DRC, Day 9: Back in Kinshasa

Today was a ridiculously long day.

                

Like every day, I went for my run in the morning, and then we had breakfast, etc before heading back up to Kitona. The only thing on the schedule was doing an outbrief of MAJ Lang’s public health findings before we headed back to Muanda to change and get ready for our flight. We ended up getting to BG Moustafa’s office before he did, so MAJ Lang and I decided to swing by the hospital and thank BG Amisi for his time as well. Unfortunately, we also got there before he did. He showed up a few minutes later, did an “inspection of the troops” (which I had never seen before, but involved a lot of medical officers standing around looking bored before he arrived). We had just enough time to thank him and whatnot, and then it was back to BG Moustafa’s office.

The doctors lined up for inspection

                

MAJ Lang did the outbrief, which included some good things he saw (not much) and then then top three “easy fixes” of his findings, which was to add faucets to the water pipes to keep them from running constantly and drain the pool to decrease the standing water (and thus, mosquito breeding sites); add water treatment to the water distribution (not really an easy fix, but still important); and fix spacing of latrines, trash, and kitchens in the recruit areas. I’m pretty sure none of these will actually happen, because BG Moustafa nodded and said that none of this was a surprise to him, and he had submitted it up to Kinshasa in the past, and nothing was ever changed.

MAJ Lang briefing BG Moustafa

                

In other words, he didn’t want to take responsibility for the problems.

                

After that, we headed back, changed, finished packing, and then headed to the airport to wait for our flight back to Kinshasa. LTC McCullough gave me a coin, which is kinda about time, since it was my third trip in working for him. Whatever. It was nice anyway.

                

The flight was uneventful, and then we were back in the O’Costelo for another two nights. The next large group of travelers (nine of them) was also there, in preparation for flying out to Muanda tomorrow, and the whole bunch of us went out for dinner. I probably should have stayed at the hotel and ordered a croquet monsieur (grilled cheese sandwich), because after a week in Muanda, I had forgotten how loud people can be, especially a group that large of people who were jetlagged (and therefore a little punch-drunk) and excited to be in the Congo. It was so ridiculously loud, and I just wanted to get out of there. My introvert alarms were all going off, and there was nothing I could do about it.

Shrimp

              

The shrimp was good, though.

                

The worst part was probably the civil affairs guys from USARAF, because they were acting like incredibly pretentious jerks all night, and sadly, that reminded me a lot of having to go back to work and deal with the pretentious jerks who make my life miserable there. I don’t know what it is about these civil affairs guys sometimes, but it just drove me crazy, and I wasn’t the only one. MAJ Lang was pretty frustrated by it, too, and when I told him that that was a little bit like what my life was like at Ft. Stewart, he said he understood why I’m so eager to be in the office as little as possible.

                

Ugh. Makes me really hope the job at USAMRIID at Ft. Detrick can be mine next year.

DRC, Day 8: Beach and Dinner Time

Ah, Sunday. Day of rest. Or something.

                

The day started early (0600, so not that early) with an attempt at a 10 mile run. The plan was to run on the road along the ocean, toward Banana, until I hit 5 miles, and then turn around and come back. Well, at around mile 2.6, we realized that the road was too washed out to continue, so we headed back and did a little bit along the airport, for a total run of 6 miles. The problem was, the 6 miles felt awful, much worse than I expected, which really goes to show how important it is to eat right and stay hydrated if you want to stay active, neither of which I’d been doing. Not enough water, not enough vegetables… I’m in for a world of hurt when I get back to the States.

                

After the poor attempt at a long run, we did some work on writing reports and whatnot before it was time to head to the New Cliffs, because Phillipe wanted to take us to his private beach and to eat some fish that he had caught. I thought this would be a quick trip, but I was wrong. The beach was almost an hour drive away, when you factor in the stops he made us make so he could point something out. Then we made it to his beach, hung out there for about 20 minutes, and then headed to the restaurant, where it was a two hour wait while they grilled up the fish and whatnot. The fish was delicious, as were the beers we consumed while waiting for it, but in all, we didn’t get back to the hotel until 7 pm (after leaving at 1).

Dinner being cooked

Playing after the dinner

                

Tomorrow’s going to be another short day. All we have on the agenda is out-briefing General Moustafa, and then we’re getting on the plane to take us back to Kinshasa. I can hardly wait to eat dinner in a real restaurant again, without having to deal with Phillipe and his cigarette smoke.

DRC, Day 7: The Weekend

Today was a day off of normal activities, so there’s really no much of anything to report. We woke up an hour later than usual and went on a 5+ mile walk around the “neighborhood” (instead of the usual run, because I’m planning on doing a long run tomorrow morning). Even though it was a walk, the walkers in the group are used to power walking, so it was a bit fast-paced for me. There was more than one instance when I was jogging a few steps to catch up.

