Medical Elective 2005 and Beyond

After relaxing in San Francisco for a day or so I prepared for the worst as I made my way back to Australia. The weather had been horrible in SF with rains and high winds and I expected delays and more stays in weird locales over the ensuing days. However, it was actually uneventful as the weather cleared and I made my way back to Sydney with no complications. I sat next to women in her late 40's who ran a travel agency in Fiji and spent most of her time promoting Air Pacific Airlines to the Americans. She was quite spritely and bubbly and was obviously quite successful in what she did. When I mentioned children however, there was a glimmer of sadness in her eyes for a moment as she confessed her lack of time in having children. She chose her career over children. Although her life had sounded like a roller coaster ride, I couldn't help but feel a little sad that she had missed the boat to having her own children. I promised myself to work hard but never forget the important things in life.

Things became slightly blurred as I returned to Sydney and unpacked and repacked as I headed up to Brisbane that evening. It felt like I'd been flying forever. Brisbane was very relaxed although I had errands to run and it was fantastic catching up with old friends once again.

The one thing my elective has imparted onto me is the importance of time. IT can be so easy to forget family and friends whilst pursuing a career. I am forever appreciative of the experience my parents have given me. Very few people would be able to begin such a journey without the strong backing of their family. So I sign off on the elective on this note. The journey that i commenced has come to an end and I sincerely hope the people, experiences and medical knowledge gained on the adventures stay with me for the years to come.

It feels like a millenia has passed since my last post. After the long weekend I began work nice and early with Dr Thornhill(left) on joints. TST as he is elegantly known around OR was the head of orthopedics at Brigham and considered himself the son of a redneck. He always had a entourage of Residents/Fellows around him and the first two days of joints were intense and interesting combined. He was great at teaching and had many fantastic stories as well about the various aspects of his career. I lost track of the number of operations we did over this week but all of it was excellent experience. Despite the week feeling extremely long in hours it seemed to fly by simultaneously. The later half of the week was spent with the other joints attending who was Dr Estok.

Dr Estok was a bear of a man with a gruff exterior and mainly did revision of joints (ie. the f*$&ups of other people's joints he would say). Yet there was something special about him. His ipod, a 60GB monster had music that almost mirroed mine. I almost passed out in theatre. It was like a dream. He had Alice in Chains, Metallica and Even stone temple pilots. On top of this he had all the usual commercial pop of coldplay and U2 and the classic sounds of Creedence, Chicago and the doors just to name a few. There were so many songs that played including the HArvey Danger Song (flagpole sitta) which felt like my playlist was being played in theatre. Revisions are very tedious operations and a full day can be taken up by only 2 revision. Joints however can last a little over 1 hour (for hip) and are much simpler. The music however, made the revision go by so much the smoother.

By thursday things were beginning to wrap up. I made my way to Harvard square to meet up with an old friend from Selwyn (Leigh) who is currently lecturing at Harvard Uni One day a week. She would travel from Providence (where brown is) for 50 miles each week to come and teach classes. We met up and reflected on the last 3 years since I've left cambridge (UK). We had some drinks and dinner followed by Coffee and I also said my Goodbyes to sparks at the same timel. This was the best photo (I had 3 attempts) that I could get of leigh.

My final day at Brigham sped by and we started at 7:30 with a revision Hip. It was a nightmare(see ernest's reaction on the left) and finished at about 2:30pm. We then completed a revision knee at around 6:30pm on a woman who I thought was morbidly obese until I headed into OR15 and found a woman 3 times her size. IT was very difficult intubating/cannulating/operating on these woman and the mood in the orthopedic hallway was tense. After leaving Brigham, I rushed home to get ready for the party. Henry, one of the scrub nurses had gotten a job with Synthes (who make the implants and tools) and was leaving Brigham for good. Christy (to the left in black top), one of the other scrub nurses was also having her 38th birthday as a spinster and it was my last night. So it was a giant celebration out in boston on Friday night as a few of the staff got together for some drinks and dancing. We all met up at Lucky Strike Bowling alley which had an amazing bar the length of a swimming pool. I couldn't believe how rude the bar staff were but I guess its just Boston. It was a fantastic atmosphere even though we never got to bowl (2 hour wait). Henry (above right holding rebecca with the beer and Lauren with eyes) was one of the first nurses who came up and had a conversation with me in OR. He was basically the first friendly person who came up and spoke to me. Christy is a spinster 38 year old nurse who has an attitude to match but is a real gem at heart She had such a hilarious sense of humour and would often give and cop shit simultaneously from all of us on her exploits with men.. Lauren and Rebecca were like the Bratz crew of the OR and they ran the place pretty much. Corinne (with katie and josh and me above right) was a new nurse who started at the same time I began my elective and thus we bonded as we settled into the routine together. All these people were what made the Harvard experience unique. Sure, the attendings were fantastic and had world renowned research to their name but it felt similar to RNSH. What made the instutituion extraordinary was the people I got to meet. I felt quite drained at 11pm thinking about leaving everyone and took off home for an early night.


Saturday morning before my flight I awoke to snow once again. Packing my bags was suprisingly simple in a small room and it felt as if I left something behind even though everything appeared in place. Josh and Katie came over to have a final lunch at my little studio and we continued out tradition of great conversations. It was truly tragic to have to leave them. I hope they will make it out to Australia one day or I will head back to boston. After the farwells at about 2:00pm I decided to leave my apartment and say goodbye to Boston and prepare for my journey back to Australia via San Francisco.

Little did I realise that one of the longest and strangest days was about to befall me.

I have never had much luck with east-west travelling within the United States ago. The first time I travelled America by myself there was a major delay in my plane after it landed and it couldn't approach the gate for an hour and half. I was stuck in some city out in the midwest for an evening before heading on the next flight out in the morning. 6 years ago I was all ready to depart the US of A and as I checked in the friendly(or not so friendly) check in lady informed me that my tickets were in fact not paid for and that I was not allowed to get on the Plane. Air Newzealand had tickets reserved but not paid in what became a huge mix up. I had to call mum who in turn had to make a few phone calls before the Manager of Air NZ at home (it was quite early in the wee hours of the morning) finally rang up the counter and cleared everything up.

