Hernia Surgery in Short 2

Chapter 2: Surgery

About a week later I had guests. Two new Peace Corps Trainees from the AZ7 group come for a few days site visit to learn more about what PCVs actually do and what the rayons are actually like. Midway through their visit I received a call from PC Medical. The surgeons return to Canada was sooner then expected so if we were to do this I must go to Baku the very next day. I sadly had to abandon the newbies and go to Baku. Though the doctor had said this could be an outpatient procedure Irena(my PC doctor) wanted me to stay at the hospital the nite before because surgery prep would need to begin at 6am and again the next nite to be careful for complications. I very much disliked this idea and was a bit argumentative but some battles must be abandoned that others can be won; as the PCV motto goes “Be flexible”. In hindsight it was the better plan of action. Getting up at 5am to get to the hospital would have been difficult and it was rather painful to walk the next evening.
Spent the night in the hospital, no food or drink allowed, was woken up all to early the next morn by a couple of cute nurses who couldn't believe I spoke Azerbaijani but not Russian and really wanted to practice the 12words of English they knew. They shaved my belly & half my pubes with 10cent disposable razors. 'Twas one of the more awkward, ticklish and scratchy experiences of my life. I was wheeled into intensive care where the other patients were quite surprised to see a foreigner. A fellow who was quite out of it and restrained to his bed became a bit agitated and mumbled incoherently until they placed a screen between us. The anesthesiologist came in and gave my the epidural and I settled in for the next 8hours of paralysis. I waited there, dozing for an hour, before being wheeled into the operating room. Here I was disappointed because there was a screen between my head and the surgery so I couldn't watch. Nor was there a mirror nor camera. Very bummed. I had to entertain myself by listening to the doctors talking in Russian and learning to control the heartbeat/blood pressure monitor. Heartbeat is easy but blood pressure is a hard one. Be it old age or boredom I found it much more difficult to stay awake during the surgery than it was back in Japan. Surprised the hell out of me when I first saw smoke rising from the surgery area. Apparently the were using lasers or cauterizing something. If you want to see what this surgery is like you can watch videos on YouTube or GoogleVideos. Interesting, grisly stuff.

Hernia Surgery in Short

Hernia Surgery in Short

I wrote this story once. Bloody power failure occur ed mid upload onto Blogger followed by the power coming back on with a surge that caused the bulb above me to explode. Fortunately the office has a couple very good power stabilizors and surge protectors and though my computer survived the upload did not. Major ambition killer it was. Glass shards in my hair, darkness reigning the office, alone, combined with the gas not working that day and the pissing rain outside I decided to go to Baku to get my monthly shower and let this project set for a bit.

But now Im back. The holiday season is over and Im ready to get some work done. Lets start today with the conclusion to the Hernia Saga.

Chapter 1: Preperation

Remember last October. 5 months+, nearly 6months after first being diagnosed with an inguinal hernia I received word from the PC Medical staff that Washington DC in its infinite wisdom finally approved me for an "elective" surgery to sew shut the large hole in the muscles in my lower abdomen that are supposed to keep my intestines on the inside. It seems Washington believes that aslong as a hernia isn't currently strangulated then fixing the problem is elective rather than priority. Most common cause of strangulated hernia is constipation or similar gastric distress. Most common medical complaint of PCVs in AZ – gastric distress. Meh.

I travelled to Baku to inspect Tusi Hospital where AZ-PC Medical wanted to do the surgery and to meet the surgeon. I must say that the AZ PC Medical staff is very caring, informative and effective. Thank you Irena, you're damn good at what you do. We first went to meet the surgeon. He office was at the Oilworkers Hospital in Baku but he often handles surgeries at Tusi. The Oilworkers Hospital was a crumbling Soviet relic, marble floors in the lobby disintegrating, a doorway boarded up with an overturned table and warning tape, we waited a few minutes in the doctors office on a couch with ancient cracked pleather revealing old discolored foam before the doctor arrived and met with us in a conference room. I have been told that in the last few years the government has dedicated many millions of manat to buying equipment and refurbishing but I saw no evidence of this. Dear reader you may gather I did not expect much. The doctor, a tall, balding Russian I expected brusque arrogance, an expert who would disdain the questions of an ignorant patient questioning his "expertise". Let me say here that while this is a frequent attitude presented by "experts" here this is less a commentary on the local or even post-Soviet culture but based more on my experience with doctors in other parts of the world. In Japan I had a few experiences with hospitals and while ta few doctors I dealt with there were very professional(in the idealized Western sense) a very significant number were unwilling to answer questions or to take my concerns seriously. Fortunately there, in the last couple years at least, my language & cultural understanding was such that I could argue, be obstinate, and force them to take my concerns into account. Sadly my Azerbaijani & Russian aren't up to that task here.

