Goodbye Tour

Friday was our last day in the hospital. It feels like we had just arrived, I feel like I had just gotten into the swing of things… but already it is time to go. I am going to miss the kids, doctors, and nurses who all taught us so much, and I am going to miss my friends here. I tend to get very sentimental about goodbyes. I build them up in my head and but a lot of weight on making them meaningful and timeless. Because I tend to overdramatize goodbyes, endings can be a stressful time for me.

Our day at the hospital was perfectly status-quo. Pediatric rounds in the morning followed by outpatient clinic in the afternoon. It felt good to check-in on my patients and go through the well-learned motions of the history, exam, note writing, and plan. Most of my patients are doing a little better, which is always a nice feeling. Once our time in clinic for the afternoon was over, we said goodbye to the many people who had helped us, taught us, and laughed with us at the hospital.

We went home to quickly do a little packing before leaving for our evening “goodbye tour.” We had been invited over (or simply decided to drop in on) to several people who we had grown close with during the trip.

It started with tea at Vera’s house. Vera is Zambian woman who is a nurse at the hospital, teaches at the nursing school, is studying for her master’s degree, and is a church founder for a community close-by Zambia. She is also the seamstress who we were told to go see if we wanted anything made during our time here. She truly does it all! All 4 of us had gotten several items made from beautiful cloths (chitenge) that we found at the market, and during our visits for measurements and sizing Vera would share stories with us, answer our questions about Zambian tradition, and serve us corn from her garden. After all of our clothes were made we saw Vera in the hospital halls. “Thursday is your last day” she said “come over for tea and corn just one more time.” We were thrilled—we couldn’t think of a more perfect person to have one last chat with before we left.

After Vera we made a quick stop by the Thumas. Dr. Thuma and his wife Elaine were people who had welcomed and hosted us during our first trip 2.5 years ago—he works mostly at the research side of the site and has been a pioneer in malaria and HIV interventions in the community. All-in-all they are an inspiring couple, and the type of people who I really hope I can be like when I grow up. Dr. Thuma’s intelligence, ingenuity, patience, and compassion are qualities that I hope to also hold in my practice as a pediatrician. We meant to just drop by quickly, but we couldn’t resist taking a seat and chatting with Elaine about future plans and things to come. It was a heartwarming little visit.

We were grateful to be invited to dinner by Chris and Marlys Book—a couple who had been the first to welcome us to Macha on our arrival one month ago! They both attend my church in Harrisburg when they are in the US, reaffirming that the world can sometimes be incredibly small. Their hospitality seemed to be a consistent theme throughout this trip, and Friday night was no exception. They cooked us an amazing meal, and we reflected on our times in the hospital and learned a lot about the different poisonous snakes and bugs in the area—something that was conveniently withheld until the last day of our trip! Eek!

By now it was dark, and we utilized our flashlights to navigate our way to Amanda’s house. We were very cautious given the preceding conversation about poisonous snakes, and played our least favorite game: “Stick or Snake?!” Amanda is a missionary nurse working in the pediatric ward who is originally from Canada. She has been someone who we could turn to with questions and also for advice on how to get things done for our patients. She was someone we turned to when things got tough, and could debrief with when things got confusing. She had been a huge blessing during our short stay.

We finally returned home after 10pm. We still had to shower, organize, and pack… but our “goodbye tour” was not done. I had told my dear friend Mutinta we would have her and her daughter Chileleko over for popcorn and cookies once we made it back to the dorm! Unfortunately we got back much later than everyone was ready for, so we had a quick silly PJ dance/goodbye party with Chile and cleaned out our fridge with Mutinta. She also woke up early this morning to send us off this morning. Mutinta’s friendship was probably the most special part of my trip 2.5 years ago, and for me the sweetest part of this trip was being able to spend time with her and to meet Chile. Thanks to the internet we have been able to stay connected even over many years across an ocean, and I know we will continue to be in each others lives in the years to come.

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Mutinta and I 2.5 years ago…
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Me this year with Chileleko, Mutinta’s daughter!

All in all, it was a truly wonderful, heartworking, and very thorough goodbye to the community of Macha and all the people who have made it such a phenomenal trip. I am leaving feeling completely satisfied with my experience—and with the quality of sentimental “goodbye” time we had! There are so many unknowns in my future; I have no idea where I will go for residency, or what kind of global health program they will have. I am holding onto a small seed of hope that this is not the last time I will visit Macha Mission Hospital. My time in medical school and the Global Health Scholars Program may be coming to an end, but my life feels like it is just beginning!

