October 14, 2009


Azerbaijani word of the day qrıja (greeja) = hernia.

Don't know how but I got one. Didn't really understand what a hernia was before. Just noticed some shooting pains in the groin some evenings when lounging on my comfy chair(the chair made of slate wood nailed together that was found in the garbage pile). Then one day a buddy and I went on a 20km hike from Quba to Qusar. About half way there it became apparent something wasn't quite right. At the end of the trip I hopped in the shower(I love visiting people with real showers, bathing with a bucket and the water pipe in my yard gets old). Anyhow, in the shower, looked down and what should I see but that part of my groin was swollen, red & throbbing; unfortunately not the good part.

5 minutes later I was on the phone with PC Medical in Baku. Doctor Irena told me she couldn't diagnose anything over the phone but to come into Baku sometime that week and she'd check it out. Couple days later I head down, get an examination and learn that I'm the proud father of a little bastard hernia. For those of you who, like me at the time, don't know what a hernia actually is; a hernia is basically a small rip in the abdominal muscles which allow the internal organs, usually intestine, to slip out a wee bit. This generally occurs at the hole where the large arteries and nerves travel from the trunk of the body down into the leg. The doctors say this is something that doesn't heal by itself, surgery is required to stitch it back together.

No idea how I got it but I do a lot of yardwork, gardening, chopping wood, and moving cement bricks & furniture and thats just to relax after walking an hour to work and an hour back. It was all a great aerobic workout, I had lost about 15kg and went from my biggest belt hole down to a new smaller hole. I've since started taking the marshrut up to work{and gained some weight back :)}.

Anyhow since by itself a hernia isn't really dangerous that this is an 'elective' surgery.....'elective' until it strangulates anyhow(thats where the muscles your internal organs are peeking out of decide to clench down, cutting off circulation and necessitating quick surgery before something blows due to pressure or gangrene/necrosis set in). PC-Washington requires a 2nd opinion from a surgeon and then the bureaucracy in Washington decides if it really needs surgery. In the mean time I was given a truss to wear which keeps constant pressure on the problem area and keeps my internals from peeking out and trying to be external.

Fortunately a former PCV in AZ had had a hernia and they had a truss in stock.

Here's what it looks like. Nope, not a self portrait.

Well all of that was last June. In August I got the 2nd opinion and it was last week that Washington decided to give the green light. Since then I've been putting on this damn truss every morning before heading out. It's not terribly uncomfortable but it can be a bit awkward to arrange it all & use a squatty-potty. Also its bloody undignified to put on/remove when Ive got guests staying over in my one room apartment. But, it is a life saver. If I don't wear it it only takes a minute before the hernia starts acting up. When this first happens it's not painful but rather a weird queasy feeling and then I have to apply pressure just the right spot to pop my insides back inside which is an amazingly odd sensation.

If this was PC-South America folks with serious medical conditions would be sent back to the States. If everything can be fixed in 1 month they ship you back to country to keep working, if more than 1 month PCVs are generally Medically Separated. Over on this side of the world we're sent to a world-class hospital in Bangkok. The PC docs tell me that a hernia operation is fairly simple and the last PCV who had a hernia had no problem getting it done in in Baku. This week I will meet with the surgeon the PC docs recommend to do this surgery. They say he trained in the US & Canada and is highly qualified.

Thats all fine but I'd really rather go get this done in Thailand. Not only is the food and weather a lot better over there but I'm told the doctors and nursing staff at this hospital are great. Here many of the doctors Ive met are of the old Soviet mind-set; an I'm the expert, you know nothing, you don't ask question, you will accept anything I say type mind-set. Back in Japan I had the misfortune to visit the doctors a few times and some of the doctors there had a similar idea of the patient-doctor relationship. But there at least I was generally much more fluent in the language and able to argue. Also they are much more polite and curious about explaining things to foreigners. I find 'authority figures' here to be much less patient or open minded.

But the biggest issue I have with surgery here are a couple details I noticed at the hospital where I went to get the 2nd opinion. I went with two female PC doctors to a nice new hospital with modern equipment and we only had to wait 5 minutes. We checked in at reception and started walking to the exam room wing reception directed us to. But as we started climbing some stairs some random Azerbaijani man(I can only assume he was staff as he wasn't wearing any sort of uniform are name badge) started yelling at us and telling my PC doctors they couldn't go with me to the other part of the hospital. The politely explained that they were my doctors and translators but he continued to be belligerent. It was only when they threatened to call...someone, I can't understand fast Azeri arguing, that he finally gave up. Finally we get to the examination. It was a decent exam room with modern exam bed and lighting and it even had a computer with specialized medical record software that the doctor knew how to use(in the rayons not unusual to find places that have computers but the staff doesn't know how to use it or in schools beautiful new computer rooms that are locked because otherwise the children will break them and nobody knows how/has the money to fix them). The doctor was good, she answered my questions and said that though they usually knock the patient out for the surgery they could do an epidural so I could sit-up and watch if I wanted. She seemed to think that was very strange for some reason. But as I lay on the exam bed I noticed that the brand new, exam light above my had some sort of red-brown liquid splashed and burnt-dried to it....possibly old blood, possibly coca-cola. And between the corner and the medicine cabinet there was a bunch of spiderwebs. As is so often true in developing countries, some folk are trying so hard and have the trappings of development but such glaring oversights are made that its heartbreaking.

So thats were it stands as of now. I wear a truss, try to avoid lifting anything that weighs more than I do, shove my guts back into my belly from time to time, and await meeting the surgeon and seeing the hospital where its proposed to do the surgery. If I don't like the looks of it I may insist it be done in Thailand and we'll see what happens from there. More stories to tell the grandkids someday.

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