Photos-肯亞所見系列(4)-b

Photos-肯亞所見系列(4)-a

肯亞所見系列 (4)

Sunday, January 08, 2006

The Breaking Point (轉折點)

The Final week arrived and departed with the blink of an eye. After spending Saturday enjoying new years eve sipping wine and watching movies on the laptop, I awoke on New Years day with a phone call from Dr Ochieng. There were a few major operations at hospital and he needed an assistant. So I drove in with Alfred immediately on the Sunday and we began operating on a few caesars and an exploratory laparotomy for a patient with acute abdomen. The laparotomy lasted for 4 hours and we found two perforations in the small bowel. This patient had been stabbed in the abdomen and the superficial skin was merely sutured without any exploration underneath. Needless to say he was on the brink of death by the time we operated on him. It was the work of our doctor the changa (metho) man who was obviously too drunk to care. I saw him on action on the wards. He would see one patient then go off for a drink and so on. It was horrendous. It was also amazing to see how little people cared in the public system here. There was no night nurse on in the female wards and it was sad to see that nothing could be done because of the bureaucracy and paperwork required to dismiss a staff member at the hospital.

The rest of the week was a complete blur that flew by in an instant. I spent the days acquiring medical supplies from a shop in Kisumu which composed of pins and plates. The staff was very rude and even undercharged us. Needless to say they were very keen to get reimbursed for the miscalculation even though the receipt stated otherwise. They eventually drove up to Siaya to meet us later in the week to correct the mistakes they made. IT was very frustrating especially because it was their mistake and they were very rude. The days were filled with countless operations. I had gone until midnight and had to get a room in Siaya rather then return to Wagai. I spent about 1000 shillings for a very Spartan room and there was so much dust and no window. It was actually hilarious to sleep somewhere that was worse than our place in Wagai. But at least my bed wasn't broken here like it was in Wagai.

Me and Dr Ochieng spent the night in the hotel near the hospital to talk about life. It was amazing to have this doctor treat me like a colleague rather than a lowly medical student. Although he knew I was a student, he treated me always with a level of respect and always asked for my opinions.

We went to the hospital the following day and spent another day mostly doing wards and clinics. It was rather quiet and I was exhausted by this stage. Rosie also came up at this stage to collect me for the return trip to Nairobi via Kisumu for the start of my trek. I spent the next few nights attempting to pack my stuff although it was difficult in the dark. Luckily I got some time on the last day to give the house an overall clean and hopefully I did not leave anything behind.

My Last day at hospital was very sad saying farewell to all the staff. There were also patients on the wards who had their casts put on by the changa man and it appeared as if something was weeping. We decided to remove the casts and to our amazement found open fractures which were simply left and plastered over. It was atrocious. All in all there was 2 patients who was in that category and we had to clean the wound out. My last patient that I looked after had arrived as I was about to leave. This was a boy who was hit by a mini van driving on the dirt road. It was not considered an emergency and the x-ray man refused to do a mobile and insisted that we resuscitate the boy first then bring him up. After some convincing he eventually came down and performed the x-rays which revealed multiple fractures including base of skull. It was very sad as I will probably never find out what happened to this patient.

Eventually I made my way back to wagai and said farewell to all the kids and people working there. Of course I had to have a final soccer game with the kids. We made our way back to Kisumu for the night and I returned to Sunset hotel. I also met up with Andy from moving mountains who organised the entire experience for me. He was bringing up two new people for wagai. These were John and Kate who were teachers doing Gap years and basically living out here for 3 months. We had plenty of fun having some drinks and giving them the low down on Wagai. I was mildly jealous that they were taking our place and part of me longed to return. The sunset was simply amazing this week and I think the Sunset hotel is truly the most amazing place to stay in kisumu.

Eventually we flew back to Nairobi and was met by Osman and the gang. We spent the day visiting animal sanctuaries and I had a chance to get real up and close with them. We spent the evening with Dr Ochieng who was in town for a meeting to sort out the staff problems. It appeared as if things were moving and change was going to occur. IT was very positive. We spent the rest of the evening at Dr Ochieng’s house which was situated near the slums. It was an eye opener. Although the house is amazing by Kenya standards, it still saddened me a little to see a clinician live in such conditions. There was also tight security around the whole neighbourhood because it wasn’t safe.