Six years is a long time and one can forget so much in such a time. As I arrived at the airport I realised it began to snow harder. It mattered not I told myself. The check in man told me at the counter that my tickets were not confirmed for some strange reason and that only my Boston-Detroit was confirmed but my Detroit SF was not. We had a brief conversation about Brigham and turns out his sons were delivered there. After this revelation he decided to try and help me out. Before I knew it I had a first class ticket to San Francisco. It felt like my luck was changing but the the curse was only beginning to surface. As I sat waiting to board a delay notice came up of 15 minutes. Once again I took no notice and remained ever positive. As time wore on the delay time seemed to stretch and strech further. The snow was causing severe delays all around. 2 and a half hours later we eventually took off on our flight to Detroit with my spirits still in high standings. I was assured that the flight to SF would be the same plane and hence it was ok to arrive late. The Folks at Northwest airline seemed so genuine at the time.
After we landed at Detroit and some pampering later, one of the stewardesses (They were all japanese for some reason and in their early to late 40's) asked me where I was going. I told her SF to which she replied that the plane has been changed and is now leaving from Gate A6 (we landed at A66). As I was getting my bags and rushing out, she yelled out and said "oh by the way, your plane has left" in a very general, blaise and a I couldn't give a F*$& tone. I felt like I had walked into a David Lynch Film. 90 minutes later of wandering and asking finally established that I had indeed missed my flight and that I was going to have to hop on one the next morning. They were going to provide hotel and dinner for me in the meantime although I had to argue and beg. Weather, they had informed me, was not a cause for compensation. After catching a taxi to Best and Western I crashed immediated and awaited my arrival in San Francisco the next day.

Early next morning I left for the airport feeling like the worst is behind me. As I go through the whole ordeal of checking in and heading for the gate it dawned upon me how tired I was. I needed more sleep. Eventually I made it to the gate and hopped on the plane. As the plane left the gate and headed for the runway, I looked out at Detroit and was glad to be rid of it. It gave me the creeps... Just seconds after the engines fired up and it looked like we were given the greenlight to go, something clicked in the cabin and everything turned on and off. The plane was now shutting off and we sat still for 10 minutes. The captain then informed us that there was something wrong with the hydraulics and that the engine would need to be fixed. After 1 hour he informed us we would be getting a new plane and we would have to disembark. After 3 and half hours of sitting we finally got our plane and after another 5 hours of flying I finally arrived in San Francisco at 6pm E.S.T. Exactly 26 hours after my plane was suppose to take off and around 28 hours after I left the house in Boston. It was very painful as I had next to no luggage with me and felt like pigpen from Snoopy and the gang. I was never going to fly Northwest Airlines every again

Christine (childhood friend) picked me up from the airport and we headed back to her house in Foster City. We all went out for a great feast at Elephant Bar where they serve giant american portions. I have no recollection in my life of ever eating as much as I did tonight and all I wanted to do was vomit (although I may have eaten this much the last time I was here). They have a dish called the sampler (see below) which is basically every appetizer available on one plate. It was frighteningly fatty but delicious nonetheless. We spent the rest of the night playing their gamecube as I got destroyed by the girls in all the cute nintendo games. It was shameful

Tomorrow is my one rest day before I fly once again for Sydney. The blog is almost at an end and I feel refreshed and renewed to finish my medical degree. If there is one thing elective has shown/taught me it is that I am dying to finish my degree and become a working qualified professional...

The indian restaurant was simply amazing. After an amazing dinner in which I found Chicken Kashmiri and Mushroom Pilau we stayed and ate until closing time talking more about life and everything in between. I was truly going to miss these guys. At the same time, one of the porters at the hotel was finishing work and we promised to have drinks with him. His name was steve and he had given us amazing advice and great locations for us to see montreal in a short time.

The least we could do was buy him a drink. We headed back to the hotel and met up with Steve who we soon discovered was a conniseur in wine. Xavier was another person who joined us for a drink at this time and both of them had studied in France on wine making, tasting and of course drinking. They brought out two bottles of red and we had a blind tasting. IT was very difficult. The first bottle was from Canada and it was amazing for the price; Osoyoos Larose (from British Columbia) sort of a cabernet merlot blend. The second bottle was even more sumptious and was a Domaine Gramenon (Cotes-du-Rhone 2003) from the Rhone Valley in the South of France. The grapes were from a vine over 105 years in age and made by a woman. This meant it was very minimalistic wine and plenty of tender love and care went into making it. It was a natural wine and contained no sulphites. My palate was truly satisfied. Halfway through our evening there was a solitary man that remained at the Bar who they told me was the gossip columnist on TV. He had 2 little dogs in his bag and acted very peculiarly. Both Steve and Xavier warned me about him and there was definitely something strange about him. I took a photo of his dog in the bag for Kaz and then proceeded to return to drinking.

Eventually he got up from his seat and proceeded to join us unannounced. IT was very intrusive and strange. He was interested in Ernest who was scared out of his wit. This is a dog who is friendly 100% of the time and it was a real sight to see him cower in the corner afraid of this man. He was leathery like too much botox had been injected and it simply wasn't right. I did not make eye contact or even speak to him but half way through the conversation I heard him say to Xavier "Could I suck your dick?" and both me and katie gave each other looks of puzzlement. Did he just say what I think he just said ?
Ten minutes later he left finally and all of us breathed a sigh of relief. Xavier said it was common for him to say things like that to random strangers and that he often got very aggressive. I guess you meet all sorts. It was probably one of the strangest and funniest moments of my life. Uber Surreal, yet uncomfortably humerous simultaneously. Joelle from the bar also joined us and we all sat around and conversed until 3am. I definitely want to bring the folks back here and enjoy the wine later on.

Today we drove a longer scenic route back to Boston and it was night time when I arrived. I cannot believe I am almost finished. I got my GP allocation and it appears as if I am going to gladesville and lismore for my terms. It should be fun.

As the door close on Boston a moment of quiet reflection dawns upon me and I hope that the people I met both in Kenya and Boston will stay in touch in the years to come.

Saturday was a relatively short day as I spent it in bed watching movies. Terrence Howard is fantastic in Hustle and Flow. It will be hard to decide to wins the Best Actor this year at the Oscars. After opening my eight packet of Raisin Bran in 2 weeks I noticed an irregularity in my cereal box which alarmed me. It came to my attention that there was grit on my raisin and when I tried to clean it I realised it was actually sugar. After almost vomiting and emptying the packet I realised that every raisin was sugar coated to the brim. I wanted to be sick. I was eager for snow and was told that it should arrive that night around 1am in the Morning. When midnight came around there was enormous commotion in my street. I am not sure to this day what was happening but all the attention was fixated on the building in the next block from me. They had two of the ladders from the firetrucks going up to roof of this one building and everyone (including me) watched with morbid fascination.

