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
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.