                

After the walk, we worked on various reports and whatnot that we all had to do. I updated the paper I’m working on with the other members of the MEDRETE team back in June, including the information from my re-evaluation of the hospital this time around.

                

At 12, we were all supposed to go down to the New Cliffs restaurant for lunch (and an opportunity for faster internet), but the three guys from the embassy were still working on reports, so they sent MAJ Lang and I up ahead. Unfortunately, we ran into Phillipe, a really obnoxious Belgian-Congolese (white man born in the Congo) man who I don’t think does anyting but sit at the New Cliffs and drink. He took it upon himself to change our lunch order to clams, and while those were the smallest clams I had ever consumed, he also paid for lunch, so I guess I can’t fault him too much. At least, for that. For the other ridiculously stupid things that come out of his mouth, yes, I’ll fault him.

                

That was pretty much the day, culminating in returning to the New Cliffs at 6 for dinner and watching the sunset over the Atlantic. In all, it was a low-key, relaxing day with no obligations, which was nice in and of itself.  

DRC, Day 6: Going into the Weekend

Yay! It’s Friday! The last day before the weekend…in a town where there’s nothing to do… Oh, well.

                

We got an early start to the day to go to the women’s sensing session, which was actually pretty well attended, with about 43 female soldiers, officers, and police. It's a very civil affairs thing, and it was facilitated by a woman from Dyncorp, which is doing the civil military operations training during the exercise as well. She had the women go around the room and ask what they did in the FARDC (or police). There were quite a few nurses and nursing students, but a lot from the “regular army” as well. Then she asked the reasons for joining the military, which is pretty similar to why people join the military in the States—no money for education, hope to get training, want to serve/defend the country, etc. The last question was about what they hoped to get out of joining the military and what they still hoped to accomplish, and that opened up the floodgates. Almost universally, they said that the opportunities for the good training—English language training, computers, etc—was always given to the men, because they assume the women would mess it up. They said they aren’t treated as equals, there’s nobody to help with the childcare when they’re at work, nobody respects them, and on and one. They said it’s a problem with the leadership, that the views of women in the military come from the top down.

During the sensing session

After

                

This was confirmed when, after the sensing session when we were getting a picture, the general drove up, saw that the sensing session had already happened, and told me that I should work with the women to teach them how to be better soldiers, because they all think they’re there to “service the men.” I really didn’t know what to say, but it definitely made me believe the women who said that they get no respect from the leadership.

Talking to BG Moustafa

                

After we were done with that, we all headed to Banana Naval Base (where the Congo meets the Atlantic), to give the Navy doctors a chance to shake hands with the navy people (the navy that has no boats…), and then the Navy doctors hopped on the Kin-Avia flight back to Kinshasa, while MAJ Lang and I get to suffer through a weekend in Muanda with nothing to do. It’s really not fair, but I guess that’s life. What I’m really bummed out about is that I’ve now been to DRC three times, and I still haven’t seen the bonobos (apes that are only found in DRC; there’s a reserve about an hour outside Kinshasa). I’m sure they’ll find something for us to do in Muanda… or I’ll just take a lot of naps and do a lot of reading. One of those, I’m sure.

DRC, Day 5: Last Day at the Hospital

Today was, with any luck, my last day at Kitona Military Hospital. Hopefully forever.

                

The work day started with the pediatrics ward, where I did rounds with the doctors and nurses. Although their antibiotic selection seemed better than it was in June, they also had fewer patients, so it was hard to tell. Also, they’re still treating anything with fever as “malaria”, even if the malaria tests are negative, so that’s a little frustrating. I’m not sure what it’s going to take to change that practice. Probably getting to the doctors when they’re still in medical school. I’m sure that’s where they’re getting this information, that everything that looks like malaria clinically must be malaria.

Seeing a patient with Juvenile Rheumatoid Arthritis

                

They also had a five-year-old girl with Down Syndrome, and they kept asking me how we treat Down Syndrome in the States. They couldn’t understand when I said that there was no treatment. I think they couldn’t grasp that there was anything that we couldn’t treat or cure.

                

I was spared from having to stand in on a cesarean section by MAJ Lang, who came by to pick me to take to see the water distribution center for most of the base. It was actually off-base, and it was pretty obvious that nothing had been done to improve the area since 1954 (we joked about that; we’re talking about getting tee-shirts that say, “Kitona Military Base. Unimproved since 1954” since that’s the year that people always give when you ask when something was last fixed.) It used to be a water treatment and distribution center, but we’re guessing that when something at the “treatment” stage of that broke, they just redirected the pipes to turn it into a distribution center only. The infrastructure is still there, but a lot of the stuff is too old and corroded to be of much use. MAJ Lang said his solution would be to scrap the old treatment center and add a smaller, semi-portable set-up (like what we used in Iraq and still use in Afghanistan) to the pipe at some point.

