Photos-肯亞所見系列(2)-b

Photos-肯亞所見系列(2)-a

Photos-肯亞所見系列(2)

肯亞所見系列 (2)

Monday, December 19, 2005

Kakamege Forest (Kakamege 森林)

The weekend had finally arrived and much has happened since the last entry.
After dropping Rosie off and doing internet we headed off to Kundu Bay early next morning to a mission hospital. It was run by the Seventh Day Adventists and I was amazed at how organised everything was at this hospital which compared to Siaya. We had woken up at 4am just to drive out to this mission hospital and it took us 3+ hours just to get there. The car broke down a few km out of town and me and boys had to push the car for 2km along a flat. All in all a funny day. It amazed me how friendly people were and how eager they were to help in the pushing.

After returning home from kundu bay we quickly packed and headed off to the Golf Hotel at Kakamege city for a bit of relaxation on the weekend. It took about 2 hours drive and the most beautiful sunset and moonrise (yellow dusty) before we arrived at our hotel. It had electricity and hot water so I could not complain. It was an amazing night of sleep.

On the saturday we woke up and lazed about before going to Osman's brother's hotel for some lunch. There was also a HIV conference on at the hotel and we spoke at length with the organisers on their tactics to reduce HIV prevalence in Africa. It was fantastic. Lunch was equally amazing as there was all the skoomo wicky and mutumbo I could eat. We followed this up with a relaxing game of golf and we were all pants. VEry funny to watch how pants we were. Took about 3+ hours to play 9 holes.

The evening was spent watching over the videos of ourselves over the last week and enjoying some meals. We ordered some room service and I could not believe how rude most of the staff at the hotel was. They were openly hostile and rude. They even came in and cleaned up the dishes after we ate without even knocking. Then a call came at 12am to inform us that they needed to come and pick up the receipt. I was enraged and spent the better half of 5 minutes yelling down the phone. Eventually it all settled and I went to bed.

Today I awoke a bit grumpy due to last night's events. The manager came and apologised at breakfast and all was well for a bit of time. We made our way to the forest and saw some fantastic scenery and wildlife. We then packed up and left Kakamege knowing that our weekend was at an end and we had to return to wagai.

We stopped in Kisumu and hung out with Osman's family for the rest of the afternoon and hung out at the large shopping centre.
The up and coming week should be great with Christmas arriving and a large event being planned at the orphange. I hope the packages arrives and that we can have festive celebrations. (posted by Phil Huang @ 12:09 AM)

週末終於來臨了. 在這個週末和上一個中間, 發生了好多事.

在機場送走 Rosie 和寫完上一篇文章的隔天早上 [註: 應是當地 16/Dec], 我們前往 Kundu Bay 的一個教會醫院. 這是一個由 “基督復臨安息日會” [註: “Seventh-Day Advent Mission” (SDA), 簡稱安息日會, 是基督新教的一個非傳統教派. 此教會藉醫療, 教育, 廣播及社會服務, 將信仰傳至世界各地] 所創辦經營的. 我很驚訝的發現, 和 Siaya 區域醫院相比較, 這裡的一切顯得是如此的有組織多了.

我們早上 4點鐘就起床, 開了 3 個多小時的車程才到達這間教會醫院. 車子在鎮外幾公里處卻熄火了, 我和隨行的幾個小孩子只好下來在平地上推車推了大概有 2 公里遠. 總而言之是很好玩的我也很驚訝的發現, 路過的人是如此的友善, 也急欲一起來幫我們推車.

從 Kundu Bay 返回宿舍後, 我們馬上稍整輕便行李, 趕往Kakamege 市的 Golf 旅館過一個放鬆心情的週末. 我們車子大概開了 2 個小時才到旅館; 可是途中的日落和月昇 (帶有黃暈灰環), 卻是我所見過最漂亮的景象. 旅館內有電力和熱水, 我不會抱怨這個的. 我睡了一晚安穩美好的覺.