Overall an amazing week. Tomorrow I make my way towards Mt Kenya for the first part of my journey. I am hoping for some amazing photos. I just can't believe how quickly everything has flown by. (# posted by Phil Huang @ 12:38 PM)

實習的最後這個禮拜, 彷彿就像是在一眨眼之間, 來了又走了. 上禮拜六 [註: 當地 31/Dec] 的除夕夜, 我是在啜飲紅酒觀賞著膝上型電腦裡的幾部電影之中度過的. 新年的第一天早上 [註: 當地 01/Jan 星期天, 理應休假中], 我則是被 Dr. Ochieng 的一通電話給叫醒的. 他說當天有排了幾刀大手術, 他需要人幫忙; 所以我和 Alfred 在禮拜天的早上, 一起開車趕緊到 Siaya 區域醫院中去, 馬上進行幾個剖腹, 也替一位急性腹部疼痛的病患做了 Exploratory Laparotomy器官檢查剖腹開刀. 單單這個器官檢查剖腹開刀就花了 4 個小時, 不過我們總算在病患的小腸中發現了兩處穿孔. 這位病患當初是因為腹部被刺了幾刀後送到這間醫院裡來的, 在沒有做任何腹部檢查是否有被刀子傷到的情況下, 他的表皮皮膚馬上就被縫合起來. 不用說, 我們要替他做這個腹部器官檢查剖腹開刀的時候, 他的小腸被刀子刺傷所造成的穿孔, 已經是讓他命在旦夕了. 這位病患是那位有長期酗酒問題的醫生的病人. 很顯然的, 那位醫生是只顧自己去喝個爛醉, 根本就沒有在照顧他的這位病患. 我曾經親眼目睹到這位醫生在巡房時是怎麼巡的. 他是每巡完一位他的病患後就跑出去到外面喝一下酒, 然後再進來巡第二位病患; 巡完第二位後又出去喝酒再進來巡視下一個病患這樣的. 真是有夠嚇人的不負責任. 我也很驚訝, 在這裡的公立醫院系統中, 根本就沒有幾個人是對於這些事有在關心的. 而且在女性病患的病房裡, 晚上也沒有夜班護士在值班. 我很難過的看到, 由於官僚作風與要辭退一位醫職人員所需要的繁複文件工作, 居然使得在這間醫院裡, 什麼事也都不能做.

這個禮拜接下來的幾天過得很快, 時間飛逝的好像是讓我在腦海中只有留下一片模糊的印象似的. 我隔天 [註: 應是當地 02/Jan] 到 Kisumu 的一間店裡去領購一些像鋼釘和鋼板的醫療供應品. 店裡的職員很沒有禮貌, 還自己算錯帳, 少算了我們錢. 不用說, 雖然收據上是少算了我們錢, 他們在事後可是很急於想向我們收取他們自己計算錯誤的差價. 他們幾天後甚至於還開車到 Siaya 來和我們會面, 要親自把這個錯誤更正過來. 這讓我很生氣, 特別是因為他們當時對我是很沒有禮貌在先, 接著又是他們自己的計算錯誤; 然後在事後卻還期待要我花時間配合他們, 來更正他們自己的失誤. 這個禮拜的每一天我都很忙, 天天都是在從事數不清的手術一直到半夜 12 點多才結束的情形下度過的. 因此, 為了節省每天旅途往返的時間, 我就自掏腰包, 晚上夜宿在 Siaya .一間靠近醫院的小旅館裡面. 這間旅館裡的房間, 是像 Spartan 古代斯巴達人住的地方似的簡陋; 房間內到處是灰塵, 不但一扇窗戶也沒有, 還居然每晚要收我費用 1,000 肯亞先令 [註: 約合台幣 480 元]. 雖然住在這間狀況比我在 Wagai 的宿舍還不如的旅館房間裡, 但值得欣慰的是, 至少它的床腳可不像我在 Wagai 的那張睡床一樣, 是斷裂的.

這個晚上, Dr. Ochieng 來到我這間靠近醫院的小旅館房間裡面, 和我暢聊人生. 我也很驚訝, 他這位很有經驗的大醫生, 居然是把我當成就像一位他的同事醫生一般的看待, 而不是一位位階遠比他小的實習中的醫學院學生. 雖然他知道我還只是一位醫學院的學生, 可是他對我卻很尊敬, 還處處問我對一些病例的看法.