MAJ Lang studying the settling tank with the FARDC engineer and a water employee

                

That was pretty much our day, so we headed back to the hotel and worked on our reports and whatnot. After finishing that (and taking a nap), we headed to dinner at the New Cliffs and prepared for tomorrow. There’s going to be a “sensing session” (when people can air their complaints) with the female soldiers/officers tomorrow morning, so I might go to that, to see what the complaints of the female service members in the FARDC are.

DRC, Day 4: Evaluation of the Hospital

It was back to Kitona Referral Hospital today, for the first full day of the medical engagement of Operation Lion Rouge. It was exactly as I remembered it—the good and the bad (but mostly the bad).

                

I started the day by going by the lab to talk to them about the MEDRETE back in June. The lab supervisor is the same as then, so he was able to reiterate some of the points that LTC Cannon had made during their two weeks working together. Unfortunately, they really don’t have the money to mitigate any of the big deficiencies that were pointed out, such as not getting their equipment properly calibrated in the ten years they had had it. They also have some pretty big issues with electricity (as the entire country has), which puts a damper on the things they do and the things they can do. Dr. Olivier from PEPFAR wants to increase the capacity of the lab, especially in terms of HIV diagnostics and monitoring, but in order to do that, they need to have reliable enough electricity to keep and air conditioner going (because the machines run hot) as well as a refrigerator for the reagents. Currently, the hospital only has one generator, and it goes to the high-impact areas (the operating theater) when city electricity is down. In order to do the changes Dr. Olivier wants, the lab area would have to have its own generator.

                

They have made some positive changes, though. One thing I noticed is that they have the instructions for each of the lab tests printed out and taped to the wall, above the machine that runs that test. I don’t know if they had that before, but the paper looks new enough that I’d believe that they didn’t. I’m going to choose to count that as a win.

Lab instructions

               

The second area I went to was the blood bank. Unfortunately, the blood bank has a new supervisor since June. I’ll have to ask why the old one left. Since he’s new, he wasn’t able to explain what positive changes they had made since LTC Cannon was there. One thing that he noticed, however, was that they would draw a donor’s blood before they did the questionnaire and screening, which meant that if the tests or questionnaire led them to be excluded, that they had wasted that tubing and donor bag. Little things, but in a hospital that broke, every little bit helps. Well, when I talked to them today, I’m pretty sure they said that they do the questionnaire and testing first, then do the donation. If that is indeed the case, that’s a positive impact of the MEDRETE.

                

My last stop before I saw patients one-on-one with Dr. Patrick was the adult wards. For each of the patients admitted with malaria, I asked if they had a positive blood smear, and the answer was always yes (yay!). However, Dr. Patrick explained that even when the test is negative, they still treat, which is exactly what they did before (sigh). I guess we couldn’t have expected to change the way they do things with one lecture about diseases that look like malaria but aren’t, but I was a little hopeful. Oh, well. Anyway, they had a couple of malaria patients, a couple of hypertension/diabetes patients (yes, that’s a problem in DRC as well), and a couple of TB patients. They don’t have isolation rooms or even a separate ward for the TB patients; they’re just in the ward with other patients, a hypertensive and a malaria, in this case. I guess the bright side is that they didn’t put either of the TB patients in the same room as the patient with HIV and Pneumocystis pneumonia.

                

We ended up finishing early (MAJ Lang was doing an environmental/sanitary assessment of the base while I was at the hospital), and then headed back to the hotel to write our reports. I still need to see pediatrics tomorrow, which could be interesting. MAJ Mann found a lot of mistakes with the antibiotic selections while she was there, so I guess that’s what I’ll focus on. 

DRC, Day 3: Back to Muanda

Well, I’m back in Muanda for another six nights. The joys.

                

We got up this morning to go running, as always, and this time managed to find the running path I went on before, the one along the Congo River. Since the hotel now is further from the river than the Fleuve, we only did a short loop (about a mile) before heading back, for a total run of about 4 miles. It was nice, but the problem with running with people taller than you is they also tend to be faster.

                

Because of traffic, we were running a little late for the N’Dolo airport and our flight to Muanda, but of course, nothing in Africa runs on time, so we still had to wait after making it through customs and security. The flight was uneventful (always a good thing in those little prop planes), and then we were back in Muanda.

