Big Tuesday

1 day old Mylomeningocele

Replacing skull flap on 10 year old. 

Big ruckus on the floor after I brought our last patient to his bed. Angry father decided to take it out on a local physician. Not one of our patients. 

  He went after him at the crowded nursing station. A huge crowd came out of nowhere. I found myself blocked in by curious Arab mothers.

  There was a lot and yelling and screaming pushing and I decided it was time for the little white American to get out of there. Palestinian authorities showed up and arrested the man. 

  Unfortunately, our other nurse was caught in the middle and was very shaken by it. 

  No body was injured. 

  We have two or three cases today. Then leave to Ramallah her group PCRF dinner. Then we are going to Pres. Abbas compound to meet him. 

Down and ups in a day

Wednesday was our last day of surgery. Ending with a very difficult case. We had a three month old that needed a VP shunt. Unfortunately, she had several congenital anomalies that made her very tough to intubate. Unsuccessful after several attempts, her heart rate dropped and needed chest compressions. She came back but never had spontaneous respirations.  She was bagged but still had low O2 sats and the decision was made to place a tracheostomy. 

Not how you want to end the last case of a mission. 

She is doing well in ICU but will need several procedures due to her underlying syndrome. Trach should be temporary. 

 I had time to waste waiting for a taxi so I went to the salon across the street for hair wash and blow dry. We have a big night ahead. 

 

We dress in our finest, ok, cleanest clothes and get in the van for a ride to the president's compound. Pass through a lot of security, sit in a couple rooms, and finally meet Palestinian president Mahmoud Abbas. 

We drink tea, chat. Doctors ask for a surgical microscope and laparoscopy. He says OK. 

Inshallah

Thirty minutes later we are off to dinner. 

Is it Monday?

Drive to Rafidia hospital. 

Nablus street. Our group waiting for taxi. 

Hotel al Yasmeen

8am to hospital, 10 pm to hotel

Out first full day. Three cases. But every complication in the book today.  

Complicated positioning, complicated airway, complicated skulls, difficulty obtaining blood from lab, and difficulty waking patients from anesthesia. 

  A very long day. 

Large frontal craniosynostosis on a two-year-old from Gaza

Dinner

Meza and mixed meat platter at Al Rausheh. 

Clinic day

  Today was the best clinic day I have had since coming to Palestine. We screened 30 patients and scheduled 12 for surgery.

  No body yelled or screamed at us and we were finished by 2pm. 

  We are in the OR. Dr. Samar and Jo are doing a laminecty on a 12 year old boy with osteogenesis imperfecta. Positioning him prone with his fragile contractured body was a challenge. 

  This is Hanna, PCRF social worker and I. 

Another Feburary in Nablus

Round 3!!
I leave in the morning, retuning to Nablus with the pediatric neurologist to Rafidia Hospital.  Then taking 4 days to explore Madrid on the way home, ahhhhhhhhhh, siesta.