Archive for January, 2006

Liveblogging from Sri Lanka – Entry #4  

Posted in Liveblogging from Sri Lanka at 9:27 pm by Jyoti Puvvula

Liveblogging from Sri Lanka blog posts are written by residents and faculty in the Harbor Family Medicine program who elected to go to Sri Lanka to provide medical treatment to those affected by last year’s tsunami. These posts serve to document the efforts and experiences of these residents and faculty while they are in Sri Lanka on this resident organized trip.

As we returned from another long camp and dinner to orient the 3 new US health providers and to bid farewell to the staff from east coast who would be returning tomorrow we got the news of the 4 blasts in Colombo- one a ¼ mile from our work, 2nd near the camp where we had been working earlier in the day and 2 others. As our street was being fortified by military personnel we got orders to close everything down and get indoors—especially for the safety of our local staff. Our staff—all Tami—who hate the war more than anyone else also understand and tell us that being a young Tamil man can be a curse, as many are viewed by the government with suspicion and picked up by the authorities if found wandering outside late at night. Each has stories of family members lost in the conflict, or seen bomb blasts.

While Paul was giving report to the US headquarters, we thought of calling home to let people know that we are all safe. But then having watched occasional CNN here, we realized that for most Americans back home this is probably a distant land of Indiana Jones and not necessarily newsworthy, and besides the headlines are probably focusing on some car chase on the 110 freeway or the upcoming superbowl. Well, we also like the locals calmed down and huddled around the television waiting for breaking news and worrying about the performance and the batting averages of the Sri Lankan cricket team in the 1 day test match with Australia. Tomorrow morning it will be business as usual and the rest of our team will head back east to Kuchevelli.

Liveblogging from Sri Lanka – Entry #3  

Posted in Liveblogging from Sri Lanka at 4:22 pm by Jyoti Puvvula

Liveblogging from Sri Lanka blog posts are written by residents and faculty in the Harbor Family Medicine program who elected to go to Sri Lanka to provide medical treatment to those affected by last year’s tsunami. These posts serve to document the efforts and experiences of these residents and faculty while they are in Sri Lanka on this resident organized trip.

Each day at the camps has been quite an experience. People uprooted from their homes, family and crammed into make shift shanty towns. The first camp was at the base of a huge garbage dump. A camp that is mainly cardboard boxes, since the last one with 400 homes burnt down a few weeks ago. The second one is a large shed near the dumpsite where each family has little more than 5’ X 7’ space to live in and the next camp is an old dilapidated school with classrooms divided into space for 4 or 5 families by sheets and saris. The camps only get grimmer each day and this is how they have been living for over a year. Carol tells us that the average life of an IDP (internally displaced persons) camp is 5-9 years. Almost all have lost loved ones, any belongings, stripped of their livelihoods as fisher people etc and now having to live in this urban squalor. Forget personal space, privacy, shyness, dignity…

Our ancillary staff is amazing- they left their families in the villages back east to come help us at the camps here. Each of them has endured so much- lost family to conflict, tsunami- yet they all smile. Our patients (who are predominantly Muslim Tamils, and then other Tamils and Sinhalese) wait for hours in the heat to see us and are so grateful- they bless us and kiss us. In the midst of such loss, I don’t know how they have found the strength to go on- the kids manage to figure out ways to play cricket event in the dump site, run around, pose for pictures.

Carol Knobloch- our national coordinator here- is an amazing women. A former ICU/ER nurse has been doing this work for about 10 years and can tell us of crazy stories from Kosovo to Afghanistan. She tells us a story of how a few weeks ago, they had gone to the shanty town where our driver Robinson lives- to take rice, beans and 5 blankets- to what he said were families in need. Looking at many of the other cardboard houses, she had asked him, “what about all the other families?” and he had told her the rest of us have enough. She was wondering how do we all learn how much and when do we have enough.

Well these past few weeks have reminded me again of how much I have and how easy it is to take for granted all that I have. The people here- the patients and staff – have taught me how to endure and be able to smile through adversity (which I don’t have much of), and I think of when I can return here with the residents to go back east and work with this amazing group of staff and people.