Sunday I woke up and looked out my window. It was snowing and the entire street was flooded with snow. Cars and roads were buried and it was amazing to see people trying to get by. The buses were still running. I went for a walk around 6pm that night around Copley square and could hardly find another living soul out. It was very cold and the wind chill made it easily below zero centigrade.

Spine began somewhat strangely on Monday and Tuesday as both meetings that began at 7am were cancelled. This meant I sat around for the first hour waiting unbeknownst that the consultants were not coming to the meeting. Both days involved intensive spine surgery which is laborious. I was allowed to scrub in for all the surgeries and Dr Brick was a true legend. Hailing from New Zealand, Dr Brick took me under his wing immediately and looked after me for the remainder of the week. He was a very easy going person and greeted everyone in theatre that he met. He was also interested in teaching and clinic was an excellent experience as I realised that transverse process fractures are actually benign (felt like a right royal retard though telling patients they probably couldn't ride horses for a few weeks only for Dr Brick to tell them they can get on a horse immediately a few minutes later).

It was also around this time that it dawned how everything was going to end very shortly. My 3 month elective-hiatus had come to an end and I realised that I needed to see all the movies I had missed out on before the Oscars were aired in March (a typical ritual). Looking at the nearby cinemas I realised there were around 8-10 movies that I desperately wanted to see and only about 10 days to pack everything in. Tuesday night I saw Brokeback Mountain and Munich with Johanna and Wednesday and Thursday I saw Capote, Walk the line, Syriana and The New World with Sparks. It was six movies in three days and I was drained. I would go to hospital at around 7am in the morning and leave around 6pm. I would then catch a 7pm session followed by a 10:30pm session and return home to bed at around 1:30am only to do it all over again.

It was a good endurance test and it also meant that the movies had to spectacular to really keep my interest. I have to admit that not all of them blew me away but notable mentions definitely include Brokeback and Walk the Line. Unlike Ray from last year, Walk the line has an immersed theme of love throughout and its saving powers. Phenomenal performances and both joaquin and reese performed their own singing. ITs going to be tough deciding who between hoffman and phoenix will win. Capote was equally amazing but intensely disturbing. The rest were all great movies also but did not reach the extra zenith to make them extraordinary.

Friday was spent entirely in clinics and we saw around fifty patients between me, the fellow (shahan), Catherine and Dr Brick. It was an excellent teaching experience and Dr Brick had more variety in his patients because he performed spine and joints combined. Shahan was an armenian who actually quizzed me this week. HE had some great questions and I have to admit that I could only get 60% correct on most of them. Who memorises the 6 extensor compartments of the wrist anyway ? He was good fun though and definitely a character.

The week ended with Josh, Katie, Neal and myself heading off to a NCAA hockey game. The atmosphere was not entirely mind blowing compared to a premiership football game but it was still excellent fun.
Neal was still working up to about 8pm and had to miss the first period. After the game he had to return to hospital to finish paper work and finished eventually around midnight. It was also at this time that I felt tremendous sadness that it was to be my last weekend in Boston. I had 7 days left before I took off for home and my heart sank.Josh saw the change of mood in me and after a lengthy and somewhat random conversation we decided to head into a car and drive into Canada.

Saturday morning we left close to midday and drove to Montreal (about 300 miles or 4 and half hours) which involved going through New Hampshire and Vermont.
Both states were beautiful and the snow gave the landscape an unique glimmer in the sunlight. We arrive around 5pm to our hotel and after a quick nap we headed out and explored the city. I felt like I was in Paris. Everyone speaks to you in French automatically and the architecture and streets have a european feel that was definitely absent from Boston. We ended up in St Jeans, a place that only serves Steak and Chips (no joke.. the menu only has steak and chips and there are literally nothing else). After a hearty meal last night we returned back to the hotel and went to sleep.
There was a celebration at the hotel as a 4oth Wedding anniversary was taking place.

This morning we woke up and decided to do further touring. We began at one of the produce markets in Montreal which had the most amazing vegetables and fruit. IT was all fresh and I felt like I was in a little alley in Paris. I bought a pork and brie sandwich and it was simply heavenly. Shortly after we made our way up to Mount Royal where we all did some ice skating. IT was funny to see texans ice skate and you can watch a video of Josh making a fool out of himself at http://www.philiphuang.com/bwh/joshskate.wmv

The lookout at Mount Royal was great and Montreal was a sprawling city which masked its size once you entered. Only from the viewpoint can you truly appreciate the size of the city. I must also remark that it has been around -14 degrees centigrade for the last two days. The water on the right was in the car overnight and had become frozen solid. My ears and fingers feel like they are going to drop off even though I have gloves and scarves. I miss australia terribly and am actually looking forward to some sun. We ended this afternoon with some crepes in a nice patisserie and drank some cappucino. Josh and Katie have been alot of fun to travel with. It is always a blessing to meet decent people (I'm trying to convince them to come out to Oz) and they are truly unique characters. We definitely shot some serious shit last night over dinner and the conversation switched from love to marriage to religion and to sex. The usual route of course... I can't wait until they come and visit Australia. They are dying to meet Kaz as well. I also got a chance to see some of Kaz' photos on the web and it was excellent to see their Safari Photos. www.pbase.com/dshaw

Tonight we will go and have Indian (yay ! I hope I can find a chick kashmiri and some pilau) and we will return to Boston Tomorrow.

My last week will be spent with the Head Honcho (Dr Thornhill) and of course Neal. I am very excited as I have heard he is a hilarious man. He has come into theatre a few times when Brick is operating and they give each other plenty of shit. I looked into his room the other day and he has an entire entourage following him. At least 5 people scrubbed in. I hope I can squeeze in. There is also another Australian Fellow here who trained at RNSH that I met who is on his team and it should prove interesting..

