If you're wondering where I've been...

If you're reading this you probably already know the answer. It's been 78 days since I boarded a plane from Tricities airport in Tennessee bound for Monze, Zambia. 78 days that have absolutely flown by and somehow simultaneously felt like a lifetime. A couple of weeks ago my friend Rosemary messaged me to ask the most surprising thing I've experienced since being here and I answered honestly. The most surprising thing to me has been how normal it all feels. How comfortable I am in an environment that should feel alien. How quickly I've adjusted to daily power outages, bucket baths, and doing operations on awake patients without electrocautery. How rapidly deep connections form when there is noise to distract you from the people you're surrounded by. How much a place I've never really known has come to feel like home in just 78 days.

I've been contemplating writing this blog post for a while now. I figure I am no celebrity and there can't be too many people who are interested in reading what I have to say. I also don't even know if blogs are still a thing or if they're something that died in the 2000's and my millennial brain just missed the update. Nonetheless, I have had enough people ask for updates that I figured maybe, just maybe, this would be a good way to let people know what I've been up to. And if any of the stories you read in my blog inspire you to want to contribute to the work we're doing in Monze I will also add a link to donate supplies with the promise that I will tell you when your supplies come into use (which I can almost guarantee will happen quickly).

I could write a lengthy textbook on all of the cases I've done in Zambia in the last 78 days and I am certain I would still run out of pages so instead of naming each procedure one by one I'll pick a few favorite moments that've happened so far. If you didn't know, the hospital I am currently working at is called Monze Mission Hospital. The surgical department is spearheaded by Dr. Sufyan Ibrahim, a bit of a renaissance man, and true "does-it-all" general surgeon. We also have two surgical residents and 8 interns currently training under the umbrella of the department. Monze is a level 2 hospital, which in Zambia means that it's considered a regional referral center that provides life-saving care but is not expected to have speciality care or certain other resources afforded to level 3 and level 4 hospitals. I can say with confidence that Monze provides the quality of care of a level 3 hospital with the resources of a level 2 which is truly impressive and requires a lot of creativity. Over the years, they have opened their doors to many visiting teams from the US and beyond and in doing so they have learned to provide basic speciality care across a variety of surgical fields. One of the most recent advances at Monze has been the addition of cancer care.

My first week of work we scheduled 3 women with breast cancer for modified radical mastectomy. The 4th year surgical resident working with me had never been a part of a breast cancer operation. The first surgery we did together he assisted, the second he performed about half of the operation with close supervision, and by the third he did the majority of the case himself. By the end of the week he was buzzing with excitement over his new skill and actively looking for more patients to operate on (he was successful, btw, we've since doubled his number of mastectomies). The patients also did well with one woman even having a surgical cure which has traditionally been fairly unheard of for them as the great majority of women who present with breast cancer in rural hospitals in Zambia have advanced disease.

Last month we had a 1 year old come in the night after swallowing a button battery. That may sound like it's not a big deal but it is a HUGE deal because button batteries cause significant damage to the surrounding tissue especially when they become lodged in the esophagus as this patient's had. Traditionally at Monze they have approached ingested foreign bodies using a blind technique whereby they insert a catheter into the patient's mouth, advance it down their esophagus beyond the foreign body, inflate the balloon, and pull hard hoping the balloon will displace whatever has become stuck. This method is relatively successful for benign things like coins, but because batteries can erode into tissue, they aren't as easily retrieved. Unfortunately on this occasion we were unsuccessful and the patient had to be transferred 4 hours away to the level 3 hospital in Lusaka where he waited all night for an operation and by the time the battery was retrieved in the morning he had experienced significant damage to his esophagus and was at threat of forming a tracheoesophageal fistula. If you're wondering why I'm telling you this heartbreaking story it's because I am hoping it will be the last time we have a case like this to tell about. After that patient left Monze I went on a mission to find a pediatric endoscope so that we could retrieve objects like that button battery on our own and prevent the delay in care that puts our patients at such significant risk. Believe it or not, I found one hidden away in our very own supply closet. Since that time, we have now retrieved 3 coins and a screw using our pediatric endoscope and a biopsy forcep. I am confident that the next swallowed battery we get will not be making the 4 hour trek to Lusaka. Improving access to care is exciting! And the whole reason I'm here so yay for little successes.

One last story from the past week and then I'll call it a day. We had a 5 year old present to our surgical clinic for review with what her mom described as a "swollen belly" that had been growing larger for 2 years. She appeared to be pregnant with quadruplets and had been seen at a few other clinics and told there was nothing to be done. Thanks to donations provided to the ETSU SEAL Global Surgery Fellowship Program Dr. Schuh and I were both sent to our respective sites with portable ultrasounds through the Butterfly IQ App. My butterfly has been by and large the most useful thing that I packed in my suitcase. I looked at this little girl's belly in clinic that day using my ultrasound and was able to identify what appeared to be a cystic mass taking up the majority of the right side of her abdomen. Given that her liver, kidneys, and pelvic organs looked normal we assumed this was likely some type of mesenteric cyst given her age and lack of symptoms as well as the appearance on ultrasound. We booked her for the operating room and removed it the following week. It was, in fact, a large mesenteric cyst we removed along with about 15 cm of her small intestine. She tolerated the surgery well and today she is eating, drinking, and running around the children's surgical ward. She will go home tomorrow with a flat belly and a surgical scar! This is really just a shout out to Butterfly for making diagnostics in clinic a possibility so that we can provide timely surgical care with confidence.

I have so many more stories to tell, both good and bad. For all of our many successes we have also had some losses that I will carry with me for the rest of my life. I will try to update this little blog as often as possible when I have access to power and internet so if you're curious enough to keep reading sign up for updates I suppose. In the meantime I'll add a link to my Amazon Wishlist or if you don't care to buy a specific thing you can Venmo me and I will let you know what I buy from the pharmacy with your funds. Right now our biggest needs are wound care supplies and glucose test strips while we await our new supply shipment's arrival. Thank you in advance!!! And thanks for reading if you've stayed with me to the end :)

Twalumba,

Katy

https://www.amazon.com/hz/wishlist/ls/21K8DSSEDMA6D?ref_=wl_share

Venmo name: @Katy-Kazen