Liveblogging from Sri Lanka – Entry #2  

Posted in Liveblogging from Sri Lanka at 3:37 pm by Gilbert Granados

Liveblogging from Sri Lanka blog posts are written by residents and faculty in the Harbor Family Medicine program who elected to go to Sri Lanka to provide medical treatment to those affected by last year’s tsunami. These posts serve to document the efforts and experiences of these residents and faculty while they are in Sri Lanka on this resident organized trip.

On the first “health camp” we drove just out side of Colombo through some pretty crowded streets (still a bit better than Delhi traffic) in our small minivan. As we got close to our site our host pointed to a giant hill of trash, the city dump. He said “we’re here”. And we were. This camp of Tsunami refugees have been living not more than 10 feet from the dump and sometimes just up against it for the last year. The camp is on the side of a hill and the shacks are smaller than most bedrooms in the U.S. A small plastic pipe jets out of the ground and that represents the camp washroom, shower and sink and the runoff trickles through the rest of the camp. It’s remarkable how efficient people can be at keeping clean and getting things done. As our shade is being prepared for the clinic the women and the children start to line up, us in the shade and them in the unrelenting heat. The ground is full of debris, uneven and muddy. Our booths are set up like open confessionals with a seat each for the MD, the translator and the patient. And we start seeing patients. URIs, wounds, skin stuff and stress stuff and nutrition stuff. In a few hours Jyoti and I saw about 130 patients. For those of you who have been to Tecate with the UCLA students it’s about the same thing with the same level of poverty. Just the unrelenting heat, flies and fowl smell and you can imagine the camp.

Yesterday the mayor put a health camp and we participated there with a lot of pomp and circumstance. When we first arrived I thought it was a stadium with a sell out crowd for a cricket match but oh no it’s the people waiting to be seen by us. “Are you kidding there must be a thousand people here!” and we only have ten doctors. Well it turned out to be about 3 thousand and some of the doctors ran away after a few hours. After several hours and I don’t know how many patients later, I looked outside and the crowd was only getting larger. Leaving to the bathroom we had to fight to get through the building and courtyard. We started in the morning and finished at about 9 PM. Each of us went through a few pads of prescriptions. I can’t say enough about the people we saw. They likely waited hours to see us and some were very sick and through it all they were soooo patient and soooo grateful it was unreal. Oh the things we saw!!! Our team of pharmacist, translators and mid-level providers are awesome! By the time we left there was a huge crowed trying to fill the Rx we wrote out- good luck guys!!

Liveblogging from Pakistan – Entry #3  

Posted in Liveblogging from Pakistan at 6:23 pm by Fred Kim

Liveblogging from Pakistan blog posts are written by residents in the Harbor Family Medicine program who elected to go to the northern region of Pakistan to provide medical treatment to those affected by the recent devastating earthquake. These posts serve to document the efforts and experiences of these residents while they are in Pakistan on this resident organized trip.

It’s been few days since we left the US. I am becoming used to getting up to the sound of roosters. Two nights ago, Sanjeev, Cathy and I, along with our three translators, Izas, Sohail & Anita left the Balakot camp and headed for Satbani. Satbani is a mountain village at an elevation of 5000 ft, blanketted by snow-covered mountains. After a rattling jeep ride, then on foot, climbing a muddy trail, we reached our destination camp and found a tent full of unorganized medicines from all over the world. Although we were delighted to find Ciprofloxacins not needing ID approvals and an array of IV antibiotics, few were salvagable, burried in damp cardboard boxes and tipped over iodine bottles. Not even having times to organize and set up the cliniic, we were greeted by line of local people who have been waiting for us since the earthquake three months ago. It’s ironic that none of us even thought we were going to be in Pakistan three weeks ago. As we are seeing patients our first night, we started setting up three tents for male and female clinics and a pharmacy, jumping in and out of our new work area/home and meeting our new patients.