The rest of the week seemed to fizzle out after the flood. Not too sure what happened there. Perhaps it was the switch of chief residents, or maybe because it was relatively quiet. Either way, there seemed to be nothing much happening at hospital. I also met Dr Vrahas briefly who is other half of the trauma team. I didn't really get to interact with him at all this week unfortunately but he seemed nice. Trauma started out so strongly for me this week (in part thanks to Neal and Jeff) but I am a bit lost now that the week is over. I have not really had any interaction with the new residents whatsoever and have been mainly workin with the interns who are really only 1 year ahead of me and unfortunately are so busy with the ward work. Kevin (the intern) has been feeling bad all week for me and has been so run off his feet that all he could teach me was writing notes. Its been a real disappointment overall really...Part of what is shitty being a medical student is that fact that we have to stick to residents like glue. Feeling uncomfortable and lingering around on the wards without purpose like we don't exist is almost daily living. Some would even say it is initiation. Yet what alters our experience and changes our perceptions of medicine are the registrars and residents who approach us and makes us feel at ease. What made Hands and Trauma Part 1 so fulfiling was the fact that the teams made me feel comfortable immediately. They understood and remembered what it was like to be a student and never made me feel conscious about following them. They would introduce me to everybody and allow me to participate and scrub in on surgery. All of this was of course lacking in the last half (3 days really) of the week. The new residents seemed really nice but we barely exchanged 3 words. Jordan, the 2nd year resident who I was supposed to be paired up with was so busy that I didn't even see him once this week. I felt like a lost orphan again on the wards, scraping the trash looking for food and hoping I can find a parent who can teach and guide me. Alas it was not to be. I started going to hospital later and later and today got there about 7am. Ward rounds was just beginning and ended about 15 minutes later. Then there was stillness. Nothing was happening. dead calm. The operation for a C6-C7 discectomy wasn't until 1:30pm. I just sat in the common room and did nothing. Occasionally Kevin would tell me that he was off to do some boring paper work and that it wasn't worth me going but really that was just a cop out. I hated it when they said that. True that paperwork wasnt exciting but it sure beats sitting around doing shit all. And thats the main lesson I hope I never forget when I finish. Something, no matter how trivial or tedious will always be superior to nothing. To have followed Kevin around would have certainly been superior to sitting in the room watching the finals of the African Cup of Nations live on the computer. When a resident or intern tells me that I wouldn't be interested in doing "this or that" he isn't really looking out for me or being considerate. He has only his own interest at heart. He would rather get the job done and not have to deal with a student following him around. Reading over the above passage it would appear as if I am bitter. But that is untrue. Just waking up and going to the hospital has been an immense experience in itself. And the last week and a half has equally been brilliant. Dr Harris was also on brilliant form today and it was hilarious to be in theatre in the afternoon. It hasn't been all negative. Part of this venting is to remind myself that even at brilliant institutions, things remain the same.. I want to never forget what its like to be on the receiving end of negligence. To be transparent. I want to make sure that i never treat another in the same way again. I walked down the changing rooms filled with lockers at the end of the day and felt completely drained.

On the plus side, I spoke with Catherine today who was the Spine Resident. She was very helpful and gave me a detailed outline for the ensuing week. It gave me hope once again but we'll have to wait and see.

I also met up with Sparks this week whose roomate Johanna(from NZ who is working on a PhD about neuropsychimmuno which is all about emotional factors affecting post op etc etc) and she was interested in doing med. So we all went out for a meal and discussed the various routes one can enter medicine in Oz. It was a relaxing evening and we went to a local pub after dinner and had a few drinks

Josh the anaesthetic resident also invited us to his house tonight for some drinks and candlestick bowling.He was pleasantly suprised by his photo (supposedly he has HUGE ears and a tiny nose but the previous photo close up shows otherwise). We arrived at Josh's house fashionably late in greenline and we proceeded to drink some Australian wine. Josh was a Southern Baptist from Texas and was not as conservative as typical christians were. They understood the meaning of grace in christianity and were not preoccupied with viewing non-conformists as destined for hell. It was excellent hanging out with him and his wife. We met some of the anesthetic team and had some drinks (cherry beer, kriek) with fantastic conversations. We made out way to the milky way lounge and waited for about 30 minutes for a lane to play some candlepin bowling.
The pins are long cylinders and we used a coconut (4 pounds) to bowl. It was suprisingly fun even though I sucked big time. IT was a great way to end off the week and we were surrounded by good company..I also got to meet the family dog who is there on the right. His name is Ernest.. spelt without an "a" I was told. Leaving Josh's house in a bit of a daze I proceeded to have a fantastic night sleep. They are anticipating 12 inches of snow this weekend in Boston which is supposedly going to beautify this entire city.. Hopefully it'll live up to the hype

And indeed I am traumatised. Not because of the surgery but because of my brief romp through e-bay. After the success of the 4 Sydney guys who sold themselves for a good time and beers etc on ebay for about a grand, hundreds of similar auctions have appeared from people selling themselves to become your friend for a weekend. Some sell invites to their birthday party, most just promise time spent with them in their company. It makes me sick to the bone to think about this. There was even an auction on ebay for a girl who wants to get breast implants and promises the winning bidder a before and after photo. Such is the insane world we live in and sometimes I wish I could curb my curiosity. It reminds me of the time I went and downloaded the hostage beheadings in IRAQ because the news said they were available. I was never the same since that day. Issues aside, I hope it all passes. Most of them are getting no bids which is always a positive sign. The most noticeable one is a group of 4 girls from the Gold Coast who are offering their company for a weekend (etc etc) and the starting bid is $10,000. There were no bids at the time of writing this. Anthony had made it up for the weekend and we had an excellent time around Boston. I picked up a few more workshirts for hospital as I underestimated how many I would actually need. We had a nice meal at Uno Chicago Grill (thickest pizza I've ever had) and then he headed back to New York. It was so surreal once agian meeting people here overseas. I think I will help set up a database next year of where everyone is going for elective and that way people can catch up with one another. It was a great weekend.

From the point of the hospital, it has been a fantastic week. IT started relatively early at 6:30am although I had to be there much earlier as the week progressed to see the patients before rounds commenced. I was able to scrub into every single surgery and Jeff and Neal (mentioned previously) were brilliant in their teachings and giving me hand on. Neal would pass me instruments here and there and get me to cut or drill or stitch. IT was a real difference from the surgical registrars at home who often found students to be more of a chore and hinderance. I promised myself that I would never become like that and would attempt to emulate myself after them. I also met Josh(on the left) the anaesthetic resident who is a pretty cool guy whos been out to Oz previously. It was an excellent day in theatre as we repaired a difficult medial tibial plateau fracture, Hip hemiarthroplasty and debridements. The residents here have a great relationships with the consultants. Dr Harris (on the right), the trauma consultant was an exceptionally humerous man and had a great relationship with the residents. He treated them like colleagues. I've also noticed that students and residents are not put on the spot as much as they are at home and i am definitely less on edge as a result.