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Me in a dress made by Vera, on my last day at the hospital
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Oceans Apart (2/21/2018)

Macha is a peaceful, wholesome, isolated place. The dirt roads, lack of internet, slow pace, and excess of card games makes me feel like I’m a kid away at summer camp. But while things on this side of the Atlantic feel serene and complete, things back in the US have continued to progress at a stressful pace. During the time we have been here, “The Match” has been on every medical student’s mind. The Match is basically a computer algorithm that places you in residency program. You create and submit a rank list placing the programs you interviewed at in order of interest, the schools do the same, and then The Match does its magic—hopefully resulting in you matched and at a place you are excited to be.

Today (February 21st) is the day that our match lists are officially submitted. The sporadic and unreliable internet has made this process a little challenging for my teammates and I. We have had to set aside special time (and data) to double and triple check that everything is in order, all the boxes are checked, and all the extra fees paid to participate in The Match. But being separated from the adrenaline and anxiety of the process has also been really nice! The physical, temporal, and technological distance has allowed me to remember to trust God with these big life events. I have done my part—I have studied, I have smiled at my interviews, and I have created my idea of a rank list. The rest is out of my hands, and I am okay with that. Sitting here in the night breeze as deep thunder rumbles in the distance, I know that my God is involved in the little and the big parts of my life. I am grateful to be an ocean away.

Livingstone Weekend

This weekend, the 4 of us took a trip to Livingstone to celebrate Elizabeth and Laura’s birthdays! As we loaded up to head out Celeste and I realized that this was the first time we left Macha since our arrival 3 weeks ago. We were excited for a small change in pace and to experience some new things.

When we were here 2.5 years ago, we took a few trips to Livingstone as well, so we didn’t feel like we needed to do ALL the big tourist things. We didn’t have grand plans for the weekend; we just wanted to hang out, walk along the falls, and see what opportunities arose. Whelp, all the opportunities arose—Saturday we went to the falls, then on a mini-safari, then on a sunset cruise on the Zambeze River!

Today we head on back to Macha, but I am enjoying some wifi access and finally getting to check emails. Because the internet is available here, here are some pictures of our adventures!IMG_5645.JPGIMG_5646.JPGIMG_2958.JPGIMG_2559.JPGIMG_9429.JPG

The Faith Factor

Everyone has a different reason for going to medical school, and different motivations and inspirations behind their dedication to this difficult path. For me, my faith has been a pivotal factor in my journey to pursue medicine, and continues to be the driving force behind my career aspirations and decisions. One reason why Macha is a meaningful place for me to train is because it has a strong church and mission connection. With what seems like an extra dose of serendipity, it is actually a Brethren in Christ (BIC) mission site, which is the same denomination as my church in Harrisburg! What drew me to my church in Harrisburg was its focus on social justice, community advocacy, and following Jesus in an authentic way.

It has been uplifting to walk to church with other site employees and be invited to Bible study at the Hospital Director’s house. Because life here moves at a slower pace, I have been trying to take time to debrief, journal, and pray daily. There is something deeply peaceful and spiritual about this little town, and I have found it easier to connect to God and open myself to what lessons I should be processing and taking to heart in the day to day.

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The road to Macha Mission BIC Church

The book I mentioned in a previous post, “In the Company of the Poor,” has been very inspiring and reaffirming to my soul, and has reminded me of the Biblical root to my medical aspirations: “Spirituality is not some immaterial realm pertaining to our soul but not our body, to our beliefs but not our actions. Rather, our spirituality is the comprehensive way in which we live out faith.” I’m drawn to medicine—to diagnosing, treating, healing—because it is a practical application and outpouring of my spiritual convictions. It is the way that I personally feel pulled to follow Jesus and to help others.

Fr. Gutiérrez goes on to affirm a truth I have believed for many years—that following Jesus implies a preferential treatment of the poor. “ …in this way we see that accompaniment of the poor—so central to the message of the gospel—must always be a reference point for our primary task: following Jesus.” Of course, there is no easy correction to the health disparities that we see globally and even within the United States, but I hope that my career will be marked by care and priority for the overlooked and vulnerable. I hope it will be said that I followed Jesus with my life.

It has been refreshing and reaffirming for my soul to be in Macha again, and Celeste and I were very excited to learn that it would in fact be possible for us to continue to stay here for the final 2 weeks of our trip! I am so happy that I will be able to continue to build relationships with the staff and patients in the hospital, and stay close to some dear friends. Please pray that I stay open to the truths and lessons that are meant for me each day in this beautiful little town.

Camping Lamps in the OR

Today was a rainy, stormy day, and Celeste’s and my last full day at Macha Mission Hospital. On Monday we will finish out our last 2 weeks at Choma General, because Macha has a limit on the number of medical students who can rotate through at a time. Celeste and I are pretty bummed, but trying to look on the bright side—we will be back in Macha again at the end of the trip, and it will be both cool and educational to see how another, larger hospital in Zambia operates…. Plus there will be a grocery store there!