隔天早上 [註: 應是當地 03/Jan], 我們一起到醫院裡去, 整天做的大都是一些巡房和門診的工作. 雖然只是一些例行的工作沒有什麼重大緊急的病例, 但幾個晚上以來連續缺乏睡眠的結果, 卻讓我覺得很是筋疲力盡. Rosie [註: 安排 Philip 實習的慈善團體 Moving Mountain 所派出的接送業務代表, 12/Dec 也是她在奈羅比機場負責接 Philip 機的] 這時也出現了, 她是來安排要帶我經 Kisumu 飛往奈羅比去參加 8/Jan 開始的登山之旅的一切相關事宜. 雖然房間內是一片漆黑 [註: 看來 Wagai 的宿舍裡應該是又沒有基本電力了] 很難做到, 但我接下來的幾個晚上總是回到宿舍裡, 想辦法去儘量打包行李. 幸好, 我在醫院裡的最後一天下午 [註: 應是當地 06/Jan], 可以先行離開回到宿舍裡, 把房間做個總清理大掃除. 我希望我在那裡並沒有忘了什麼東西是還沒有收拾的.

待在醫院裡的最後那一天 [註: 應是當地 06/Jan], 我向所有同事過的醫生和護士們一一道別的時候, 心裡覺得好難受. 此外, 我發現病房內有一些被那位長期酗酒的復健醫師給打上石膏的骨折病患, .他們居然有不明的液體從被裹上的石膏裡面滲流出來. 我們決定要把石膏拆除掉, 看到底是為什麼; 卻很驚訝的發現到, 病患的骨折處竟然是沒有先予以處理接回就直接打上石膏封裹. 被這樣粗暴惡劣處理的骨折病患還不止是一位, 而是兩位. 我們只好把化膿潰爛的骨折傷口處先清理乾淨, 日後再讓其他醫生們另外安排時間接手去做正確的矯正處理. 就在我即將要離開的時候, 我在這間醫院所照顧的最後一個病人被送進來了. 這是一個小男孩走在一條黃土路上時, 被一輛迷你小巴給撞傷了. 這個病例不被認為是需要急診, X 光師拒絕為他就地緊急做 Mobile 移動 X 光片; 他反而堅持要我們先替病患做復甦術讓他清醒後, 再帶他到樓上的 X 光室裡照 X 光片. 經過一番的說服後, 他終於下樓來替病患照了幾張 X 光片. 而在這些 X 光片中, 我們發現病患有多處的嚴重骨折, 其中一處還包括了在頭蓋骨的底部. 對於我將永遠無法得知這個小男孩被急救之後會是怎麼樣的結果, 我心底實在是非常的難過.

最後, 當我趕回 Wagai清掃完宿舍房間之後, 我向住在附近的所有小孩子們和在那裡工作的人們 告別. 當然, 我也和他們再打了一場臨別的足球賽後, 才到 Kisumu 的 Sunset Hotel 日落旅館去. 當晚在旅館中, 我見到了慈善團體 Moving Mountain 裡負責籌劃要帶領我們去攀登肯亞山的 Andy, 他順便也把兩位要到 Wagai 去的新人帶來給我認識一下. 他們是將要在 Wagai 住上 3 個月正在參加 Gap years 計劃 [註: 這是以專門教育貧窮落後國家的兒童為主的一個慈善義工團體, 參加的團員除了教導孩童外, 有時還要幫忙建蓋教室或裝設水管或屋頂天花板的修繕工作等事] 的教師 John .和 Kate. 我們在房間裡聊得很開心. 一面喝著一些飲料, 我一面詳細的告訴他們兩人, 有關住在 Wagai 時的一些必須注意事項. 講到我自己都有點妒忌起這兩位即將要去接替我宿舍房間的人起來了. 我知道, 內心中有一部份的我, 是很想再回去那裡的.

這個禮拜的日落景色, 簡直是讓我讚嘆不已. 我覺得在 Kisumu 這個城市裡, 如果是要住在旅館裡的話, 那日落旅館就真的是一個最棒的地方.

隔天早上 [註: 應是當地 07/Jan], 我飛回了首都奈羅比, Osman [註: 他見習的督導頂頭上司醫生] 到機場來接我., 然後我們就去 Nairobi Animal Sanctuaries 奈羅比動物庇護園 [註: 在奈羅比國家公園的正門附近] 參觀, 也讓我有個真正親近一些野生動物的機會. 晚上我則是住在 Dr. Ochieng 的家裡, 他因為要解決醫療人員的 “問題”, 因此也到奈羅比來和相關的人士會談. 看來Siaya 區域醫院裡的有些人是要被 “調動”, 有一些改變是終於要發生了. 這對醫院來說, 實在是一件正面有益的事情. Dr. Ochieng 家的房子是位在 slum貧民區的附近. 這讓我真的睜大了眼睛. 因為雖然他家的房子以肯亞人的標準來看是很棒, 但看到一位臨床醫師是住在像這樣的一間房子裡, 還是讓我不禁替他感到有點難過. 就因為房子並不是座落在治安很安全的地區裡, 所以他家的四周相鄰附近, 在夜晚時候的警衛巡邏就變得很密集.