Since we set up the clinic, we started treating about 130 patients each day. Especially for women, a female physician was in dire need and Cathy’s presence at the camp delighted the community of 11,000 people. Together we saw patients with goiters, super-infected scabies, acute respiratory infections, COPD, malnutrition, diarrhea and many more. Many people with missing limbs came to check their healing wounds. We were also sadden to see few non-reduced fractures that are too old to do much other than a pain control. After making several visits to tents and homes of Satbani residents, I wondered if any of these will count as home visit for the residency.

The next day we visited tent schools, seeing a sewing class, several children who lost their parents and an 8 year-old girl who was teaching ABC’s and Urdu to a bunch of 5 and 6 year olds. It was truly inspirational to see that no one has abandoned education and well-being of these little children. No earhquake of this magnitude and devastation could stop the will of these resilient people. Between the breathtaking surroundings, listening to heart-wrenching stories of children and treating patients, I look forward to returning home but also worried with what is going to happen to the residents of Satbani once our time here is over.

Liveblogging from Sri Lanka – Entry #1  

Posted in Liveblogging from Sri Lanka at 8:14 am by Jyoti Puvvula

Liveblogging from Sri Lanka blog posts are written by residents and faculty in the Harbor Family Medicine program who elected to go to Sri Lanka to provide medical treatment to those affected by last year’s tsunami. These posts serve to document the efforts and experiences of these residents and faculty while they are in Sri Lanka on this resident organized trip.

We got on the flight from India to Colombo not knowing exactly what we would be expected to do there- the last email we received from the main office in Oregon had asked us to continue on to Sri Lanka while the rest of the team of residents would be diverted to Pakistan due to the increasing violence here. As our flight descended over what looked like a tropical paradise of lush green forests surrounded by blue-green waters, we were yet to find out about how the so called “pearl of the Indian ocean” holds stories of destruction left behind by the tsunami of a year ago and decades long civil conflict and is now sometimes referred to as the “tear drop of the Indian ocean”. We also wondered about the residents who were flying into Pakistan about this same time, wishing we were with them. We had left the cold northern India having viewed images of children and people in the quake area wearing plastic bags or socks on their feet to protect themselves from the harshest winter to hit northern India and Pakistan in the last 70 years.

We were picked up at the airport by Kiru-our local coordinator- and updated about the current situation in Sri Lanka. We would stay in the Colombo team house and work at the tsunami camps around Colombo on the west coast. Throughout the first day people kept arriving at the team house- Paul Bollinger- who is helping set up the first EMS service here in Sri Lanka and 4 staff members from the east coast (where we were originally supposed to work) who were being evacuated due to the daily insurgency in the 2 towns. The house is now full. We are all settled in the house- sharing it with Siva (the cook and housekeeper), other staff, many species from the insect kingdom, a 10 foot monitor (from the crocodile family) that eats turtles outside the front doo,r and fred the rat (who I have not seen but know exists, since the last housekeeper being Buddhist would always catch the rat in a plastic bag and set it free down the street only to have it return to its home).

Our first night here, after having heard stories from Carolyn (the national coordinator for the teams here), I started to cram the management of venomous cobra and viper bites, elephant crush injuries etc. In the meanwhile watching the increased security presence and hearing gun shots (which turned out to be festival fireworks), Gilbert has been planning escape routes from the house in case of disaster and ways to ward off the omniscient common fly.

Liveblogging from Pakistan – Entry #2  

Posted in Liveblogging from Pakistan at 4:16 pm by Fred Kim

Liveblogging from Pakistan blog posts are written by residents in the Harbor Family Medicine program who elected to go to the northern region of Pakistan to provide medical treatment to those affected by the recent devastating earthquake. These posts serve to document the efforts and experiences of these residents while they are in Pakistan on this resident organized trip.

Three months ago when the devastating earthquake hit northeast Pakistan, I don’t even remember where I was or what I was doing. While such extreme force of nature consumed over 70,000 lives, I probably heard about the disaster from an evening news which then went onto talk about some movie star couple’s breakup.