禮拜六早上 [註: 應是當地 17/Dec] 我們醒來後, 我在旅館附近到處走走, 看了一下, 然後到 Osman [註: 他見習的督導頂頭上司醫生] 的弟弟所開的旅館餐廳中用午餐. 在這家旅館中, 剛好有一個 HIV 的研討會在召開. 我們花了一段時間和研討會的召集人討論應該如何減少非洲 HIV 病患的方法. 這個討論, 很不錯. 午餐也不錯, 因為有 Skoomo wicky [註: 一種肯亞蔬菜] 和 Mutumbo [註: 腸子] 讓你吃到飽. 飯後, 我們穿著長褲就下去打場輕鬆的高爾夫球. 看到我們是如何的穿著長褲就下場 [註: Philip 是捲起長褲褲管, 請看照片], 實在是有趣. 我花了 3 個多小時才打完 9 洞.

晚上我們就一邊在房間內用餐, 一邊觀看著我過去幾天所拍攝的錄影帶. 我叫了room service 到房間裡, 卻發現這間旅館裡大部份的職員都很沒有禮貌, 他們是公開的對你懷有敵意與粗魯, 甚至於在我們用完餐後, 居然門都沒敲一下就直接進房間內來收取碗盤. 然後又在半夜 12 點時打電話給我說, 要到我的房間裡來取回他們忘記收回的用餐簽單. 我非常的生氣, 和他們通話的 5 分鐘中, 我有一半的時間是在電話中大聲的責罵他們. 最後事情解決了以後, 我也回到床上去繼續睡.

由於前一晚所發生的事, 今早 [註: 應是當地 18/Dec] 我起床以後, 脾氣很不好. 但是因為飯店經理在我用早餐時, 有前來向我鄭重道歉; 所以後來我一下子就釋懷了. 餐後, 我們到森林裡去走走, 風景很棒, 也看到了一些野生動物. [註: 此時大約是當地時間 18/Dec 早上 10:00am, 台北時間當天下午 15:00pm, Philip 曾用他的手機打電話給我們聊了大概有 5 分鐘]. 之後, 我們就回到旅館去收拾行李準備要離開 Kakamege, 因為我們知道, 我們的這個週末渡假之旅已即將要結束, 我們必須要回到 Wagai 去了. [註: 別忘了, 在那裡要過的是沒水沒電的生活]

我們回程下午在 Kusumu 停留, 和 Osman 的家人一起過, 也到一個大的購物中心裡去逛了一下.

接下來的一個禮拜, 隨著聖誕節的到來, 應該是很棒. 在附近的一個孤兒院裡, 我們打算舉辦一個盛大的慶祝活動, 我希望我在離開雪梨的那天所寄出給在肯亞的我自己的包裹可以在那之前到達, 好讓我們過一個歡樂的聖誕節! [註: 我因怕他當地的醫療情況不佳又有很多機會接觸到 HIV 陽性患者, 因此我也在 15/Dec 用FedEx 寄了 80 根 disposable syringe拋棄型安全針筒和 6 小盒 (每盒只有 4 顆) 貝殼型巧克力請人代轉給他. Philip寄給自己的包裹裡是他事先在雪梨買的一些餅乾和糖果, 準備在聖誕節和新年的慶祝活動中, 可以和那些孤兒院的院童們分享] (posted by Phil Huang @ 12:09 AM)


Sunday, December 25, 2005

A week of Surgery (一整個禮拜的外科)

After the fantastic weekend in Kakamega we returned to wagai and found it intially difficult to settle in especially because the battery (which relied on solar power) had died and we were reduced to darkness. I felt like I was a homeless person living in the dark with candles my only solace. It did provide some early nights however.

Monday began with surgical clinics but ended at about 11pm. Surgical day is placed for tuesday and yet there were just emergencies after the next. I got to assist on a strangulated hernia and emergency caesarian. We finished theatre after the emergency caesarian (tube was strangulating the baby but we did not know that until we delivered it.. it survived) at around 10pm and went to local hotel for a meal with Dr Ochieng (eddie) and Dr Kodada the anaesthetist who was a jolly man reasonably big. We ate a nice dinner and Dr Ochieng let me drive the Hospital ute back home to Wagai from Siaya. It was an excellent drive and there was not a soul on the road.

