i like your face.: May 2015

5/25/15

Samuel: 9 months

9 months! A Pierce resident on the outside for as long as he was on the inside. Sigh, time is flying.

Two teeth finally popped through this month! He's got his two middle bottom teeth, and he likes to use them. He's starting to figure out how to chew food (instead of just slurping - ha), but also bites while nursing. Trying to stop that before he gets top teeth too... ouch! Speaking of nursing...

Nursing continues to go well and he still seems so happy to do it, which just amazes me. I worry about my supply a lot of the time (all of the time), but he seems fat and happy and still interested (James self-weaned completely at 7 months because it just wasn't worth the effort for such little milk). We saw Dr. Z yesterday, and Sam weighed in at 18lbs (31st%, up from 24th at 6 months!). He's nursing 4-5x/day, plus 3 meals of solids (still mostly purees - he has gagged and vomited when I give him things like chunks of avocado or banana, much less cheerios or small torn pieces of bread). We've tried a little fine motor practice of self-feeding, and he loves to play with the food, but he doesn't put it in his mouth. Maybe I need to have him practice when he's really hungry.

The other big milestone this month was mobility! He has been rolling around quite a bit for a month or so (like, across the room to get a toy), but he started army crawling about a week ago! He can go pretty fast across the room when he's mad and wants to get to me. He's a strong little dude! No signs of pulling up yet, but he is strong and can easily hold on and support his weight when I stand him up at the coffee table.

His favorite thing, hands down, is his brother. He loves to watch James and laugh with him (and James LOVES to make Samuel laugh). Sam enjoys it when James sings "Wheels on the Bus" to him, and laughs at the wipers going "swish swish swish." After nap time, Sam usually hangs out with James in James' crib for a few minutes while I put laundry away. Sweet brothers. Though, don't be fooled - James also beats up on Sam and pushes him over a lot, and says he likes it when Sam bonks his head :( But I'm sure he's got his day coming... I have a feeling Samuel will be bigger than James!

Samuel also enjoys playing in the bathtub and our little back yard pool (below is the pool at Mema and P\paw's house). He loves to splash and, of course, watch James :)

He's our sweetest, snuggly baby and it is so fun to watch him grow and develop in this season!

5/23/15

Thoughts from Zambia, part 3

Day 4-6

Breen showed me his home and I met his housekeeper, Phyllis. She
offered me lunch: chicken, pumpkin mash, rice, and a cold Coke. It
was very delicious and fresh. Breen arranged for me to have a room
next door. There are two rentable homes next to his that are owned by
the Hospital. The nuns who manage the hospital grounds didn’t really
know I would be there, but Breen thought it would be fine. He said if
they gave me trouble to refer them to him. Thus far, no
confrontations with nuns…

My house is dusty but comfortable. The front door opens into the main
room, which currently serves as a storage area for some building
supplies. Several large bags of mixable concrete fill a portion of
the room. An old broken couch and chair are all that’s left in this
room. A longer hallway runs off the main room with several doors off
on the right. The first door is my kitchen. It has a non-functioning
sink, non-functioning small refrigerator, a few pots and pans, and a
working electric stove top. Further down the hallway is a bathroom
and further yet is my room, the last door on the right.

My room is simple. Single bed, sheets, pillow, and blanket. I
requested a mosquito net that Phyllis kindly provided. Breen
remarked, “Oh yes, the Americans don’t like mosquitoes.” I have a
functional sink (most of the time), a lamp, and a small table. It is
comfortable and adequate for me. Not sure how James and Samuel would
have done…

After I unpacked, Breen took me on a tour of the hospital. We visited
L&D, postnatal ward, antenatal ward, GYN ward. These are all adjacent
rooms and are connected with outdoor sidewalks. It was obvious that
everyone knows him and that he is running the show. Breen is an Irish
OBGYN who has been the primary women’s provider in Monze for ~15
years. He lives in Monze but travels around Africa providing OBGYN
care and educating new African doctors. Currently, there are 6 “med
students” and 1 “intern” resident. The 6 students have spent nearly 6
weeks with Dr. Breen and have only one week left before moving on to
another rotation. These men and women will move out into Zambia and
be GPs for their community. They are trained in basic management of
OBGYN issues, but also are learning how to perform c-sections as well.
Being able to perform an emergent, safe CS is important for their
training. The intern, Dorica, has been with Breen for 4 months and is
great. She is well trained and knows well how the system works and
what the standard methods of management are. She walks the students
through cesareans (even though she’s done only ~20!) and is assisting
in hysterectomies. See one, do one, teach one is for real here.
Sometimes at UNC it feels more like see one, see one, see one...

