invitees. What an opportunity to see a local wedding! Despite both the groom and the bride being of different faiths, the ceremonies did not take too long and then it was food and dancing. We all had fun!

We had been negotiating with various travel agents for a weekend trip to Kaieteur and Orninduik falls. Finally, after finding the right price, on Sunday morning we were at the Ogle airport to take the small 12-seater Cessna 208B to the Kaieteur Falls. It was raining heavily and the trip cancellation was looming on the horizon. However, 2 hrs of waiting was rewarded by a sudden clearing of skies and takeoff

There are no roads to this protected national park and the only other way is to hike for 7 days through dangerous rainforests (that many still do, believe it or not). Neither were we brave nor did we have the time so we flew over miles and miles of dense Amazon rainforest for about 50 minutes and then the falls suddenly appeared.

The Kaieteur Falls are about 4 times higher than our own at Niagara so one can imagine the absolute perpendicular drop of the coffee coloured water. I believe that they are the world’s largest single drop waterfall by volume. There is sheer isolation without any touristy stuff here. The 12 people on our flight, one pilot and one guide were the only souls (apart from the 2 park rangers and one local guide stationed there). Not even mosquitoes! There are carnivorous plants in the jungle that eat all the small insects. I was fortunate enough to see the little golden frog that was discovered in the jungles of Amazon in 2008 and had made the news. It did hide but not before I had taken its picture!

Orninduik falls were another 25 min flight away and as the falls are not deep, we enjoyed bathing in them. It then started to rain just as our time to return was drawing near. Our pilot was very experienced and he brought all of us safely back to Georgetown in the evening. A lovely end to an eventful week about which I will tell in my next post.

Cricket Stories – Aug 10

Today I will share with you a West Indies cricket experience. For those of you who are uninformed, cricket is a sport, not an insect! It is widely played throughout the world except for North America! Countries have their own teams (e.g. England, Australia, NewZealand, India, Sri Lanka, South Africa, Pakistan to name a few). As the Caribbean countries are small, they play as one team: West Indies and it is one of the powerful teams in the world.

Created in 2013, the Caribbean Premier League is an annual Twenty20 cricket tournament held in the Caribbean and most Caribbean teams participate individually, with each other. The matches are much sought after and we were lucky to have one in Georgetown where Guyana Amazon warriors were playing St. Kitts & Nevis patriots.

With our new found OB/Gyn friends Jennifer and Kristen, we went to the Providence stadium to see the colourful and noisy carnival last night. Remind you, Jenn and Kristen along with Beth are (or at least were) cricket naive. All three of them had a crash course in cricket, thanks to aunty ‘Google’ and uncle ‘Wikipedia’. And then it was a blast. Yours truly tried a hand at taking selfies and after many miserable failed attempts, nailed it and the proof is here for all to see!!!!

 

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Follow Shalini’s blog at < https://traveldocanesthesia.wordpress.com/ > and see her great photos with the postings.

Block room in Georgetown!

There were a fair bit of medical students hanging around, it was their last day and they did not know what do so we started teaching them. They were delighted to practice their BMV, LMA insertion and intubation skills on a mannequin. We did make a make-shift block room in the PACU but there was no patient for us! Perhaps in the coming week?

Guyana end of week 1!

Today is the end of week 1. We have been in Guyana for 7 days now. This was a very eventful week and I will report the interesting events.

Clinical work is interesting in the Georgetown public hospital corporation. We had a teaching session with the residents (at various levels of training) on Thursday and got to know them as well. Now I can tell a few names and I am sure I will get better, as the days go by. Maxine is the senior most and will be visiting Hamilton, Ontario in a few months time. She is waiting for her CPSO license. The PGY4s (this is a 4-year program) visit Hamilton for 3 months, regularly. This is such a wonderful opportunity for the Guyanese residents as they get to see things that they have only read about.

We visited the OB suite. It is a relatively new building that was finished in 2017. There were 4 C-sections planned for the day. The place is run by nurse-anesthetists who do all spinals/GAs. Attendings are available in the building across the street in case of problems. It was Deja Vu for me and it seemed that I had stepped back in time, at least 35 years! There is minimal OB analgesia service and lack of equipment/personnel may be partially to blame. Also, the residents/attending stay in the main ORs.

Just as we were getting the hang of the Project Dawn, we had to move out on Friday as the place was needed for a larger orthopedic group. Now, we are in a hotel in the town. This is a reasonably comfortable place and we both have our own rooms but we have to eat out every night. I am worried about restaurant food for 12 nights. I have not hand-washed clothes for more than 2 decades and this is not something I am looking forward to!

On Saturday, we walked to the botanical gardens and the attached zoo. This was a nice trip and we saw some strange animals. We met one of the anesthesia consultants who was also there with his daughter. On our way back, Beth bought coconut water and we did some grocery shopping. Beth cannot stop trying to pet stray animals and I cannot stop telling her not to. Let us see who wins.

We went out with the two OB/gyn residents from USA and had a nice evening. Today, we walked to the local Bourda market and bought some fruits and vegetables. We are both craving fresh greens and fruits! No to mention “LATTE”!!!

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Follow Shalini’s blog at < https://traveldocanesthesia.wordpress.com/ > and see her great photos with the postings.

We arrived on Monday, uneventfully. I was surprised that my ultrasound machine did not create any problems! Our pickup was there, waiting patiently for us.

We are staying at a place called “Project Dawn”. It is a fascinating place that was the brainchild of a nun Dr Cameron Gannon who started it as a medical centre in 2002. It is not a medical centre anymore but houses almost all of the medical/educational teams that come to Guyana for voluntary work. There is a common kitchen, the place is airconditioned and is guarded 24/7.

We were picked up by the hospital van on Tuesday and spent a very eventful day at the GPH (Georgetown public hospital). We met consultants Drs Fernando, Shankar, Acosta and Feng (?Du). There were many residents at various levels of training and I am sure I will remember their names as the weeks go by. There are 5 operating rooms for ortho, general surgery, ophthalmology, ENT, urology, gyne and some thoracic work. Cardiac teams visit off and on and do cardiac surgery as well. They tell me that there is a fair bit of trauma. The residents are all very keen to learn! Most drugs are available. Today we did a laparotomy for perforated viscus and Beth was thrilled to use halothane. Though everyone here wants to use propofol, I think I will use thiopentone on Thursday for Beth’s benefit! We are also preparing for our first teaching session tomorrow.

Like most operating rooms world over, there are no lunch breaks. An ex-nurse delivers food for a small price and many doctors buy from her. I think Beth and I will do the same. The meal is about CAD 2. Today we tried a typical Guyanese lunch of chicken wrapped in ‘roti’ that she had brought over.

Today (Wednesday) is a national holiday here so we are staying in. We went for a long walk with our bottle of water and an umbrella. The sidewalks are full of lotus and lily plants, all in full bloom. Did I mention that it rains every day?

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Shalini’s blog is at < https://traveldocanesthesia.wordpress.com/ >.

We will be following the postings of Dr. Shalini Dhir during her time in Guyana. Her blog is < https://traveldocanesthesia.wordpress.com/ >. This first set of postings leads up to her departure.

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Anticipation – July 15, 2018