After a few hours sleep we woke up for surgery day. This involved more hernias, a prostatectomy and removing an osteoma. It was a great day with Dr Otongo (magoo) and he was still a bit socially awkward but good fun nonetheless. We were quite bored at night once we returned from home in the dark and I resorted to setting tissues on fire in fletch's (one of the girls who lived there previously and was still in kenya) ashtray on fire. I was that bored. The boredom came to a head after the ashtray exploded from all the heat i had put it through. That was a sign from god for me to get to bed and off I went.

Wednesday started quite slow and ward rounds revealed what is to hopefully become my major project here. I had discovered 7 patients on the wards with severe fractures who were merely managed by skin traction and had no reduction for their fractures. Most of them had been on the wards for about 7 weeks now and the bone had healed with the new deviated angle. Some of them were almost 45 degrees deviated from their anatomical baseline. It was horrific to see and Dr Ochieng confessed he had little or no options as they could not perform ORIF's due to the lack of pins and plates and even basic tools. There was also no protocol set in place for fractures at Siaya hospital and the physio's managed all the fractures. I was determined to ensure that no further fracture patients had to endure such deformities. The closest hospital was in Kisumu and most of the patients simply could not afford to travel there for proper surgery. I was dazzled. I was thinking about contacting the rep from smith and nephew that I met at AOA for some promo pins and plates but I knew this would merely be a temporary solution. The doctors were keen to perform osteotomies on these patients to correct the deformity and place them in plasters. I was unsure... The doctors here perform all types of surgery and i was not so sure how it was going to go. I contacted Ed graham.. one of the legend reg's at RNSH but he was not to be found. It has since been troubling me as they want to go ahead with the operation on Tuesday. I rang my sister and she was also quite hesitant with going ahead with the ostetomies especially with the risk of fat embolism and the like.

The afternoon was spent playing football with the kids and Fletch had arrived to celebrate christmas with us in the evening. We played some Texas poker in the dark by candlelight and used matchsticks for currency

The next two days were spent at Dophil clinic in Rabour with Dr Philip. It is like a small private clinic which has about 12 beds for patients and a small room for minor procedures. The first day was reasonably quiet and it gave me time to think about the orthopaedic problem at Siaya. It made me realise how much I love ortho.. At about 4pm a patient came in with severe DKA and we had to explain that insulin is for life to the entire family. They had to sell one of their cows just to pay for the medication.

The following day was spent at Siaya in the morning where we logged all the fractures in the hospitals in terms of their fracture and how long they had been in the hospital. The afternoon was spent at Dophil where I got to perform a circumcision on a boy all by myself. I also had the chance to type out a letter (Dr Philip Has a computer) of protocols for Siaya in terms of managing fractures which stated the importance for immediate reduction to correct deviation and ensure good union.

We then packed up for our obligatory weekend getaways to electricity, hot water and of course internet. We decided to stay at imperial hotel (based on recommendation from Lonely planet). It had a great view of lake Victoria. Fletch also received a text from her girlfriend that they were never going to get back together and she was quite down. We spent the evening of the 23rd having a few beers in the bar and having good discussions on life and love.

Today is Christmas Eve. Its mainly a day for recharging and sorting life out. I purchased a overnight luggage bag so that I can reduce the number of bags. I also went and saw Harry Potter here in Kenya. Interesting experience attending the cinemas in Kenya. The film was a bit scratched and the audio was dodgy but I loved the film nonetheless. The boy who wants normality despite being special.

Tomorrow we return to Wagai where we will spend Christmas with the Orphans. Will hopefully get back next week for another update. (posted by Phil Huang @ 2:01 AM)

在 Kakamega 渡完很棒的週末回到 Wagai 後, 我發現日子裡的起居生活, 開始變得很難適應起來了, 尤其是太陽能面板的電池因儲量不足, 我們整個宿舍都必須省電, 因而房子整個晚上就會陷入一片漆黑當中. 我覺得自己好像是一個無家可歸的街頭遊民縮在房間裡的一個角落一樣, 只能靠著點燃的那根蠟燭的微弱光線, 帶來給我一絲溫暖的慰藉.. 不過, 這也造成了我有好幾個晚上是很早就上床去睡的情形.