I met Mike and Huange (pronounced Hun-jay), the married couple living
in the other rentable house. Mike is a PGY3 family practice resident
at UT Southwestern; Huange is a biomedical engineer. They have been
with Dr. Breen for 2 weeks and will be with him until the end of May.
They are both extroverts, talkative and friendly. It’s been really
nice to have them here. They’ve taken me around Monze and shown me
good places to eat. They have paid for their house and have a maid
who cooks for them. They’ve taken me in and fed me a few meals.

Dr. Breen is a man of habit. He eats the same thing for breakfast
every morning, has a routine for rounding on patients everyday, and
every night he goes for a swim. He doesn’t have a pool but knows a
local man who does. Apparently, Breen has delivered this gentleman’s
grandchildren and offered his private pool to Dr. Breen. So, each
nigh at 5pm Dr. Breen treks off down the dirt roads for a quick dip in
the pool.

So at 5pm on my first day in Monze, Breen, Mike, and Huange, and I
went for a swim. The pool is outdoor and is very cool. The weather
in Monze is comfortable: 70-80s in the day, 50s at night. The air is
cool at 5pm and the pool is cold. So none of us swim for very long.
An outdoor shower is there. Mike says that this is where he and Breen
shower because the water is more reliably working. The shower water
is cold but at least it is flowing. After the pool, Dr. Breen took us
further into Monze to see the railway tracks and to see other parts of
the city, all walking distance. It gets dark early and it was pitch
black by the time we arrived back at the hospital at 6pm.

I didn’t sleep too well my first night, waking up at 2am. I could hear the music of
the local Saturday night parties. Finally back to sleep at 3am.

The next morning was Sunday, and Breen always golfs at 0630. Though
there is a golf club in Monze, only 6 people are members. That
morning the three of us went at sunrise to the Monze Golf Club. Breen
hires a couple of local men to caddie. They carried our bags and
found where our balls landed. It was nice to play a bit of golf.
It’s a 9 hole course with rough fairways and very rough rough.
Interestingly, they don’t have greens.

They have “browns.” Browns are essentially a green made of sand/dirt
(much easier to maintain). There are holes but no flag pins. Once on
the brown, Martin (one of our caddies), would take a pipe and level
out the sand/dirt between your ball and the hole. Martin would
announce whether the brown was fast or slow – essentially based on the
amount of sand/dirt that was there. Though I hit the ball well and
got to the browns pretty easily, putting was very different and I was
terrible. But we had a fun time.

Later that morning, I went to Heshima Shopping Center “For All You
Groceries and Household Goodies” across the street from the hospital.
I picked up two bottled Cokes and two bottles of water for 12K
($1.60). Mike and Huange invited me to early lunch: seared onions and
potatoes, oranges, and avocado. Good stuff.

Mass started at 11am. As mentioned, the hospital is a Catholic mission hospital run
by nuns. The small chapel on campus seats about 150-200 and has a
rotation of traveling priests who rotate every week. We got there a
bit late, and the singing had already started. It was beautiful.
Thick harmony. Amazing African rhythm and style. They had a guitarist
who played through a small amp and provided background texture.
Percussion was 3 on djembe and 2 on shaker. A group of 40 men and
women made up the “choir.” Just amazing… I could listen to it all
day. It was Ascension Sunday and the priest preached from Acts. He
didn’t talk about the Gospel too much. Rather, he mostly chided
Zambians for not working hard enough and blaming others for their own
problems. It was a kind of “pick yourself up and work” message.

That afternoon we had a BBQ with friends of Dr. Breen. It’s not a
frequent occurrence but was well timed with my arrival. It was a very
familiar menu: grilled steak, chicken, pork. Lots of salad and sides.
And plenty of beer. There was an African brew available called Castle
Lager. It was good; not as flavorful as some of the craft beers in
the US but better than Bud Light. We had interesting conversation
about regional politics/economics/attractions with locals and
international visitors from Norway at the BBQ. We went back home
afterwards and I went right to sleep with the help of my friend Benadryl.