Taking a seat in the conference room while my PC Medical escort and the doctor spoke in rapid Russian I expected the worse but insisted on introducing myself. In Azeri "Salam alekum müəllim. Mənim adım Kriş. Çox şadam.” (Salam alekum doctor. My name is Chris. Its nice to meet you.) to which the doctor responded “It's good to meet you to. My name is XXXX. Irena has been telling me about your hernia and I hope we can take care of it quickly.” in slightly Russian accented but quite fluent English. A wee bit taken aback I quickly learned that this doctor had done much of his training and residency in the UK and occasionally went on work trips to Canada. Indeed if he was to do the surgery it would be necessary to schedule within the next month because he was soon going back to work in Canada. As we spoke I learned more about his qualifications and the procedures used in repairing a hernia. He asked me a number of questions about my condition, listened to and answered my questions, took my concerns and requests seriously and promised to accommodate them to the best of his abilities. My main concern was that I not be knocked out by anesthetic. Rather I wanted an epidural(spinal tap) so that I could remain conscious and watch the surgery as I had when they reconstructed my leg & knee after the motorcycle accident back in Japan. The doctor was of course a bit concerned that most patients become distressed by the site of blood and such but seemed to appreciate my interest in his art and all similar engineering puzzles. I was assured that this wouldn't be a problem.

Next we went to visit the hospital where surgery would be completed. This hospital was newly built and indeed as we looked through one of patient rooms one could still find price stickers on some of the furniture. The bathroom was clean and well tiled with a hot shower and Western-style toilet. The nurses were polite and seemed able. On closer inspection later I began to realize that everything, though new, was of low quality and would in a few years fall into disrepair. The doors and corridors weren't built large enough to allow easy access by the patients beds and were severely scuffed and dented. The doctors and nurses where all apologetic but I couldn't be allowed to inspect the operating room for hygienic reasons. This was very reassuring as I had already decided I wouldn't allow surgery to be done in a hospital that would allow such a breach.

A final note about the hospital. When you enter the patient wings of Tusi hospital or the fancy expat dentist Peace Corps sends us to they make you put on little blue plastic baggies over your shoes with elastic bands to hold them on around your ankles. Presumably to keep the street dust, animal feces and dirt out of the hospital. I Japan schools, dentists and lots of hospitals made you leave your shoes at the door and wear slippers. In hospitals these slippers were “sanitized” under UV lights when not in use. I haven't decided yet if this is all still a good idea or just a hold-over from the old, dirtier days. In Japan it doesn't seem necessary anymore but in this country it seems like an excellent idea. It just feels odd to wear plastic bags on your feet.

So it was decision time. Did I feel comfortable doing the surgery here in Baku with this surgeon and hospital or would I insist on being sent either to Washington or to the PC medical center in Thailand? Tempting as a week or to in either place was I could find no rational reason to insist so. Though simple emotional obstinence, “I just don't feel comfortable doing it here!”, would have been sufficient in the end ethics and respect for the tax-payers dollar won out over my desire for a nice vacation.

アプデット ＝ Update

Heyya loyal reader,

Its been a long time since my last post, pardon. I could say I've been busy, which is true enough, but it would be alot more accurate to say I just haven't felt like writing anything. Alot has happened and I fully intend to update this blog....sometime in the next week when the cleaning lady isn't looking over my shoulder asking alot of questions in Russian.

すごい長い間なにも書かなかったねー。　ちょっと忙しかったし、手術？なった？し、怠け者し、すみませんね。今日友達からメールくれて、「どうしてブログになんか書かなかったの？」って書いた。　じゃあ、本当に頑張る、今週書こう、ぜったい。今無理けど。。。となりに嫌な人がいる。「どうして中国語書いてるの？本当に中国語できるの？中国人嫌い。日本は何？中国と一緒じゃない？」って言ってる。すごい嫌な奴。　もー、行く。　また後でね。

Robot Head Crashes

A couple months ago my first kitten, Robot Head, went missing soon after the arrival of his brother, HAL 9000. I always assumed he found another home where he got feed more or maybe a neighborhood dog got him.
Well, to my surprise I found him alongside the road the other day while walking home.
A piece here, and a piece there and his little little robot head last. He'd been hit by a car.

Looks like he lived a good life until then though and his brother lives on, getting fat on mice and lizards from my garden.

Good bye Robot Head.

A New Project

My sitemate and I have begun working with a new project. It's called the Mental Health Initiative(MHI). MHI is a project sponsored by the Open Society Initiative, part of the Soros Foundation. The mission of this project is to provide social, educational & medical to mentally & physically challenged youth in the villages surrounding Quba.