On tuesday, it began like any other at around 5am as we checked out all the post op patients from the day before. Ward round came and passed and we were in theatre at 7am. After repairing a distal radius, the next patient was wheeled in. IT was very difficult intubating this patient but eventually we got it. Suddenly, a nurse ran in and told us that the next room had flooded.Construction workers had hit a mains water pipe and water was flooding into the theatre next door at an alarming rate. IT was like a ride from Universal studios. For the next 45 minutes there was chaos in the entire theatre as all operations were cancelled except one. The one that remained was a spine operation which was in the flooded room. They had made the incision into his neck when the water came in and had to move the patient down 3 rooms and continue the operation as fast as possible. It was an insane sight to see everybody running around with towels and moving instruments to prevent the flood from spreading. I have video of it but its a little rough (had to edit quickly). http://www.philiphuang.com/bwh/bwhflood.wmv


Neal and Jeff finished their trauma term today but Neal will be heading to joints where I'll be in the last week.. I also found out that Neal's family was from taiwan but he had only been back there once. Ben(close up) starts tommorrow as the replacement and seems like a good bloke. Should be an interesting transition nonetheless. Hopefully theatre will be open by then.

So ended my first week at Brigham. Besides being exhausted and being reminiscent of my 3rd year ICA's there was also the fact the weather was terrible (Snow, hail, sleet etc). Most people at the hospital tell me the weather is actually fantastic ! and that is usually gets down to 0 degrees fahrenheit...

The rest of this week was spent with Dr Blazar and Dr Koris (moustache). Both were excellent teachers. They were always keen to talk to me and teach me various things but would only do so when I showed interest. They made me work for it basically. The residents (registrars) were equally brilliant. All were patient and eager to teach and allowed me to close and do suturing. Katie was the main resident I was on with this week and she showed me the ropes. She is PGY2 and they choose what they want to do the time they graduate. She will be a consultant in orthopedics 5 years after graduation. I was extremely Jealous.
Brendan (flexing)was a PGY4 and was a typical orthopod and alot of fun. Neal was a resident in joints who i will work with and i assisted him this week on a car crash patient who had multiple fractures in her hand and wrist. It was an excellent week. The Clinics were filled with exceptionally interesting patients and although I wasn't passionate about the hands it was still great experience to see the cases. There was a lady who had an infected elbow prostheses and had to have it removed. A custom replacement was built for her but she had no elbow joint for over a year. It was surreal and a little creepy to see her in theatres with her dangly arm but no joint.

We saw a total of 38 patients today in clinic and I was exhausted by the end. Besides Monday, I have had a 7am start every day. Next week I commence trauma and supposedly they start at 4:30am which will be a real treat. I am also heading in tomorrow (saturday) at 7am as Katie is on call this weekend in Emergency and there should be fantastic cases. Pharmaceutical advertising is an ever presence inside the hospital and Brigham is outfitted like a giant shopping centre. ITs amazing how large the hospital is. The posters in the clinics are deceptive. They are all "AMAZING" pictures of the joints but on the bottom there is a clear sale for tramadol+acetaminophen. Just one of the many adverts one can see around the hospital.


Another thing you notice immediately is the efficiency to which everything is done. Although the residents whinge and complain, it can't be denied that things are done efficiently in the operating theatre. People in boston tend to be so much ruder than the rest of America but at least things get done. Patients are infinitely more neurotic and demanding and most are on zoloft, effexor and the like.
I got to catch up with James Sparks (had stephen hawking as a supervisor back in Cambridge)
this week as well and we had a great meal at my place. It was great to catch up and see him. He has not changed one bit. It was good to catch up on old times and just sit around like we use to back in the college days at Selwyn.

Anthony Barker (who i did vietnam with) is currently on a bus from new york and hopefully I'll see him tonight and hear about his adventures also... Trauma here I come

Early morning I catch the public transport to the Hospital. Its simply amazing (isn't everything??) how efficient everything is. The morning was chaotic as paperwork had to be filled in and I got my own little ID (which is a real difference from Kenya). Security is equally tight at the hospital. I also got my timetable which involved me swinging through 4 different fields of orthopaedics over the ensuing month (Hands, Trauma, Spine, General Joints). It looked comprehensive and surgery was often spread over 3 hospitals. I also met Dr Simmons (on the left) today who is the Hand Surgeon and we began immediately on to Outpatient clinics. It was interesting and reminded me of the clinics at RNSH. Eventually around early afternoon and a hearty lunch later I was handed several journals and a chapter from the book Dr Simmons had written and instructed to familiarise myself with the anatomy and examination of the hand. Tomorrow was going to be a 7am start.. I headed home and realised I left the papers in the suites and will have to pick them up tomorrow. Groceries arrived in the evening and I felt more at home in Boston. Anthony (who i did vietnam with) will be travelling up this way on the weekend and it should be great having someone who knows Boston inside out.

The final day in nairobi was tremendously sad. Me and Noel woke up a little late but packed in some breakfast as quick we could (even though the previous night's meat was still fresh in our stomach. We made our way quickly around Nairobi once again and went to the giraffe and cheetah sanctuary again. We also made our way to the elephant and rhino orphange which was equally amazing.
Dr OChieng was in Nairobi and all of us sat down to a late lunch. The team made me an excellent shirt as well with JApanese Mzungu written on the front and my usual menu of mutumbo, sukuma and ugali on the back. The drive to the airport was a solemn one and there was next to no conversation in the car.
The next few hours were a bit blurry as I made my way through checkout after an emotional farewell. I was so envious of Noel and the adventure he was about to have. I know the team will look after him. Leaving Nairobi was so difficult but I knew that further adventures awaited in Nairobi. I could not believe how quickly time had passed. It was almost coming to an end.