The next morning was my first work morning. Breen has a predictable
schedule during the week:
Monday: Rounds + OR
Tuesday: Rounds + GYN clinic
Wednesday: Rounds + OR
Thursday: Grand Rounds (long rounds)
Friday: Rounds + OR

There’s lots of OR time which is nice. The ORs generally only run
from 8am-2pm. The scrub techs are ready to close up shop by the
afternoon. So there’s only enough time for 3-4 cases per day. He
does a lot of different cases: TAH, TVH, radical hysterectomy,
vesico-vaginal fistula (VVF) repairs, perineal repairs. There are
two OR rooms. Both are lighted mostly by natural sunlight through
open windows. Sterility is desired but hardly achieved. They have an
autoclave which gives them sterile instruments, gowns. We wear
waterproof aprons underneath the sterile gown b/c the gowns aren’t
waterproof.

Just like in my room, the water supply is not guaranteed. To scrub,
someone pours filtered water over your hands while you use a soap bar
to wash your hands. The OR instruments are worn out. Many of the
clamps don’t grasp well. The cautery device is frequently
non-functional. During our OR cases, the power would go out
frequently. All the patients get spinal anesthesia (except
emergencies) so they are awake, though sedated, during the cases.

My first OR day, we did a radical hysterectomy and VVF repair. He
gave me a lot of autonomy and let me do a lot without immediate
instruction. It was one of the first times I was given that kind of
freedom in a hyst. We don’t often get to do radical hysterectomies
open in the US (mostly robotic). It was nice to dissect out the ureter
and follow the entire course into the bladder. The radical hyst is
done for cervical cancer – and there’s a lot of cervical cancer in
Zambia. Poor screening, high risk sexual practices, HIV all put
patients at higher risk. Our patient was obese with a BMI ~40 which, for
Zambia, is very very very obese. Dr. Breen says he hasn’t seen anyone
that large in a long time. So, it was a difficult case but went well.
I think I had more patience for it b/c I’m used to that kind of BMI.
Breen mostly did the VVF repair. He’s working on getting a camera
mounted to his head so he can record his cases and use them for
teaching.

After the cases, there wasn’t much happening in L&D. There is a
general clinic that runs everyday. Mike has occasionally helped in
that clinic – so we decided to help out. It was full – patients
lining the walls and out the door. I explained to the triage nurse
that I was an OBGYN. So I sat in a small room with an exam table and
saw a bunch of OBGYN patients. It was very similar to my continuity
clinic. I saw a patient with PID vs. gastritis, round ligament pain,
retained products of conception. We had to take the RPOC patient to
L&D for a curette evacuation of her uterus. She stayed overnight for
antibiotics and to monitor bleeding.

... More to come!

The antepartum ward at Monze Mission Hospital (check out those hospital linens!)

5/19/15

Thoughts from Zambia, part 2

Received this email update from Stuart... Yay for (some) internet!

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Days 3-4

It was nice to get some sleep on the airplane from Dubai to Lusaka. I

vaguely remember one of the flight attendants asking aloud if he

should wake me for my meal. In my dream state, I began practicing the

face I would give him if he woke me up. It would have been part “are

you kidding me?” part “do you know what my work week is like?” part

“do you know what this food did to me last time?” Fortunate for him,

he did not wake me up.

The first minutes of Zambia were much like any other flight. Taxi to

the terminal. Captain turns seat belt light off. Everyone tries to

get up even though there’s no where yet to go. But getting off the

plane was when it was different. We exited directly onto the tarmac.

There was a breeze in the 75 degree air that smelled fresh and clean.

The handpainted sign above the terminal entrance was welcoming. But

shortly following was one about Ebola screening. I could see the line

into the terminal was stopped for a health inspection. Thus far no

cases of Ebola have been in Zambia. By the time, I got to the check

point, I could tell it was pretty simple. Just a look at my

conjunctiva and temporal temperature. I passed.

The line began reforming in the next room. It was a small room with

several turnstiles at one end. Each turnstile was labeled – Natives,

Tourists & Visitors, etc. Someone behind the counter was collecting

money for Visas. I got in the appropriate line, only 5-6 back from

the front. Apparently this was fortunate. Occasionally multiple

flights land simultaneously and it can take hours to get through this

line. But I moved through quickly and, once through the turnstile,

was immediately at the baggage claim. It had kind of an

indoor-outdoor feel, but a functioning carousel was moving bags

around. I found both of mine without trouble – all the way from RDU

to Lusaka without losing a bag.