Flying over Bas Congo. The cleared patches are oil test wells

                

Our only official duty today was to go around the installation and do introductions. We met with BG Mustafa, the base commander; the head of the nursing school; and BG Amisi, the hospital commander (COL Amisi last time I was here). I think we came up with a plan for activities for everyone. MAJ Lang, the environmental science officer, will go around with the base engineer and do sanitation and hygiene surveys. BG Mustafa said he should find quite a lot of things wrong. The two Navy doctors will stay at the nursing school, mostly giving an overview of trauma care for the two days that they’re here. And then I’ll be at the hospital, doing a follow-up from the MEDRETE in June.

Outside BG Mustafa's office. He's the one in the striped polo shirt.

              

I still have open sores on my heels from my blisters that I got while hiking in Lesotho, so that makes being in boots pretty painful. I’ve been putting Neosporin on them, so hopefully they don’t get infected. I’d rather not have tropical ulcer as a souvenir of my time in Africa.

DRC, Day 2: Dealing With Kinshasa

Today felt like a pretty long day, and unnecessarily so. It started when MAJ Lang and I went for a run, trying to find the running route we took from the Fleuve last time (this hotel is fairly close to the Fleuve). However, we were on the right track, and then got stopped by a roadblock and had to turn around. Sigh. We still managed to get three miles and change in, and then it was time to begin our day.

                

We went to the Embassy for the RSO brief, and I was “uninvited”, because I’ve been here within the last 90 days and the room was too small. So I hung out with in the Office of Security Cooperation, waiting for the others to finish. When they were done, we went down to the PEPFAR section and saw Dr. Olivier (the military PEPFAR coordinator, who went out to Kitona on both of the previous trips). Then we had the fun task of pulling money out of the cash cage. Because this trip has two separate missions, and thus two separate lines of accounting, they had funding memos for much of this part of trip, including the hotel in Muanda ($700), the rental car ($1050), the interpreters ($1050), and the interpreters’ travel expenses ($600). That was a lot of cash to be pulling out in my name, and I hope to get rid of as much of it as possible, as soon as possible. I think I’ll pay for the hotel room and rental cars as soon as I get there, instead of saving it for the end.

                

After that experience, which took a couple of hours, we headed out to lunch at a Lebanese restaurant (not bad, and not too expensive), and then went back to the Thieves’ Market (for a third time for me…) so the other people in the group could buy some souvenirs. I was pretty much done at that point and just wanted to go back to the hotel and take a nap. Even though I’m not fighting jet lag, I’ve forgotten how draining just being out in this heat and humidity is. It’s going to be a long week at Kitona, starting tomorrow…

DRC, Day 1: More Travels

I didn’t write anything yesterday, because as far as I’m concerned, yesterday and today are the same day. I guess that’s what happens when you travel through the night and only sleep in airplane seats.

                

I went on a long run yesterday morning (well, longish—only six miles, which is a short run back home, but with the altitude and hills, I’ll call it a long run in Lesotho) and then bummed around the hotel until the shuttle came to pick me up for the airport at 2. After that, it was a quick check-in process and short flight to Johannesburg, where I then had a seven and a half hour layover.

Three African airports... Yeah, let's go with the African luggage security system of plastic wrap

                

The Johannesburg international transfer system is interesting. In Maseru, they only gave me my ticket for that flight, and said I had to get the remaining tickets in Johannesburg. Well, I get to international transfers, and I see a line of desks and agents, none of which were for Kenya Airlines. So I go through security, thinking I’ll get my boarding passes at a Kenya Airlines desk at a gate. Wrong. The gates aren’t airline specific, and they don’t have agents sitting there. So then I went back to the unsecured area, finally found an automatic check-in terminal, and checked in, changed my seats, and got my boarding passes.

                

By this time, I had about six and a half hours left of my layover.

Zebra pelt, anyone?

                

I went and got a massage (because, why not?), exchanged my remaining South African Rands for U.S. Dollars, and then headed to the lounge. Since I was flying Kenya Airlines, which is a Sky Team partner, I couldn’t use my Gold Star Alliance card to get in that lounge. So I paid $30 to go in another lounge, which had food, drinks, outlets, and wifi, so I was okay paying. Unfortunately, they closed at 10, which left me with two hours to kill before boarding.

                

Once I finally got in the air, I was out for the entire flight, waking up once to realize that I had missed a dinner service (who serves dinner at 1 am?) and that was about it, and then arrived in Nairobi around 5:30 am local time. The flight to Kinshasa didn’t leave until 8:30, so I wandered around, bought some hot chocolate (have to take malaria pills with milk, after all), and met up with MAJ Lang, the environmental science officer for U.S. Army Africa (USARAF) and my companion for this trip, and we chatted until it was time to board. And again, I was out for most of the three hour flight to Kinshasa (I did wake up for the food this time).