總而言之, 這個禮拜我是過得很不錯. 明天 [註: 應是當地 08/Jan] 我就要開始前半段之旅去攀登肯亞山. 我希望沿途可以多拍攝一些很棒的照片. 我只是有點不敢相信, 這個禮拜裡的所有事情, 居然一切都是這麼快速的飛過我眼前來發生. (posted by Phil Huang @ 12:38 PM)


[後記]

我考慮了很久, 到底要不要把 Philip 所提供的在肯亞 Siaya 區域醫院實習時所照顧的最後一位病患的照片, 放到這篇中文翻譯的文章裡頭來. 由於我有一位大學時代的好朋友, 在失聯近 30 年之後, 我們終於在 2005.03.14. 又再度地取得聯絡, 雙方也在國際長途電話中暢聊了近況約有半個小時之久. 誰知一個禮拜之後, 她在住家附近要過馬路時, 卻被一輛三重客運的巴士給撞傷倒地, 緊急送醫後就一直昏迷不醒到今天. 看到這張照片中的病患受傷情形, 和我這位大學時代好友受傷的部位極為相似, 讓我的情緒是百感交集, 久久不能平復.

Philip上個禮拜可能是真的很忙, 在無法與他取得電話聯絡, 或看到他所傳寄的任何 blog 訊息長達有一個禮拜之後, 終於在8/Jan 的早上, 我看到了他這篇於台北時間當天 09:38am所傳寄出來的“一個轉折點” 文章, 這時我的一顆七上八下的心, 總算是稍稍放下了一些.

唸完他整篇的文章後, 我不禁回想起7/Jan 晚上在台灣的 HBO 電視頻道上所觀賞的“Out of Africa 遠離非洲” 這部電影. 這部電影是在 1985 年發行, 導演則是 Sydney Pollack. 它由 Meryl Streep 梅莉史翠普和 Robert Redford 勞勃瑞福所主演; 影片全程是在肯亞實地拍攝, 當年曾獲得 7 項包括最佳影片在內的奧斯卡金像獎. 我第一次觀看這部影片時是在台灣, 當時才 31 歲的我在觀賞影片時的重心是放在梅莉史翠普的演技, 和她在劇中對勞勃瑞福所說的那句話 “Why is your freedom more important than mine? (為什麼你的自由就比我的自由來得更重要呢?)” 之上. 如今已經是 51 歲的我, 藉由兒子的筆述肯亞見聞, 我發現我是全程在欣賞影片中的肯亞獨特景色, 和勞勃瑞福在劇中對梅莉史翠普所說的那句話 “有人說, 在非洲, 你可以看到這個地球上最遠的地平線” 之上. 有趣的是, 這部影片在劇中也不能免俗的提到 Philip 在下半段之旅中即將要攀登的那座在坦桑尼亞境內的 KilimanJoro 吉力馬札羅山. 或許, 在帶著全新的角度再次觀賞 “遠離非洲” 這部電影之後, 我終於可以了解, 為什麼 Philip 會對非洲的落日景色是如此著迷的原因了吧!



肯亞所見系列 (3) [Feedback: 回響]

1) Philip 終於結束肯亞醫院的實習, 他如此年輕, 就接觸人間的生老病死大關, 很令人心疼, 而他悲天憫人的胸懷, 也非常令人佩服. 世間有些事, 他若不是親身體驗, 恐怕很難說服自己, 但是年輕的熱情, 也總是把自己置身無法評估的危險中, 父母親支持他, 但幫忙踩煞車也是必要的!

2) 見到 Philip在肯亞生活的點滴, 身為他姑姑的我除了佩服及以他為傲外, 還有深深的不捨, 放著大少爺不作, 竟深入蠻荒之地從事行醫, 愛心和耐心在他身上一覽無遺, 相信日後他一定是位最具仁心的醫生,也是最具孝心的兒子, 在此祝福他能征服肯亞大山, 但確記也要量力而為 !!

3) Reading Phil’s diary has had tears rolling down my face. What an amazing experience he is having, he is so lucky that he has the ability to make a difference there to people. I am dazzled by his stories and very saddened at the same time.

4) Kenya is fantastic?? We appreciate you had made a very good translation from English to Chinese for us, so we know very clear what Philip’s situation and daily life is in Kenya. ……Looks like he got a very good experience and saved many people's life. ………We wish him has fun in big mountains climbing.

5) I've read the journals that you've translated for your son. You must be really proud of him. He is quite optimistic even when he is in a poor environment. I'm also very impressed by your Chinese translation. VERY WELL WRITTEN AND VERY DETAILED. Well done.