I took both of my bags and my backpack and headed towards customs.

The officer checked my passport and my baggage claim ticket. It all

checked out. They didn’t ask me what was in any of my baggage. So I

walked past them and out the door – free to roam Zambia.

Jim was waiting with a piece of paper “Stuart Pierce.” He would be my

ride for the next couple days. He works as the driver for Dr. Ben Chi

(based in Lusaka) and was willing (and instructed) to come get me and

take me to my hotel. As we drove through Lusaka, we told me some

unique cultural points. We discussed the expense of buying a new car

in Zambia. No one does – nearly all are second hand from China/USA.

We were slowed by police. Jim said that police are corrupt and are

looking at registration to see if they can stop you. If they stop

you, they’ll expect you to give them some money and they’d let you

move along. If you didn’t pay, they’d take you down to the station,

where you’d pay a larger fee. We didn’t get stopped – glad he keeps

his registration up to date.

I stayed at Protea Hotel in Zambia based on recommendation from Dr.

Chi. It was a nice hotel with good accommodations, excellent

breakfast, and good centralized location. Everyone was very friendly

and seemed very welcoming to me. I was set up in room 215 with a hot

shower, king bed, and two bottles of water. Perfect.

The hotel was very near a walking mall with plenty of shops and food.
I wandered there after briefly texting Mandy. I needed to get dinner
and a cell phone. There was a large grocery store called “SPAR”. The
arrangement was similar to all US groceries. A small mobile phone
company called MTN had a small shop in the grocery. After exchanging
USD for Kwatcha (K) at a 7.7 exchange rate, I bought a mobile phone
with minutes for ~20 UDS. I wandered out and discovered Zambeef,
which is one of the largest Zambia based corporations. Valued at
~17million dollars, it specializes in Zambian beef. It was beautiful.
I found a good place for dinner called Zamchick - fried chicken and
French fries. Delicious. Not as much meat on my chicken as at KFC,
but probably fewer steroids in the chicken. Mandy would be happy…

The next morning, I woke up, packed my bags, and prepared to leave for
Monze. I went downstairs for the complementary breakfast. It was
pretty amazing. I had coffee, eggs, 1 orange, bacon, a bowl of
porridge and honey. I met Ben Chi at a small shop behind the hotel
called Mint Café. I had an Americano and we talked about the
logistics going forward. He also had some crocs he wanted me to give
to Breen. He’s moving back to the US in June so was cleaning his
house when he found the shoes.

Jim picked me up at 1050am and took me to the Lusaka bus terminus. It
was like the NC state fair with no one speaking English and huge bus
loads of people honking their way through a crowd. Women were
carrying huge platters of fresh fruit on their head.

The heat had a lot of vendors out, especially those selling cool
drinks. Men were walking around with dozens of watches and sunglasses
trying to make a sale. I’m not sure who they’re selling to. It’s all
locals and poor Zambians taking these buses.

Jim bought me a ticket with the “luxury” bus ‘Muhazhandu Family Bus’.
Planned time of departure: 11:30. Actual time: 12:15. It seemed
like a busy day at the bus station. Lots of humanity clogging up the
roads. But we finally made it out and started our 3 hour trip to
Monze.

I ended up sitting with a young mother and her ~8yo daughter. The
three of us shared a two seat side of the bus. Our svelte-ness was in
our favor and the ride was comfortable. No air conditioning but
windows open. The local radio was playing popular ‘hits.’ They were
all African spirituals, though updated and hip. The young mother
beside me was frequently caught singing along. Occasionally the
lyrics would be English and reference “our Lord Jesus, Alleluia,
praise our God.” They did have an African spiritualized version of
“Old Rugged Cross” that was fantastic.

About halfway down, we stopped at Mazabuka. No one got off – most are
headed further south, many even past Monze. Livingstone is another 2
hours south and has a lot of touristy things to do (e.g. safari, etc).
Maybe I’ll go one weekend. In Mazabuka, I called Dr. Breen, he
answered and I realized it was the first time I had actually spoken to
him, ever. And I was only 1 hour away. The phone call was short –
gotta save those minutes. We left Mazabuka for Monze after a pit stop
for the drivers; no passenger got off.

