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This will be the last letter from Africa for awhile.
Dr Mark Newton who is an American-trained and Board Certified anesthesiologist,
is on his way back from Kijabe, Kenya to the United States. Mark has spent
the past 4 years living in Africa with his wife and children (2 young
boys, a daughter who was born in Africa and another whom they adopted
while in Kenya) and working at the Kijabe Mission Hospital. Mark did his
pediatric anesthesia training in Denver and spent several years practicing
here prior to going to Kenya. He has, over the course of the past 4 years
shared some of his experiences with us. His experiences have been touching,
amazing, harrowing and amusing. He has hoped to educate us and maybe even
inspire us to get involved. In this final letter he shares some of his
thoughts about the ongoing civil war in the Sudan and its consequences.
For more information about the Kijabe medical center you can go to: http://www.webwink.com/nateandkim/KIJABE.HTM
Rita Agarwal MD
Editor
An eighteen-year-old Arabic speaking Southern
Sudanese boy arrived at Kijabe Mission Hospital (Kenya) with his head
completely covered. After some coaxing by the United Nations appointed
translator, he slowly removed the tattered scarf revealing a gruesome
sight. At the age of fifteen he had been bitten in the face by a hyena
and had not received appropriate medical care due to the ongoing civil
war. I have grown accustomed to seeing very advanced disease states but
this boy demonstrated one of the saddest consequences of war.
Sudan has been in the midst of a fifteen-year-old
civil war in which two million Southern Sudanese have been killed. Many
"westerners" may not even realize that it is located on the
African continent. The location of Sudan and the Northern Sudanese government's
role in terrorism has become highlighted since September 11. There are
many people in Sudan who are not terrorists and who in fact are themselves
victims of the same evil which was evident on September 11.
Over the last four years, I have had many
opportunities to work and teach in the resource rich country of Southern
Sudan. I have distributed grain to mothers who were literally demonstrating
the "survival of the fittest" aggressiveness during starvation.
I have dashed from the operating theater to caves in fear of the bombs,
which were to be dropped by the Northern government's Antanov bombers.
I have seen the manifestations of a disease state in an extremely isolated
pediatric population, which is not described in pediatric textbooks. Equally
important, I trained Joseph (a young man with a fifth grade education)
in my newly discovered skill of ether/EMO anesthesia. I read the book
a week prior to going to Sudan and meeting him! I soon realized that the
nausea produced by a hot, poorly ventilated, ether-filled operative room
was probably the impetus for the inventors of halothane. I also daily
appreciated the scope and number of cases that are suited for lidocaine
spinal anesthesia. Joseph has reinforced my belief that individuals with
appropriate, thorough anesthesia edu-cation can provide a reasonable level
of anesthesia care and save lives. The potential is huge, but unfortunately
the future appears dim.
The world has changed since September
11. An elderly, white-bearded, friendly Muslim man anxiously looked up
to me moments prior to the pentothal injection and said, "I really
like America!" I understood his motivation. I assured him with
a handshake and a smile that he would be treated as my brother. He seemed
satisfied and his heart rate dropped to normal levels (we of course have
no beta blockers).
The world is still the same for many people
in the world without CNN. There are newborns who do not have their open
myelomeningocele repaired, children with tetanus, and anesthesiologists,
like myself, who rediscover the value of the "gum elastic bougie".
The eighteen-year-old Sudanese patient needed multiple plastic surgeries.
Without a fiberoptic, I was only able to intubate this bilateral TMJ-fused
boy with the bougie. On some of those occasions I was the one who needed
the beta blockers. This young man thanked us for our hard work, told us
to greet our families, and then asked us for our shoes. His world had
been disrupted for many years prior to September 11. He considers himself
one of the fortunate few in Southern Sudan who after three years received
medical care (which included a new nose) and a new pair of shoes in the
postoperative plan. These last four years in Kenya have reinforced my
belief that pediatric anesthesiologists need to be directly involved with
the developing world's medical needs. We need to be willing to utilize
our gifts, skills and resources through teaching and supporting anesthesia
care providers who live outside our own borders. If you see a Sudanese
guy on CNN with a fairly new pair of Nike's, a funny looking nose and
the reporter calls him a terrorist, do not believe them because you know
the truth!
Does anyone have an extra pair of shoes?
Dr. Mark W. Newton
Anesthesiologist
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Joseph is an anesthesia nurse who I trained on each trip
to Lui, Southern Sudan. He has a 5th grade education, and is now the Department
Chief at Lui Hospital
Meningocele: Positioning for a myelominigocele;sacral
teratoma in Kijabe, Kenya. Very late presentation is common.
One of the feeding programs in an area of severe starvation
in Southern Sudan.
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