After 24 hours of travel, tired Sanjeev, Cathy and I arrived in Islamabad. We were greeted both by red flower petals on the ground and many desperate hands willing to carry our luggage for monetary help. I must felt I was taking such a leap of faith when I came to Pakistan, but after meeting Asif (our coordinator) in Abottabad who oriented us on our projects, it was clear who was taking a leap of faith. We were given a responsibility of setting up a clinic in a village where medical help could not reach due to the initial earthquake, then mudslide caused by heavy rain. As these Pakistanis entrust their health in these three young Americans, I am both humbled and inspired to make my next two weeks in the foothill of Himalayas worthwhile for all that’s involved. I fell asleep last night to rest what felt like a post-call brain to the sound of heavy wind and rain. Surprisingly, I found this sound both familiar and comforting.

Liveblogging from Pakistan – Entry #1  

Posted in Liveblogging from Pakistan at 3:26 pm by Catherine McPhee

Liveblogging from Pakistan blog posts are written by residents in the Harbor Family Medicine program who elected to go to the northern region of Pakistan to provide medical treatment to those affected by the recent devastating earthquake. These posts serve to document the efforts and experiences of these residents while they are in Pakistan on this resident organized trip.

Hi everyone,

We arrived in Balakot today, a very large tent camp community in the area of a former city, a city that no longer exists really, except for the people who survived the earthquake and are living here in the tents. How they survive like this for more than a few days or weeks amazes me, to be honest, much less for months. The tents are small, and wet. They’re on rocky rough soil, with water and mud everywhere. It has rained since we arrived, and probably for many days before. It is very cold and very wet. The roads are passable, but just. This morning we drove here, we had to drive around many areas where landslides were partially blocking the road (these are new, per Asif our guide, the rock slides weren’t there even just the night before when he’d driven home). Speaking of driving: I will never complain about LA traffic again. I’ll take the 405 anyday compared to this!!! :) To get into the Balakot camp, we drove over a narrow bridge which apparently used to be 5 feet to the left of where it is now, you can see the posts marking where the edges of the bridge used to be. I kept a tight grip on the edge of my seat, but it’s apparently pretty stable, despite it’s new location.

Tomorrow we hike up to another area, where I believe we’re going to stay and set up a makeshift clinic. This area, unlike where we are now, has not had any medical care available to them since the quake. There used to be a very narrow road to it, but even that is too unsafe to drive on, so we’re going to hike it instead. Lets hope that it doesn’t pour on us tomorrow, the way it is today! I’m not sure when you’ll hear from me again via email, as I don’t think we’ll have such things available there (currently I’m emailing from the Army base inside Balakot). We worked with a small Northwest Medical Team today that arrived here about a week before us, and have a clinic set up here at Balakot. They’re giving us some of their surplus supplies to take with us up to Sathpani, to help us get our clinic started. We won’t have much, and we’re not really sure what we’ll see, but at least being here today has us somewhat prepared. I see the women and children, Sanjeev and Fred see the men, and some of the children. In general, women take care of women, and men take care of men. There is no physical interaction between women and men who are not their husbands, including medical care. Even if a woman’s husband says that it’s okay for her to be treated by a male doctor, few women will be willing to do so.

Today I saw mostly women and children with complaints of cough, fever, etc. I was scared, the first time I laid my stethoscope on a child’s back this afternoon, I expected to hear crackles everywhere, I was sure that living in these conditions, they would all have terrible pneumonia, and in fact a couple did. But not all, some were just your run of the mill URI….at high risk still I’m sure for becoming something worse, but somehow, not there yet. I don’t know how these people maintain even relatively well, all things considered. They live many people in each small wet tent, on the wet cold ground, with blankets and fires to keep them warm. They have nothing else. And yet they smile as you walk into the room to examine them, they play with their children while you examine them, they gratefully accept whatever medications you give them (along with a 2 week supply of vitamins), and they smile again a quick goodbye before they rush off into the cold rain to go back to their tents. I am humbled. I cannot complain of anything, for even though I’m cold and tired, I’m wearing a warm Columbia jacket, I have warm waterproofed boots, and I’ll sleep tonight in a relatively dry tent inside a mummy bag. When my toes get too numb I’ll pop a toewarmer into my socks and be thankful for the 6hours of heat that the package says I’ll have. And in two weeks this will be something I tell other people about, from my warm and stable home in California. But these people will still be here, in these same conditions, surviving.