禮拜一 [註: 應是當地 19/Dec 在 Siaya 區域醫院裡] 我開始了外科門診實習, 但是當天卻一直到晚上 11 點的時候才告結束. 本來我要進外科手術房跟刀實習是安排在隔天的禮拜二, 但門診結束時, 因臨時有急診案例, 我過去幫忙, 接著因為有一個嬰兒接生過程中在母體內被臍帶纏繞 [註: 這在產科中是一件很危急的情形] (我們在剛開始接生時並不知道臍帶有纏繞著嬰兒, 是後來才發現的, 不過所幸是母子平安) 和一個絞勒性疝氣strangulated hernia [註: 患有此症病患若沒有緊急就醫處理, 患者將會因腸道壞死而亡] 的急診案例, , 我馬上就被安排進入手術房去幫忙開刀..

踏出手術房的時候已是晚上 10 點鐘, 我跟 Dr Ochieng (eddie 艾迪墨菲) 和麻醉醫師Dr Kodada (一個看起來塊頭有點大很樂天的一個人) 一起到當地的一家小旅館飯店中去用餐. 晚餐不錯. Dr Ochieng 還讓我開著醫院裡的載貨卡車從 Siaya回家到 Wagai [註: 約 1 個小時的車程]. 沿途車開起來感覺很棒, 路上完全沒有看到任何一個人.

睡了幾個小時以後, 我就起床, 因為禮拜二 [註: 應是當地 20/Dec] 是外科手術日. 這一天, 我們有更多的疝氣, 1件切除攝護腺, 和 1 件切除骨瘤的手術. 能和Dr Otongo (那位長得很像美國黑人饒舌歌手 Magoo的醫生) [註: 應該是 14/Dec 下午對 Philip 英國來的室友 Kiran 大發脾氣, 讓他們倆人當天先行走人, 跑到醫院門口前的鐵皮屋小攤裡去吃午餐的那位] 跟刀, 這實在是很棒的一天. 他仍然是社交技巧笨拙, 不過他倒不失是一個有趣的人. 當晚我回到宿舍裡的家面對的又是一片漆黑的時候, 事情可就變得很無聊, 一點都不有趣了.
於是, 我就開始藉著把衛生紙丟到 Fletch (她是以前曾經住在這間宿舍裡的一個女孩, 目前仍在肯亞等待回國) 以前留下來的煙灰缸裡, 再把衛生紙點上火, 然後看著在煙灰缸裡的火光. 我的無聊居然到這種地步. 這種無聊, 一直到煙灰缸受不了我在不斷投入的衛生紙上點火所加諸給它的熱溫而爆掉了的時候才驟然停止. 我想, 這大概是老天爺要我上床去睡的一個徵兆, 所以我就照做了.

禮拜三 [註: 應是當地 21/Dec] 的日子, 一切行動的腳步也開始變慢起來了, 而巡房的工作讓我發現了我希望是在這趟肯亞實習之旅中應該要做的主要作業. 我發現在病房當中, 有 7 個因嚴重骨折而住院的病人, 他們只有被用 “骨骼牽引術” (Skin Traction) 固定包紮骨折之處, 對骨折的情形絲毫沒有任何幫助. 這些人大都已在病房中待了 7 個禮拜, 新的骨頭也已經變形不正常的癒合長出來了, 有些人甚至已脫離正常骨頭構造有 45ﾟ 之多. 這種情況真嚇人. Dr. Ochieng 也坦承, 由於缺乏鋼釘鋼板和一些甚至於是骨科裡最基本的工具, 他根本毫無選擇的只能不給這些病人施行 “ORIF” [註: 開刀復位加上內固定手術]. 而在這間 Siaya區域醫院裡, 居然沒有擬定任何骨折病患的處理規則, 所有的骨折病例都只是交由復健師去處理而已. 我已下定決心, 今後任何到這家間醫院裡來的骨折病患, 都不必再忍受這種骨頭變形的下場. 最靠近這間區域醫院的大醫院是在 Kisumu, 但此地絕大多數的病患根本就連旅費都籌不出來, 更不用說是有錢可以負擔得起到那裡去動一個適當手術的醫療費用了.