                

It was the usual scene at customs at the Kinshasa airport, a process I’m now unfortunately familiar with, and then we got our bags and headed out. Unfortunately, we’re not staying at the Fleuve Congo Hotel this time, which has me really disappointed. It was pretty much the only decent thing about going to DRC, and I was really looking forward to it. The hotel we’re in isn’t bad, but it isn’t even in the same class as the Fleuve. I’m going to see if we can get moved to the Fleuve when we come back to Kinshasa after our week in Muanda.

The pool at the O'Costelo

                

After some overpriced lunch, I took a nap, and then I navigated the hotel looking for a decent place to connect to the internet (turns out, the only place that works is the bar…) before an overpriced dinner. Neither MAJ Lang nor I was ambitious enough to try to call motorpool to get a pickup to take us to a real restaurant, so instead I paid $15 for a croquet monsieur (grilled ham and cheese sandwich). Gotta love it.

                

I think all we’re doing tomorrow is going to the embassy for the Regional Security Office (RSO) brief, which is about all the security and safety threats in the area and the rules to follow to not get hurt. It only takes about half an hour, so I have no idea what we’ll be doing for the rest of the time. Oh, well. I guess time will tell.

Lesotho, Day 5: A Little Bit of Free Time

Today I had something I very rarely have on these short overseas missions: a completely free day.

                

I slept in a little bit (translation: to 7, which is two hours later when I was getting up all week) and since I had already decided that I was going to go hiking this morning, got to take my time getting ready for breakfast, without having to worry about going running or hitting the gym or anything. I had breakfast with my team members and then we said our good-byes, since they were planning on leaving for the airport at noon and I was planning on still being hiking.

                

I had my eye set on the hill overlooking the Pope John Paul II stage (where he gave a sermon at some point in the 80’s), and I thought it would take all day. However, it was actually pretty easy to find the trail created by a whole bunch of cattle herders leading their cattle up and down the hill, and I found myself on the top of the hill (elevation >6000 ft) after only about an hour or so, less than three miles of hiking. I explored the top for a bit, but it was cold and windy, so I didn’t want to make a whole day of it. I tried to go down a different path than the one I went up, but I kept losing sight of the cow trails, so I just gave up and went back up to the top and then headed back the way I had come up. In all, it was a little under seven miles. I would have gone longer, since it was noon when I got back, but I discovered that that kind of hiking in combat boots doesn’t really work. My heels are pretty torn up from the experience.

Starting out on my hike

Up at the top

From the top

Another picture from the top

The Pope John Paul II stage, from the top of the hill

                

The rest of my team didn’t get picked up until 2, so we had a couple of hours after I got back to talk shop (and things completely unrelated to work), and when they took off, I grabbed lunch and then settled in to finishing what I needed to of this mission before leaving for the next. After sending off my reports and whatnot, I returned to my book and read that until it was over.

                

All in all, a pretty relaxing day. Tomorrow I have the morning to myself, and then I begin the continent-hopping flights that will take me from Maseru to Kinshasa, landing around 10 am on Sunday. With any luck, my entertainment system(s) will actually be working. 

Lesotho, Day 4: Last Day of Work

This was the last day of meetings in Lesotho, which is good, because I’m about meeting-ed out.

                

I decided to get an extra half hour of sleep this morning, and did 30 minutes on the stationary bike in the gym instead of going for a run. It’s not a bad gym—it has a few treadmills, ellipticals, and bikes, as well as weights and whatnot—but I’ll always prefer working out in the real world to doing something in the gym. It’s been a while since I was on a bike, though, so I probably needed it.

                

We got our first surprise of the day when Mo came to pick us up at 8, telling us we had a meeting at 8:15 with Christian Health Association of Lesotho (CHAL), the largest health NGO in the country. He says he told us about this yesterday, but nobody had any recollection of this and we really weren’t dressed appropriately; I was in khakis and a shirt (with my boots on) and our exercise planner was in jeans and a sweater. He changed into a suit and tie; I didn’t realize what was going on and stuck with my attire. Anyway, we ended up late, but that was fine (African Standard Time…). We explained the exercise with the representative and invited any nurses or doctors to give or come to academic sessions. She seemed very interested and said she would get with some of her people to see if anyone wanted to talk. Seems positive.

Site of our meetings

After that, we went out to Maruja, which was where the first Huguenot missionaries came. They have a museum about the history of Lesotho, and we were scoping it out for a potential cultural day activity. During the MEDRETEs, there’s usually a day during the weekend to “experience the culture” of the host nation. This should really be changed to “tourist day”, because it’s really about being a tourist. There’s usually a market involved and everything. Anyway, we went to this museum, which explained the history of Lesotho from the big bang on (skipping large chunks of time, obviously). It was pretty interesting, but I’m not sure how much it would be enjoyed by the people on the mission. I guess we’ll find out.