Friday is “Theater Day” which means we go to the operating room. There is a strong spirit of camaraderie and support between the medical staff here in Macha, and everyone goes to the OR. The pediatrician runs anesthesiology, the obstetrician corrects pediatric inguinal hernias, and everyone works together. Celeste and I both got to scrub in today to assist with surgeries. I was scrubbed in first—helping out with a simple hernia repair. We were about to start closing up when the lights flickered and then went out along with the low rumble of dozens of machines powering off. Did I mention it was stormy today?

Power outages are not a rare occurrence in Macha, and the surgeon didn’t miss a beat. “Okay, who has a flashlight on their phone?” he asked as he continued to collect the fascia for closure. A few minutes later, Celeste walked into the OR with her camping headlamp and attached it to the doctor from behind. The rest of the surgery, and the next one too, were completed without power and without a hitch.

I will treasure today, and my experience at Macha Mission close to my heart. Here I saw interesting cases and emotionally exhausting situations. Here I learned from some incredible, resourceful, and resilient physicians practicing in conditions that are in some ways so similar and in others strikingly different than what I am used to. And here I first assisted a surgery in a power outage with camping headlamps!

Almost a Doctor

Yesterday and today, Diana has made a point in giving Celeste and I more independence and responsibility in the hospital. Monday morning when we gathered for rounds she took a step back and told us we would be running rounds. We each took turns presenting, reviewing the charts, and writing it all out—including the prescriptions—in the plan for each patient. It was empowering and even fun to step up and coordinate the care for the pediatric ward.

In clinic, too, I got to use my limited tonga (and a translator) to do the full patient visit and follow up plan completely on my own! I felt proud that I was able to correctly diagnose the various patients who came in, and know what the next steps wound be. When a pregnant woman came in with high blood pressure and edema, I knew to check her urine protein level, order LFTS, and admit for preeclampsia and likely induction of labor. I felt like I was almost a doctor.

Medical school graduation is only 3 months away, and it still feels unreal. I will have an MD after my name, a long white coat, and people will call me Dr. Sitler. I have a feeling the first few times it happens I will turn around expecting to see my dad! Having the opportunity to step up and operate with more independence this week has helped me to feel a little more confident in my abilities.

This afternoon I popped into the OB ward to see how my preeclampsia patient was doing from yesterday. After checking on her, I began to write in the chart (with Diana’s supervision) some instructions for overnight care and monitoring. “Call overnight OB for systolic greater than 120” I wrote, then confidently closed the chart and began to walk away. Diana shot me a look, quickly grabbed the chart, and crossed out my plan. “DIASTOLIC greater than 120” she wrote. Oops! This afternoon I was grateful that I am almost, but not yet, a doctor. I still have a lot to learn, and I am still making some pretty stupid mistakes.

As graduation and residency inch closer and closer I can’t help but feel incredibly nervous…. And extremely excited!

Field Trip (2/2/2018)

Today I got to go on a field trip! Well, a trip out into the field. The HIV clinic at Macha Mission Hospital takes weekly trips out to (even more) remote villages to provide HIV counseling, care, and drug prescriptions.

I was told to show up at 8am to load the truck and head out to the village of Mobola. Of course, we didn’t actually leave til 9:30. The truck is an impressive all-terrain-seeming vehicle with 2 benches running lengthwise in the back for all the volunteers to squeeze in. We fit 12 people!

The drive was long and incredibly bumpy, but the scenery was absolutely beautiful. It’s so amazing to me how much different the landscape looks during rainy season then it did when I was here many years ago during the dry season. Everything looks so lush, bright, and green… a gorgeous contrast to the bright red dirt of the footpaths and roads. Every few minutes everyone would direct their attention out the window to a corn field, and the Zambians would assess the quality of the crop. “Kabotu kabotu” they would say, seeming pleased that the recent storms have brought some much needed rain to the farmers’ fields.

Mobola is a bustling town with many shops lining the main road. Cell phone and water towers loom in the city center, but no power lines—Mobola is too far in the sticks to be on the power grid.

I was partnered with Francis, a very helpful and patient Clinical Officer (Zambia’s version of a PA). We saw pediatric HIV cases, and he taught me how to fill out their assessment forms. When our last patient had left, he took it upon himself to give me a very thorough medical tonga lesson! I learned how to ask some basic clinic questions like “Sena kuli achisa?” (where do you hurt), as well as several body parts. He even taught me some useful symptoms like “kuso moona” (diarrhea) and “ukola” (cough). I am really excited to try some of the phrases out at clinic on Monday.

We were all pretty tired during the long, bumpy, squished ride back to Macha. When the truck pulled over about halfway back I was excited for an opportunity to get out and stretch my legs….. until I saw why we had stopped. “What is everyone buying?” I asked one of the Zambian team members. “Fresh fish!” she exclaimed excitedly. This was going to be a long, smelly ride back to Macha.