我左思右想苦尋對策. 我甚至想到上次去參加 AOA [註: Australian Orthopaedic Association 澳洲骨科協會的簡稱] 餐會中所認識的那位 Smith And Nephew 大藥廠的業務代表. 我很想向他勸募一些鋼釘和鋼板, 可是我知道這樣做只能暫時的解決問題, 根本就不能治本. 醫院裡的醫師們現在是急於想替這些病患做截骨手術 [註: 先將骨頭打斷再復位的一種骨科整形技術] 並打上石膏, 以矯正骨頭變形的情形. 我卻不確定這樣做是否妥當….. 雖然不管怎麼說, 醫院裡的這些醫生們都已做過各式各樣的手術, 但我還是不確定這樣做將會帶給病患們什麼樣的後果. 我馬上打國際長途電話給在雪梨我認識的 Ed Graham, 他是 RNSH [註: 雪梨皇家北岸醫院, 也是 Philip 平常在雪梨實習上課時的醫院]. 裡最有名的傳奇駐院總醫師, 可是我卻沒有找到他. 這件事深深的困擾著我, 因為這些醫師們將在下禮拜二 [註: 應是當地 27/Dec] 馬上就要替這些病患們動手術了. 我接著打電話給我姊姊, 她也很遲疑是否應該要對這些病患逕行截骨手術, 尤其是我們還要考慮到這樣的手術是不是會有血脂肪栓塞動脈 Fat Embolism或類似問題的危險..

這個下午我跑去和一些小孩子們玩橄欖球. Fletch [註: 她的煙灰缸被 Philip 玩火玩到爆掉了的那位女孩子] 晚上也到宿舍裡來和我們一起慶祝聖誕節. 我們在黑暗中點起蠟燭, 在燭光下玩起德州撲克牌, 用火柴棒充當現金.

接下來的兩天 [註: 應是當地 22 + 23/Dec] , 我都是跟著 DR. Philip 在 Rabour 鎮的 Dophil 多費樂診所醫院 [註: 這是一間由當地的一所教會所創辦的私人診所, 離 Wagai 到 Luanda 道路大約有 15 分鐘的車程, 剛在 2005 年 10 月底擴建完成它的志工門診與檢驗中心, 免費對病患提供由幾家世界大藥廠贊助的抗反濾過性病毒的藥物治療Anti-Retroviral Drug Therapy]. 它很像是一間小型的私人診所; 有 12 張病床給病患, 還有一間小房間專門替病患做一些小傷口的處理工作. 頭一天沒有什麼病患, 這讓我有時間好好思考有關在 Siaya區域醫院裡的骨頭整形問題, 也讓我瞭解到我是這樣的喜歡當骨科醫生 [註: Philip 的大學得獎畢業論文和劍橋的碩士論文都是和人骨的結構有關]. 大概下午 4 點鐘的時候, 有一個患有嚴重的 DKA [註: 糖尿病酮症酸中毒症 Diabetic Ketoacidosis 的簡稱, 它是一種兒童糖尿病患者由於腦部浮腫, 導致人體體內胰島素 (Insulin) 分泌不足的病症].疾病的病患進來, 我們必須詳細的向他解釋說, 此後他全家的人終其一生都得施打胰島素才能控制病情. 他們必須要賣掉家裡的一條牛 [註: 對他們來說, 牲畜牛羊是最重要的身家財產], 才能負擔得起這筆醫藥費用.

隔天 [註: 應是當地 23/Dec] 早上我都是待在 Siaya區域醫院裡. 我把這間醫院的所有骨折病人, 依其骨折情形與已住院多久做成記錄. 下午則是回到多費樂診所醫院去. 我還自己一個人完成替一個小男孩割包皮的手術工作. 我也抽空利用 Dr. Philip 的電腦替 Siaya區域醫院打了份替他們擬定的 “骨折病患處理規則”. 規則中強調對骨折病患在第一時間內, 馬上就做正確的骨頭矯正可以減少變形, 或是確保骨頭將有一個良好的再生癒合機會的重要性.