Replica huts at the museum

             

We had one final meeting of the day at 1600, with PEPFAR. We told them about the mission and asked them if they would be willing to give some academics, and not only did they say that they would be, but they also gave us the names of more NGOs that they would put us in contact with. It was pretty much a win-win, and a productive meeting.

                

The rest of the team is flying back tomorrow, and I’m not leaving for Kinshasa (by way of Nairobi) until Saturday, so I have the day to myself tomorrow. I’m thinking I’m going to go hiking. One of the guys at the Embassy said that there are plenty of hiking trails to try that are right around the hotel, so I figure, why not? 

Lesotho, Day 3: Finalizing Plans

Today was my first 9/11 out of the States, and I definitely noticed the difference. While my Facebook account was covered in cries to ‘Never Forget’ (referring to not only 9/11/01, but also the events in Libya last year), I was in meetings in a country on the other side of the globe, the date having no more meaning for them than the 4^th of July or Thanksgiving. There were no moments of silence, no news broadcasters replaying the events of twelve years ago, no American flags being waved from street corners. And that was fine. In a time when everything is always broadcast and always recorded, it was nice to have a day to when all I had to worry about was what the anniversary meant for me, not for anybody else.

                

And now back to Lesotho… As I did yesterday, I got up early to go running, trying a different route this time. Since they warned us about going around town when it’s dark out (and the sun doesn’t rise until about 6:30 around here, when I’m pretty much done from my run), I’ve been staying away from the “town” parts of the roads, which doesn’t leave a whole lot, and all of it pretty steep. Looking at my elevation chart after my run, I ascended 300 feet in less than half a mile. No wonder I had to walk up some of it.

Elevation map

The entire morning was spent at Makoanyane Military Hospital, getting the more in-depth tour (which allowed me time to ask questions to refine the mission plans) as well as the tour of the Thomas Wellness Center, the PEPFAR (President’s Emergency Program For AIDS Relief) funded clinic that focuses on HIV/AIDS prevention and treatment. After the tours, we sat down and hammered out plans. My original thought was for four doctors and two Public Health nurses, the four doctors being two infectious disease specialists (one adult, one pediatric), me (preventive medicine), and family medicine. My thinking for family medicine was because of how much obstetrics work they do, in terms of the prevention of maternal to child transmission of HIV (PMTCT) treatment of pregnant and breastfeeding women and whatnot. However, when I explained my plan, they asked, “Can we get an obstetrician?”

Thomas Wellness Center

                

Hmm. Get an obstetrician for obstetrics work. Who would have thought?

                

So we changed the family practitioner to obstetrics, hammered out the rest of the details, and then broke around 1200. Mo, our Embassy contact (he’s Basotho, and like all Basotho, no American can pronounce his name, so it got shortened to ‘Mo’) drove us out to the site where the Basotho tribe made their stand against pretty much anyone who tried to invade, a large steppe with only one path up (in other words, easily defended). We took some pictures and bought some miniature souvenir woven hats (the national symbol of Lesotho) and then headed to Kick For Life, an NGO run by FIFA (soccer people), which has a good cook. Sure enough, the lunch was pretty good, for being European-type food served in Africa.

The rock

Lesotho hat

                

We headed back to the hotel after lunch, where I quickly sent of my justifications for mission personnel to the person in charge of manning the mission, and then settled in to do nothing but read a book for the remainder of the afternoon. I had grand plans of going to the gym to get on the stationary bike, but that just didn’t happen. Oh, well. Maybe tomorrow. In the meantime, I’m going to continue sitting at the bar, sipping cheap red wine while playing on the computer and pretending to watch the rugby game on TV.

Lesotho, Day 2: Let the Work Begin

Today was the first day of the PDSS, and busy. I started the day with a run, which was pretty difficult considering the elevation and the fact that the hotel is located on a pretty substantial hill. I didn’t manage three miles, but I was happy(ish) with what I did get done, considering the factors at play.

                

Our first meeting for the day was with the Chief of Staff of Operations of the Lesotho Defense Force, a two-star general. He had with him three one-star generals, so it was quite the meeting. We explained the mission—we’re going to be pairing up one-on-one with Lesotho Defense Force doctors, seeing patients in the mornings and doing clinicals in the afternoon, the same pattern as the DRC MEDRETE. They were under the impression that this was going to be a much larger mission, so we knew from there that we were going to be fighting an uphill battle. They did eventually figure out what we were talking about and agreed that it sounded like a good mission.