The flight from Kenya to Dubai was uneventful. I had slept and awoken without any disturbance and hopped off one flight straight onto another towards New York. There was no time in between the two flights at all. The plane from Dubai to New York was amazing in comfort. Airbus had out did themselves. Seats did not recline backwards at all. Each seat was a unique Hub that had carved out its own space already. The seat merely reclined within this space. This meant seats reclined back within a already defined space which did not intrude on the passenger behind. The entertainment system was also amazing and I watched Hitchhikers and Wonka. I have forgotten how much I love movies.

14 hours passed quickly and I arrived in New York around 7am. The flight to boston was at 11 and I had a few hours to relax in the terminal. The first thing you notice about the US is the security. I was probed, searched and all my luggages were swabbed for explosives. It was a real sight. Another thing I immediately noticed was the advertising here in the states. They were selling defibrillators in magazines on the plane for home use and the napkins on the plane were sponsored by Diet Coke. I feel more unsafe in the states than i ever did in Nairobi. The news are filled with stories of fear.

Eventually late in the afternoon I arrived in my apartment in Appleton St on the South Side of Boston (Copley Square).It was beautiful. The apartment was a beautiful studio on the 2nd floor which had a Murphys Bed and a sofa bed. IT was very cosy andI fell in love with it immediately. After unpacking and setting up the internet (wireless available for free in the room) I realised how different this city was going to be. I ordered some lunch/dinner on the internet and it arrived within 15 minutes. The dangers and excesses of this city immediated became apparent and I realised this was going to be a different world...

But thats life... So little time has passed since the last post yet so much has happened. I returned to Siaya in the moving mountains bus with the gang. The drive was about 7 hours in total and we left around 4:30am in the morning. We arrived in Siaya Hospital for 2 hard days of work and commenced almost immediately. I quickly checked on our patients including George who had the bone traction inserted. He was doing quite well and the bones were well aligned in the AP plane and the bones had good separation. The man who was stabbed in the abdomen had passed away due to what they think was electrolyte disturbance. I was gutted. Changa Man
had neglected him for days supposedly and he passed away. He was only 24. The 10 year boy who had multiple fractures and was smashed in the face by a mutatu had gotten up and walked out of the hospital. It was amazing. Even Dr Ochieng couldn't believe how resilient the boy was. The afternoon was spent stitching up these security workers who had been cleavered by a gang of thugs and robbed at gunpoint. They had some pretty nasty wounds on their head including a boy who had a large V about 15 cm in size cut out on the parietal bone. We spent the evening back in Kisumu and I went to King Kong again (fantastic movie !). Naomi Watts rocked. HAd no idea she was 38 years of age. The other teachers in wagai (Becky, Kate, Ciaran and Jon) all came along as well and it was tremendous fun. We spent the night in kisumu and returned early next morning (6am) back to Siaya for my last day of work.


My final day at Siaya was a tremendous strain. Besides having 7 operations continuous, there was also mass burial happening at the morgue as they were trying to reduce the bodycount. The smell was unbearable and some of the bodies were so decayed I thought i was going to vomit. We spent the night in Siaya having dinner with all the doctors and the teachers and the atmosphere was amazing if not a little sad. It was such a draining day and I spent the evening sleeping back in Wagai for one last time.
It was excellent hanging out with Ciaran and Becky. They were so passionate about teaching. Jon is a history student here to teach who is keen to do postgraduate med and even came along to siaya to check out the scene. Kate had just finished school and was keen to be a chef here in Africa. SUch diversity was refreshing and it was such an inspiration to meet people who were so eager to help and who possessed so much passion.


The next morning we took off back to Nairobi and eventually returned back around 6pm at night. A building had collapsed in Nairobi while we were away. They cut many corners and the builders were trapped under the rubble. Overall about 20 people died although they had not uncovered all the bodies yet. IT was chaos driving around as roads were closed but eventually we returned back to Serena for a peaceful night and a good sleep.

This morning Noel rang and he had arrived long last in Nairobi. We met up and spent the day touring around Nairobi seeing the sights and sorting out administrative tasks. I could not believe it was my last day. We all went to Carnivore for dinner which is the most famous restaurant in Kenya. There is no menu and they serve only meat. You sit and they bring giants amount of meat on long skewers and you were served continuously until you felt full after which you would take the flag down from the table. I tried to struggle as long as I could but it was very difficult. Bob, one of the moving mountains workers who was here to help with the accounting was also around and we thought we'd splash on a cigar at the end of the evening. It was very serene and i felt tremendous sadness that I was about to leave all these people. They had all looked after me in various ways and welcomed me like I was family.

Tomorrow I hop on a plane at night. I will return to the cheetahs and giraffes to get better photos and show Noel as well.

I was contemplating staying one more night but I feel like it might be detrimental overall. It is hard leaving this place and the people have been simply amazing. I hope my parents and friends all come back here one day to travel as there is so much to see and experience.Boston awaits and I have been e-mailed all the details. Noel is giving me a hard time about leaving and I wish I was staying longer. We listened to the Christmas album we recorded this year and had some laughs. It will truly be hard to leave it all behind....

SO much to write in such a small space yet I will try. I begin with the end rather than with the beginning. As I was whistling a tune coming off the daunting mountain that was Kilimanjaro, a mist appeared which blocked most of my view... It must have been my confusion or the speedy descent but I began to curse the mountain out loud. I began to tell it how Mt Kenya was much prettier and why can't it learn from Mt Kenya and clear up the weather. I was swearing and cursing and grinning in my little own Phil world when I felt the ground give way... I had stepped unintentionally into a pothole the size of my head and rolled my ankle inwards (i think the medical term is inversion but don't quote me on it). Either way, I took a diving header, rolled on the ground in slow motion and quickly realised I had developed a minor sprain. What took 4 and half hours to do merely took 5 hours now to come off the Mountain but Kilimanjaro had taught me a lesson. I gave my apologies to the mountain and continued my ascent after popping a few nurofen to ease the swelling. Strangely, the weather cleared and it was actually a pleasant descent with amazing views.

The night was still young after my last blog and I had barely 4 hours left before I had to hop on a plane onto Kilimanjaro. Nairobi seems to the best resting point yet we are never still here. There are always things to organise or events to plan.
I rang Prof Sonnabend at around 3am my time after his secretary left his home number and we spoke for almost an hour. I could not believe how down to earth he was. HE is one of the few consultants who has never forgotten what it was like to be a student. He gave me the low down on all the fractures at Siaya and how they should be managed. Gave me further insight into the situation and even e-mailed me some papers. It was a fantastic conversation and I was truly grateful that he had replied to my e-mail around Christmas. It also gave me fighting spirit to get to Kili and make it back to Siaya to ensure all the changes would be carried out. I went to bed at around 4am feeling a sense of excitement at the ensuing adventure.