我們接著趕回宿舍打理簡便的過夜行李, 打算前往 Kisumu, 去渡個不得不去的有電力, 熱水澡和網路的週末. 根據孤獨星球 Lonely Planet網站的建議,我們選擇了 Imperial Hotel.帝王旅館[註: 據 Philip 當天下午在電話中告知我們, 房間是 US$ 100/晚]. 這間旅館可以看到很漂亮的 Lake Victoria [註: 它是世界第二大淡水湖] 景色. Fletch 收到她女朋友傳來的簡訊說, 她們倆人將永遠不可能一起回國, 她的情緒顯得很低落. 於是 23號的晚上我和她就在旅館內的酒吧中, 喝了些啤酒, 也暢聊了人生與愛情.

今天 [註: 應是當地 24/Dec] 是聖誕夜, 我打算要好好的休息一下, 並且整理思考一下自己的人生方向. 我也買了個過夜用的小行李袋, 好減少手提塑膠袋的數量. 我在肯亞這裡看了 Harry Potter 哈利波特第 4 集電影: 火盃的考驗 (Harry Potter and the Goblet of Fire). 在肯亞看電影實在是一個有趣的經驗; 銀幕有刮痕, 音響聲音還會跳閃, 但我還是很喜歡這部電影. 電影描述的是一個不平凡的特別小男孩, 卻極力去尋求一個平凡正常的人生.
明天 [註: 應是當地 25/Dec] 我們會回去在 Wagai 的宿舍, 並到附近的一個孤兒院裡去和院童共渡聖誕節. 我希望下禮拜能找到機會, 再來跟大家報告最新的狀況. (posted by Phil Huang @ 2:01 AM)


[後記]一個 25 歲既怕非洲蟑螂 [註: 非洲蟑螂身體較厚大, 會飛, 還會嘶嘶叫, 平均身長可達 4~6cm, 繁殖力極強] 又不喜歡住在黑暗世界裡的大男孩, 獨自一個人在那肯亞的天空下增加自己的生活經驗; 還在聖誕夜寫了一大堆醫學名詞簡稱的一篇 blog 文章, 實在是讓身為他老媽的我, 一面閱讀, 一面不知道要說些什麼. 這讓我想起了最近在台灣的公共電視台所觀賞的 2005 年年度大戲: 45ﾟC 天空下 (Main Dans La Main) [註: 對此劇有興趣者可到: http://www.pts.org.tw/~web02/45c/. 它是一齣改編自第一屆外交替代役男連加恩著作 “愛呆西非連加恩”的電視連續劇].
為了讓關心 Philip 近況的親朋好友也能夠分享他的見聞, 對醫學專有名詞一竅不通的我, 只好在聖誕節早上, 趕緊向剛上完 12 個小時夜班正想爬上床去睡覺的女兒請教. 到底這個大男孩的文章和照片是在說些什麼. 唉! 做醫生的人很辛苦, 做醫生的娘也很累呦!


肯亞所見系列 (1) [Feedback: 回響]
1)Very Well done - Both Mother and Son. So proud of you. It is so beautiful.
2)感謝妳讓我們分享 Philip 這趟非洲醫旅的歷程. 我看見一個陽光的大男孩, 正燃燒著他旺盛的生命力, 將關懷散播在那片蠻荒境地. Philip 文筆很好, 當媽的翻譯更加深動. 看來虎父(母)無犬子.
3)"肯亞" 兩字在我印像中好似"馬拉松"比賽中常是冠軍代名詞, 經由你的詳述方知肯亞竟然是這麼落後的國家, 在這麼惡劣的環境下,你可以以不同的態度甚至可以說是愉悅的心情去面對它,去適應它, 好樣的!!. 上天給予人類的天賦, 你發揮得淋漓盡致, 所謂'"心隨境轉" 乃是適應能力的最高境界, 而且你又具有一顆慈善之心, 視病人為己人, 華陀再世 , 指日可待!!. 在異地生活, 除了適應當地環境之外,更要注意保護自己的身體好讓家鄉的父母能夠安心. OK !!