View of the Barracks from the road

As if that wasn’t enough high-powered people in one room, the second meeting of the day was with the Principal Secretary of the Ministry of Defense, where we again explained the mission and he did a lot of head nodding and thanked us for our support. Then we went to the military hospital—the only military hospital in all of Lesotho—to talk to the hospital commander (lieutenant colonel) and some nurses and the only two doctors in all of the Lesotho Defense Force (it’s a small country…). We again explained the mission, they told us what the hospital needs—which is mostly stuff, which we can’t provide—and we went on a quick tour. We’re supposed to get more of a tour tomorrow.

Makoanyane Military Hospital

                

After lunch, we headed over to the Ministry of Health, to meet with the Principal Secretary there. When we told him what we were looking for—which is pretty much for them to participate in the academic session of the exercise—he quickly found people for us to talk to, and came back with the head of the programs for TB/HIV, Integrated Disease Surveillance and Response, and International Health Regulations. In other words, exactly who we needed to talk to. We explained our plan, they agreed to participate in academics, and committed to at least six hours of lectures, in order to make sure the LDF doctors know about the national programs for disease surveillance, TB, HIV, and STDs. Success!

                

Throughout the entire day, the civilian on the survey who’s in charge of the security survey spent the entire time complaining about how boring the medical meetings are and how they have nothing to do with him. I didn’t say anything, but I wanted to tell him that when he’s going on a pre-deployment site survey for a medical mission, there might be one or two meetings about, I don’t know… medical stuff? It was frustrating, but he was fairly easy to ignore.

                

In all, late night (it’s 9:35 and I’m exhausted), and my allergies are killing me. I forgot to take into account that it’s spring in Lesotho, and spring is when my allergies are the worst. Ugh. Fortunately, it’s easy to buy medications here, so I bought some generic Zyrtec (what I take at home), and hopefully will be feeling better tomorrow.

Local allergy meds. A lifesaver.

              

And now, time to go to bed, so I can go to more meetings tomorrow.

Lesotho, Day 1: South Africa and Traveling

Today was another day of traveling and exploring and seeing new places, which is always a good thing. I started the day early and went for a three mile run in the residential area around my hotel, and by the end, I could definitely feel the altitude, compared to the 10 feet above sea level I’m used to in Savannah. It’s going to be interesting tomorrow, when I’m even higher in Maseru.

Fountain seen on the run

Unfortunately, there wasn’t enough time to go on an organized tour of Johannesburg and still make it to the airport in time for my flight, so I opted to go to the airport, check in, and then get on the train and go to Sandton, which is a shopping-type area. If there’s one thing I’ve learned about international travel to developing countries, it’s that there’s always someone at the airport will to “help”, who expects a tip at the end. Sure enough, almost as soon as I walked through the doors, a man came up and offered to help, directing me to the counter and taking my bag before I could really even protest. After I checked my luggage, he asked what next, and I said I needed to go the ATM, so he took me directly there. Then he took me to the “Bag Port” (luggage storage) so I could drop off my backpack, and then took me to the train station and showed me how to buy a card for the train.

                

Yeah, he earned his tip.

                

Sandton wasn’t really all that exciting. I was hoping Nelson Mandela Square would be a historic-type thing, but no. It’s a mall. So I wandered around for a bit, bought some souvenirs, and then found myself at the Peacemakers’ Museum. It’s very small, maybe the size of a normal store in the mall, and all about Nobel Peace Prize recipients (obviously with more emphasis put on the three South Africans). If there was one thing I learned from reading the reasons why people were awarded the Peace Prize, it’s more about the hopes and wishes of what the Norwegians want to happen than anything that had actually resulted in peace. Some people had done legitimately good things that made the world a better place (ending apartheid was no small feat), but others—like “ending the Vietnam war” (in 1973) or “peace in Israel” (hmm…)—were more of what the military calls “Good Idea Fairies” than any real accomplishments.

Normal Borlaug's speech

Nelson Mendela inside the Peace Maker's museum

Anyway, after that, I headed back to the airport, hung out in the South African Airways lounge for a bit (ah, the life of a Star Alliance Gold member…) and then met up with the three others in my group before our flight to Maseru. The flight was short—less than an hour—and then we were at the airport, where I experienced the fasted trip through customs and immigration known to man. To give you an idea, there were so few people and the plane was so small that they brought the luggage from the plane in a cart, and set it on the carousel (which I’m pretty sure is defunct).  

Baggage claim

                

Our driver gave us the brief history of Lesotho as he drove us to the hotel, so I had to ask why it existed in the middle of South Africa. He informed us that during the Boer Wars, King Moshoeshoe I requested protection from the British Empire, and became a British protectorate (not a colony, as he corrected me). Everything else in the area became British colonies, and then became South Africa. So now South Africa is very diverse, in terms of tribes and ethnicities, and Lesotho remained almost entirely Basotho (the demonym of people who live in Lesotho) with everyone speaking Sesotho. English is the official language, though.