Thanks for all your prayers, the Pakistani people need them more than I can describe.

With love,
Cathy

Liveblogging from Pakistan – Entry #1  

Posted in Uncategorized at 3:26 pm by Catherine McPhee

Liveblogging from Pakistan blog posts are written by Harbor Family Medicine residents who elected to go to Pakistan for two weeks to provide medical treatment to those affected by the devastating earthquake that struck the northern region of Pakistan on November 21st. The posts from this resident organized trip serve to document their experiences.

Hi everyone,

We arrived in Balakot today, a very large tent camp community in the area of a former city, a city that no longer exists really, except for the people who survived the earthquake and are living here in the tents. How they survive like this for more than a few days or weeks amazes me, to be honest, much less for months. The tents are small, and wet. They’re on rocky rough soil, with water and mud everywhere. It has rained since we arrived, and probably for many days before. It is very cold and very wet. The roads are passable, but just. This morning we drove here, we had to drive around many areas where landslides were partially blocking the road (these are new, per Asif our guide, the rock slides weren’t there even just the night before when he’d driven home). Speaking of driving: I will never complain about LA traffic again. I’ll take the 405 anyday compared to this!!! :) To get into the Balakot camp, we drove over a narrow bridge which apparently used to be 5 feet to the left of where it is now, you can see the posts marking where the edges of the bridge used to be. I kept a tight grip on the edge of my seat, but it’s apparently pretty stable, despite it’s new location.

Tomorrow we hike up to another area, where I believe we’re going to stay and set up a makeshift clinic. This area, unlike where we are now, has not had any medical care available to them since the quake. There used to be a very narrow road to it, but even that is too unsafe to drive on, so we’re going to hike it instead. Lets hope that it doesn’t pour on us tomorrow, the way it is today! I’m not sure when you’ll hear from me again via email, as I don’t think we’ll have such things available there (currently I’m emailing from the Army base inside Balakot). We worked with a small Northwest Medical Team today that arrived here about a week before us, and have a clinic set up here at Balakot. They’re giving us some of their surplus supplies to take with us up to Sathpani, to help us get our clinic started. We won’t have much, and we’re not really sure what we’ll see, but at least being here today has us somewhat prepared. I see the women and children, Sanjeev and Fred see the men, and some of the children. In general, women take care of women, and men take care of men. There is no physical interaction between women and men who are not their husbands, including medical care. Even if a woman’s husband says that it’s okay for her to be treated by a male doctor, few women will be willing to do so.

Today I saw mostly women and children with complaints of cough, fever, etc. I was scared, the first time I laid my stethoscope on a child’s back this afternoon, I expected to hear crackles everywhere, I was sure that living in these conditions, they would all have terrible pneumonia, and in fact a couple did. But not all, some were just your run of the mill URI….at high risk still I’m sure for becoming something worse, but somehow, not there yet. I don’t know how these people maintain even relatively well, all things considered. They live many people in each small wet tent, on the wet cold ground, with blankets and fires to keep them warm. They have nothing else. And yet they smile as you walk into the room to examine them, they play with their children while you examine them, they gratefully accept whatever medications you give them (along with a 2 week supply of vitamins), and they smile again a quick goodbye before they rush off into the cold rain to go back to their tents. I am humbled. I cannot complain of anything, for even though I’m cold and tired, I’m wearing a warm Columbia jacket, I have warm waterproofed boots, and I’ll sleep tonight in a relatively dry tent inside a mummy bag. When my toes get too numb I’ll pop a toewarmer into my socks and be thankful for the 6hours of heat that the package says I’ll have. And in two weeks this will be something I tell other people about, from my warm and stable home in California. But these people will still be here, in these same conditions, surviving.

Thanks for all your prayers, the Pakistani people need them more than I can describe.

With love,
Cathy

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