Morning came around 7am and we were off to the airport. I felt slightly nauseous from the lack of sleep but it was otherwise uneventful. We arrived around 10 and made our way to picking up our Porters and guides.
I did not get to know the porters that well on this trip as they were always running getting water and moving back and fro. They were truly busy souls. The packs were carried on their heads which is the convention here in Kili. Everything you see on the left was carried up the mountain. We eventually started hiking around 2pm which is quite late and commenced our trip up Machame Route. It took us about 3.5 hours of heavy walking through rainforest but we made it to Machame camp for night 1 of our supposed 7 day adventure. It rained along the way but cleared by the time we arrived. It was beautiful at the campside. The atmosphere was invigorating and I felt refreshed. They set up a separate tent for us to have dinner in at night and it was quite nice but really i felt it was unnecessary carrying tables, chairs and an extra large tent all the way up to the mountain. I was satisfied eating in the tent and we left the extras down at Machame with the rangers.


Early on day two we began the hike up to Shira Camp. This was where I was told I could not go the usual route up the Western Breach as tourists had been crushed and killed by rocks only a week earlier or so and the route was closed. Thus we had to go around Shira and head off to Barranca and Barrafu to head up to Stellar Point. Hakuna Matata I thought and we began discussing the quickest way up the mountain.
We worked out that I could get up to Summit in 4 nights and come down on Day 5 to begin Safari which sped everything up for me considerably. The toilets on Kili are very disgusting by the way and shallow as all hell. I broke my pant buckle using one of the damn things and had to go with a belt tight for the rest of the week.


The next day we walked about 4 hours to get to Barranca. It was quite tiring but I did not feel a single bout of altitude sickness. I have to admit that I pre-empted most of the symptoms though and just took what I could to avoid feeling unwell. We
were the first non-porters to reach Barranca and last to leave Shira as well. The porters were quite impressed but I had the meds to thank. After another peaceful night sleep we were up to Day 4 and headed off to Barafu where the summit was to be attempted.
After 5 and a half hours we reached Barrafu which was 4.6km above ground. Still there were no symptoms an I felt quite positive about the summit.
It was a difficult last hour to Barafu but we made it safe and sound and ate a light dinner and went straight to bed.

Midnight came and there was rustling at the campsite as every man and his dog attempted the summit. Pole Pole (slowly, slowly) could be heard all round as we made
our way up a steep incline to Stellar POint. Western Breach (which was closed) is supposed to be harder but shorter and Stellar point route is longer but easier. However, it did not feel easier and 5.5 hours later we finally reached stellar point where it was only another easy 30 minutes until we reached Uhuru point where the
summit was. Many people did not make it to Uhuru. One german woman was knelt down in the snow frozen staring straight ahead with tears in her eyes about 50 metres from Stellar point. She had hit the wall. My Backpack was a frozen solid piece of ice at this stage and everything was frozen solid. I felt like my toes and fingers were going to drop off. Eventually we made it to the peak for Sunrise which only images can describe and my camera was frozen solid. Photos came out funny for the summit shot but it eventually defrosted once the sun came out. We quickly made out way (ran) down the mountain and reached Barafu by about 9:30am. We ate a quick breakfast and decided to get off the mountain as quick as we can. Besides the ankle rolling incident (the twist) there was little else and it was quite a pleasant descent (hard on the knees though). Eventually we made it down at about 3pm for what was to be a long day. More time was then spent getting a certificate and getting off the mountain and we eventually found a decent hotel by about 11pm after talking to my parents. I had discovered that the company I use to purchase some US dollars was based in London and of course the Bank rang my parents to tell them some purchased had been made in London.





Needless to say my parents were freaked and thought someone had stolen my card or that I had been killed etc and I was of course without a signal up the mountain. They then decided to cancel my card immediately and dad paced up the down the balcony for days contemplating jumping off. All this was told to me the minute i got down the mountain and I realised that my family was like so many others and had a knack for the melodramatic. All sorted anyway and my adventure would continue after I calmed them down.

The minute I stepped off the mountain something really strange happened. All the negative Altitude sickness that was suppose to happen had bypassed me but all the side effects from taking the medication had taken hold. I had blown my immune system to bits and I was afflicted with gastro and a respiratory infection immediately.
Once again, the thought of my parents contemplating jumping off the balcony was too much and I thought I'd just ride it out (sorry mum and dady). Of course, its Day 4 post coming off the mountain and everything has returned to normal but I was a sick burnt mess when I came off the mountain.
My skin had been severely burnt rushing down from the mountain and my face had peeled in a dramatic fashion giving flakes of gray skin. I looked like a bit of a hairless werewolf in the sun way too long. It was quite a sight.


The next morning we began Safari with our excellent driver Patrick. The term itself was a mystery to me. I often thought of Safari as a exciting journey into the great abyss of the serengetti to hunt out animals and photograph them for our own self gratification. How wrong I was. Most of the reseves have clearely marked tracks and going Safaring is alot like cruising for girls in a pub.
IT really depends on what nights you are out and you are never guaranteed to score even if you put plenty of effort and time in. Luckily we saw plenty of animals on the reserves and it was amazing to get nice and close to the action. We spent the first day at Lake Myanara which was an entire reserve based around the lake where animals would feed. The second day was spent at Ngorongoro crater which is visually one of the most amazing places I have visited. OF course my body was not in total agreeance with me but I struggled through and saw some amazing wildlife. The lodges were equally amazing and all situated up on the hills looking down at the reserve.
ITs interesting looking at the people on Safari and Climbing Kili. They are all my parents age. You have better odds of completing kili at 50+ than you do being under fifty. I will definitely try and convince my parents to return if they are up for it.