Though the law of Azerbaijan mandates that developmentally disabled people be accommodated in the schools and that certain services be provided the reality in the rayons is that government structure, schools & the populace generally have an old-fashioned & Soviet mindset regarding the treatment of these people.

For example, amongst the populace there commonly exists the belief that mental disabilities such as autism & retardation and some physical disabilities like MS could be “catching” and so these people are generally shut away in their homes or if the family has money or the connections needed to receive assistance they are often sent away to special institutions. Those who are able to go to school often face ridicule from the other children and are often considered a burden by the teachers. Schools and government institutions, though mandated by law to make accommodations or provide services, often see these youth as a burden on their time and resources and much prefer to send them away to special sanatoriums as was done under the Soviet system.

The MHI is a pilot program started last year and currently only operating in Quba and Ismayli. It is run in conjunction with the Social Services Ministry and, at least in Quba, the office is located in the Social Services Ministry building. In Quba there is a psychologist, therapist, a couple social workers and a driver. An end goal of the MHI is to develop an effective & replicable system so that next year the government can take over the program and it will become the official services system nationwide. Inshallah.

What Amy and I have been asked to do is, on the Youth Development(YD) side, to occasionally accompany the staff on site visits to help create game therapies for the clients and to create opportunities for these children to join in other youth events we help organize so they have a chance to socialize and to educate the other children in understanding their conditions.

On the CED side we have been training staff on how to access and use the Internet for e-mail, sending pictures & documents, search and paying taxes. And in using office programs. We also hope to introduce Best Practices procedures and to improve the currently chaotic office communications methods. Finally, I hope to help them develop a metrics system to evaluate the effectiveness & efficiency of their efforts.

Last week we went on our first site visit. It was a fun change of pace to go out to some of the remoter villages, play with some kids and meet their families. One kid especially, 9 years old and he seems to have MS and some mental disability so that everything he sees is he calls “ting!”. I played with him, taught him how to Hi-5 and Thumbs-Up and we talked about tings for a long time.

PC-AZ LIFE WITH A HERNIA

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.

Azerbaijani Recipes

Found a website for a variety of Azerbaijani foods. Lots of pics, a good number of recipes.
The stuffed veggies, pickles, and mimosa salad are my favorites & the rice with dried fruits & chestnuts is incredibly good but only eaten on holidays.

http://www.azcookbook.com/

Bold Statement

Here is an interview with a guy who is definitely NOT looking for peace and reconciliation with his former enemies........

"In Denmark it is now generally accepted that all known thieves here are from Armenia: Head of Azerbaijan-Denmark Friendship Community" - headline from 2DayAZ newspaper

Stuff Made While Bored - 詰らない時に作った物

Plum wine made in a 16liter water jug then racked into old PET and vodka bottles. Turned out really good. Alot better than the cheap AZ wine I can get at the shop next door.
梅Wineを作った。スゴイ旨かった。作って終わったらPETやVodka便に入った。１６Lできった！



This is a wee wood table used by xanıms(women) here to make bread dough on. I found one hidden amonst all the junk in my garden. The top was cracked and dirty and no good for making bread anymore and I had been putting it ontop of the iron ring you see in the background to use as a coffee table. In a fit of boredom I decided to make it into a chess board.

こな木の上にアゼルバイジャンのババはパンを作る。庭でこれを見つけた。悪かったからパンの作りかたは無理。



Thank Allah for Sharpies.
チェス?boardは日本語でなんというの？



Here Corey models the corn cob pipe that Elmer(another PCV) helped conceive.




Smoking old school with the corn cob and matches.
アメリカの江戸時代らしいSmokeする。




007 Vodka seemed the most unnatural choice for a vodka watermelon.
I ate him shaken, not stirred.
Vodkaスイカ食べたことがあるの？Vodkaスイカ君を食べちゃって酔うぱらくなってきった。



Yes, he does have a gold tooth and yes, he is smoking a cigarette.
スイカ君はかこいいでしょう！

Behind 007 you can also see some of the many new shelves I've built. This is one of the classy stone & glass brick with rough hewn oak shelves.

スイカ君の裏に作った戸棚がある。いっぱい戸棚でも本棚を作った。

お久しぶりなー

長い間日本語は書かなかったでしょう。僕怠け者かな。それがInternetあったら働くなくちゃってブログ書けへん。夜に家で僕疲れってなにも書きたくない。まあーね。多分、今月日本語ブログ書いてみる。

News

アパートはすごく優しい。電気で問題があるけどほとんど大丈夫。
庭にいっぱいナスやトマトやピモンやメロンがある。
桜と梅のWineを作った。旨かった！
子猫は大きくなってきた。
仕事は段々忙しくなってきちゃった。よいかも。