We finally arrived in Monze and pulled into a large parking lot next
to the “Golden Pillow Hotel.” Not sure about the name…or the quality.

I called Breen and he arrived in a white worn down SUV (he doesn’t
drive…no car) via a driver. We packed up my bags and drove to my
Zambian home. Monze is not a large city but houses 30,000 people.
The bus stop was very close to my home so it only took 3 minutes to
get there by truck. The roads were mostly dirt but the main road was
paved with only occasional potholes. Driving on the left side of the
road (British colony), we frequently swerved to dodge potholes and
people who wandered into the road.

We pulled off the main road on to a dirt road leading to Monze Mission
Hospital. Breen lives on campus as their OBGYN. He managed to find a
room for me in a neighboring house. So I was living on hospital
grounds – and I thought I lived at the hospital in NC.

Stay tuned for more...

5/17/15

Thoughts from Zambia

Stuart has arrived in his final destination of Monze, Zambia! During his short stent in the capital (Lusaka), I received this email from him, and he asked me to share with our friends and family. Thought this would be a great place to share, and for us to look back and remember this season! And hopefully over the next few weeks, he will have more to share (and internet access that allows him to share it).

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It was nice to have a few days with my family before leaving for 3 weeks for Zambia. I have been on some time/emotion/all consuming rotations the since January (November really…) that have kept me from having much quantity time with Mandy, James, and Samuel. So, in some ways, this trip to Zambia was poorly timed. It would have been great to have this month at home with my loves; or even better with them in Zambia. But God felt that this was perfect timing … “All things … for those who are called according to his purpose.” Mandy and I have a lot of technological tools in the US to keep in touch when I spend long days at the hospital. But how Facetime and Skype will work in Zambia (especially Monze) was unclear as I left.

My itinerary had me flying from Boston to Dubai, then Dubai to Lusaka. The total trip with layovers was scheduled to take 38 hours. I took 2 checked bags and 1 backpack. The large checked bag was all medical supplies for the Mission Hospital in Monze. It weighed 63 lbs. I was ready to pay the extra fee during check-in at RDU. However, the women working the counter seemed to be working at a different pace then most. I saw her check two separate passengers in simultaneously while being on the phone with a travel agency. Pretty impressive, but I think it slipped her mind about the weight of my bags. When she lifted the bags to put them on the conveyor belt, I could tell she knew it was too heavy. But she moved on to the next customer and graciously waved me on.

I started with a short skip to Boston. During my long layover in Boston from 7-11pm, I made my way to my international gate. I sat down and started reading Dune (a old sci-fi series … Thanks Wen!). About 2 hours before my flight was scheduled to leave, I noticed a huge line forming at my gate – I presumed they were standby and needed seat assignments. I wasn’t far into chapter 1 when it seemed like everyone was going through this line, all 300-400 of them … except me of course.

As the line slowly thinned out, a man’s voice, slightly accented, came over head saying “last call for passport verification for Emirates flight to Dubai. Hmmm… Passport verification. Sounded important. So I packed up my backpack. A quick note about by backpack – it was full, heavy, and included macbook pro, Bose headphones, Dune (879pages), bag of toiletries, a large medicine bag with essentials including my malaria meds, a camera lens for Dr. Breen, 4 EL Fudge cookies, 1 small bag of frosted cherrios, wireless mouse, 1 jar of almonds, wires and converters, small iphone earbuds, Kleenex, 1 pilot G2 0.38, Chapel Hill Tophey (a gift for Dr. Breen), a large bag of candy, and my stethoscope.

But I threw it around my shoulders and got at the back of the now quite short queue. The woman behind the counter was dressed in what I learned is the uniform for all Emirates women (red hat, white sash, beige dress) – very international in appearance. She quickly looked over my passport and signed my ticket. They immediately started boarding. I sat down and people-watched. And some had not gone through the passport verification. They were briskly excused from the boarding process and told to get their passport verified. Then to the back of the line.

I boarded the 777 without any trouble. In my seat was a pillow, blanket, and a small zipper pouch. Inside this gift pouch was a eye shield, toothpaste, toothbrush, and a pair of socks. I thought the socks were an interesting choice. I thought they might be TED hose at first, but after inspection they were just regular socks. Before taking off, the flight attendants walked around and offered hot towels to freshen up. Fancy.