                

After we arrived at the hotel (which is quite nice), we were joined by Mo, from the Embassy, who went over the agenda for the week. It looks like a busy day of meetings tomorrow, and then things will taper off from there.

Sunset from the Lesotho Sun

             

We shall see… 

ACLS and PALS

Not much has been going on at work since my last post. I mostly sit in my office, working on one thing or another for the medics, taking care of people's stubbed toes, and getting annoyed when things happen without people telling me (which is often).

This past week, however, I've gotten a change of pace and scenery. I've gotten to spend a few days at Rescue Training, Inc, where 10 of our medics are currently in a six month paramedic course. This is the second group we've put through this training; we're pretty happy with the results.

Our first group of graduating medics

The medics currently enrolled are about to start their clinical training (time in the ambulance, time in ERs, etc). Before they can do that, they need to pass Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS). Since my ACLS expired in July and I've never done PALS, I decided to join them. 

ACLS was one day, which included reviewing cardiac rhythms (squiggly lines), reviewing various drugs, and memorizing algorithms. It was all sorts of not fun. 

Not a picture from our group, but practicing intubations is part of ACLS

One of the many algorithms that was memorized

PALS is pretty much the same as ACLS, but for children. The biggest difference here is that everything in pediatrics is weight-based dosing (because an infant doesn't need as much medication as a teenager). That means that instead of memorizing things such as, "give 3 mg of epinephrine," it turns into, "the dose of epinephrine is 0.01 mg/kg, for this 20 kg child, give 0.2 mg epinephrine."

The other big difference with PALS is that with children, the heart usually only fails because of respiratory problems. This actually makes things easier--in most cases, if you give oxygen, things usually improve pretty quickly. All algorithms for PALS start with "supplemental oxygen/assist respirations".

Ventilating a baby during PALS

I passed both ACLS and PALS (yay), which meant passing the mock code situations as well as the written test. It also means that it's two years until I have to even think about taking either again. And since neither is a requirement to be a preventive medicine physician in the Army, I might not. We'll see in 2015.

6-13-13: Last Day in DRC

I realized earlier today that I never wrote a blog entry for yesterday. Oops. Well, nothing exciting happened. We flew from Muanda to Kinshasa and arrived in one piece, and that was just about it.

The plane that took us back to Kinshasa

Today we got back to work, with an early morning meeting at the Embassy. We had an outbrief with the ambassador, and I presented the medical piece, as the “medical mission lead”. I presented an overview of Kitona Health Zone, using the surveillance data that we heard in academics during the mission, and then touched on the kinds of patients we saw and the health assessments we did. It went pretty smoothly, but what I neglected to say was that while I noticed that the MoD had solid programs and policies in place, they were obviously having problems with implementation, based on what we saw. Oh, well.

Out-briefing the ambassador

After the out-brief with the ambassador was the press conference, and LTC McCullough asked COL Lesho to be the medical representative on the panel, as the highest ranked military officer. He did his piece well, although I would have answered some of the questions a little bit differently than he did. But that’s what LTC McCullough wanted, and it was his show.

The group before the press conference

After a quick lunch (of pizza) we headed to Camp Kokolo, which is the main military base in Kinshasa, to visit the hospital. This was the site of MEDFLAG 10, a joint-service medical mission in 2010, and also a site that LTC McCullough neglected to take us to during the pre-deployment site survey back in March. The hospital is bigger and has a larger patient volume than Kitona, as well as better equipment (as a result of MEDFLAG 10), and today LTC McCullough’s rationale for not taking us there was that they get a lot of attention from NGO’s, etc, and we would have been lost in the shuffle, whereas nobody really goes out to Kitona. While this is undoubtedly true, it would have been nice to see Kokolo in March, when we were trying to find a site, instead of being herded to Kitona. It would have completely changed the dynamics of the mission, with how many days we would have been able to work (not having to take days out for travel), where we would have been staying, and even who we would have brought on the mission. It’s kinda frustrating to get actual confirmation of being used to further someone else’s agenda.

The cardiac ward at Kokolo

Anyway, after that we swung by the Thief’s Market, where I bought some more touristy things, and then we had a bit of downtime before the reception at the deputy ambassador’s house. It’s a very nice house, and he invited quite a few medical people that we got to mingle with. I talked to the head of the PEPFAR (Presidential Emergency Program For AIDS Relief, a program started under George W. Bush) program in DRC, the USAID chief in DRC, the CDC chief in DRC, and several other equally important people. It was quite an evening, and I’m sad that I didn’t remember to bring my business cards.

               

 Tomorrow we have a long(ish) day of doing not much, and then we hop on the plane in the evening to begin the epic journey back home. I can’t wait (sarcasm).