It was a big plane. In economy class, there were 3 – 5 – 3 seats across. I was fortunate to have a window seat. Each seat had a TV screen with options for tons of movies, TV shows, music. A couple of the TV channels showed two live video feeds, one from the cockpit view and one looking down under the plane. Each seat had its own power plug. That was good.

One of my seatmates sat down and had a cough. I was sure it was TB. Even with my backpack full of everything, it did not have an N95.
But after a bit of water, his cough went away. So unless it was liquid isoniazid, he did not have TB.

It was a long flight. (12hrs with the tradewinds!), longest flight in my life (at least until my return trip against the wind). We left at 11pm Wednesday EST and arrived 7pm Thursday Dubai time. So that was a lot of time to fill.

Fortunately, I was given a bunch of movies and TV shows to watch. I spent a couple hours asleep but most of my time was spent watching Game of Thrones. It’s like Lord of the Rings meets Braveheart meets The Walking Dead. Pretty cool…

There were two meals provided on the flight. Dinner and breakfast. This too was kind of fancy. The menu was written in both English and Arabic. For dinner, I had pan-seared salmon with sticky toffee pudding for dessert was good. Breakfast was also pretty good. But I think the salmon did a little number on my belly that took about 24hrs to resolve…

I finally arrived on the other side of the world. The Dubai airport was extravagant. The ceilings were so tall with large white pillars. Lots of oil here. Fortunately, my bags arrived without trouble. I actually had to go through Dubai customs since I had an overnight layover. Customs was quick and easy. A It was 9pm and I had no where to be for 12 more hours. The airport is a little set away from the main entertainment areas of Dubai. So, I decided to just check my bags back in and go through security and explore this huge airport. I spent all of my time in one of the three large terminals.

“B” was the largest and stretched for ~30minute walk. At one end was a large food court with large silver pillars, a large caviar bar, and large indoor plant life. I had a quick dinner at a pub. I got free Wifi access and texted and Skyped with Mandy throughout my stay in Dubai. The internet is amazing. I spent the next 11 hours wandering and looking through the shops, getting snacks, and people watching. I did manage to find a electrical outlet close to a seat; I was able to watch a few more episodes of Thrones. There of course was a starbucks – always busy here too.

Three times while I was in the Airport, the Islamic prayers were broadcast over the intercom system. There were lots of signs for “Gates” and “Toilets” and “Prayer Rooms.” All oficial writing was primarily in arabic (with smaller English below). The entertainment/commercial writing was in large print English … interesting.

By the time my flight to Zambia was boarding (0900) I was delirious and very tired. It was essentially a 30h call shift with a small nap in the middle. So I slept for the entire 6 hour flight to Zambia which was good b/c that flight had far fewer amenities, certainly no complimentary socks.

I arrived safely and upon deplaning onto the tarmac was greeted by a handpainted sign "Welcome to Zambia."

More to come...

5/16/15

Strawberry fields forever

Before leaving for Zambia, Stuart wanted to make some sweet, special memories with the boys (particularly James... Samuel likely doesn't have much memory yet ha). James LOVES strawberries, and loves gardening, so we went to pick some fresh berries. It was a short and sweet trip, but we had a great time, and James still talks about it every day. Enjoy the photos... (and stay tuned for a post on some thoughts from Stuart from Zambia!)

5/10/15

Happy Mother's Day!

Most years for Mother's Day, we make a picnic and go to Duke Gardens, because we like good food, and my mama loves flowers. This year, there was a lot less strolling around looking at plants and a lot more toddler-chasing. But I don't think we'd have it any other way. 😊. Also, right after this great photo was taken, the rain started pouring and our visit was promptly cut short as we ran strollers and babies and picnic blankets back to the parking lot.

Happy Morher's Day, Mama! I'm so glad you're mine!

5/5/15

Lowe's

Yesterday after his nap, James asked to go to Lowe's "to drive blue car." I wanted to pick up some mulch anyway, so away we went... I decided last minute to pop Samuel into the seat next to him, though I thought he would probably slide all over and not sit very well. But he did great! I didn't even have to hold him from sliding down. They had a blast. Brothers are the best.