Today we packed our things and flew back to Nairobi. It was nice to have a hot shower and enjoy some air-conditioning once again. It is always much more enjoyable once you've suffered slightly. Tomorrow I get my work in gear and on Monday I will return to Siaya to complete another week of work. Got an e-mail from Noel who will oddly be in Nairobi in the next few days. Hopefully we'll have some fun adventures. I am perfectly healthy now. Albeit a healthy tan and the flaking has stopped. My ankle has returned to almost its normal size and all signs of infections has left so do not worry mum and dad :) :)

This perpetual headache is quite new to me. Not being a regular client of the old headache, it dawned on me how horrible it must be for people to suffer from perpetual headaches. We drove to Naro Moru which took 3 hours from Nairobi to begin the ascent up Mt Kenya. Met up with Samuel (the guide), George (the cook) and Stephen (the porter) who were going to keep me company for the next few days. We decided to spent the first day making our way up to the Metstation which was 10,000 ft high via the blueline hotel. This hotel costs about 300 shillings an evening which equates to about 6 aussie dollars. There were these cute puppies underneath a van which I thought had died but were still breathing. We rented a jeep which broke down (suprise suprise) and it took us 2 hours to waiting before anothe jeep came around. Eventually we made it to the Metstation at around 6pm and enjoyed a very relaxing evening of food and conversation. I couldn't feel the altitude sickness at this stage but something funny was happening to me.

The next day we made the 14km hike up to Mackinders camp which was 4.2km high or 14,200 ft. Breakfast was interesting at the Metstation as I was greeted by a monkey (syke monkey) which scared the life out of me. There was this pause as he and I stared before I screamed silently and threw my peanut butter toast out the door.
The Monkey was equally scared and screamed simultaneously with me as he dove out the door after the toast. Otherwise an uneventful evening. We set off at 8am and it normally takes around 7 hours to do slowly but I was eager keen (and stupid) and we completed it in 5 and a half hours. Needless to say, I got pretty unwell as soon as I got to Mackinders at 1pm and crashed.
I felt like I was going to die for the next few hours (slight exaggeration) but I woke up at around 4pm feeling slightly better. It was also interesting to find going to bathroom a more tiring experience than the days hike. The pit was a new challenge by itself.
By now the altitude sickness had kicked in and I lost all appetitie, had cheynne stokes respiration and could not sleep if my life depended on it. I sincerely regret not preparing meds for this mountain and will ensure that Mt Kili will be done differently. I tried getting back to sleep at around 6pm. It was the worst night sleep I have had in a long while. Its a funny thing being on the mountain and not being able to sleep yet feeling incredibly tired.
The breathing pattern also improved in the middle of the night and I finally got a few decent hours sleep at around 2am.


Acclimatisation day was spent climbing up to about 4.7km and seeing all the hidden lakes up in the mountain. It was fantastic to witness lakes at such altitudes.
The headache was significantly worse but it is easy to ignore when you are hiking. The weather got significantly worse today and it hailed for a second day in a row. The hike went from 10am-2pm and it was an otherwise chilled day.
The natural beauty and wildlife was simply amazing.The rest of the day was spent relaxing preparing for the ascent which would begin around 2:30pm.
It was almost impossible to fall asleep but eventually I got a few hours in.


We woke up at 3am and rushed for the summit. It seemed to go one forever and ever. The steep ascent went for two and a half hours where we reached the Austrian campsite. From here it was only another hour and a half to reach the summit (not real summit.. only 4.9km). The true summit can only be reached via climbing the glacier and meant for the uber professionals. Anyhow, the fake summit (or the hiking summit) was reached at around 7 where we got a great glimpse of the sunrise. I just wanted to get off the summit and the headache


was really getting into my head now. We spent the rest of the day coming down the mountain and eventually returned to Metstation at 2:30pm. After a long journey back to the blueline hotel (where my stuff was kept) I eventually made it back to Nairobi by about 8pm where I spent the evening searching for meds for the climb. It was particularly frustrating finding a place to stay as most places were booked up. After checking in and out of the Regency (terrible terrible hote) I eventually settled for Nairobi Serena which was one of the few hotels with wireless internet available in the rooms. It had been a long day and at the time of finishing this blog I had been up for 24 hours straight including the ascent with no nap. Also met up with Geoff and Andrew. Geoff is a jamaican (white) who grew up in the UK and is a guide in scotland or along those lines. Andrew is an ozzie who has london syndrome. enough said on that. Anyhow, these two friendly lads were also coming down the mountain and the many conversations about life, asian history and models and eating disorders made the descent fly by so much quicker in the end..

The Final week arrived and departed with the blink of an eye. After spending Saturday enjoying new years eve sipping wine and watching movies on the laptop, I awoke on New Years day with a phone call from Dr Ochieng. There were a few major operations at hospital and he needed an assistance. So I drove in with Alfred immediately on the Sunday and we began operating on a few caesars and an exploratory laparotomy for a patient with acute abdomen. The laparotomy lasted for 4 hours and we found two perforations in the small bowel. This patient had been stabbed in the abdomen and the superficial skin was merely sutured without any exploration underneath. Needless to say he was on the brink of death by the time we operated on him. It was the work of our doctor the changa (metho) man who was obviously too drunk to care. I saw him on action on the wards. He would see one patient then go off for a drink and so on. It was horrendous. It was also amazing to see how little people cared in the public system here. There was no night nurse on in the female wards and it was sad to see that nothing could be done because of the bureaucracy and paperwork required to dismiss a staff member at the hospital.

The rest of the week was a complete blur that flew by in an instant. I spent the days acquiring medical supplies from a shop in Kisumu which composed of pins and plates. The staff was very rude and even undercharged us. Needless to say they were very keen to get reimbursed for the miscalculation even though the receipt stated otherwise. They eventually drove up to Siaya to meet us later in the week to correct the mistakes they made. IT was very frustrating especially because it was their mistake and they were very rude. The days were filled with countless operations. I had gone until midnight and had to get a room in Siaya rather then return to wagai. I spent about 1000 shillings for a very spartan room and there was so much dust and no window. It was actually hilarious to sleep somewhere that was worse than our place in Wagai. But at least my bed wasn't broken here like it was in Wagai.
ME and Dr OChieng spent the night in the hotel near the hospital to talk about life. It was amazing to have this doctor treat me like a colleague rather than a lowly medical student. Although he knew I was a student, he treated me always with a level of respect and always asked for my opinions.

We went to the hospital the following day and spent another day mostly doing wards and clinics. It was rather quiet and I was exhausted by this stage. Rosie also came up at this stage to collect me for the return trip to Nairobi via Kisumu for the start of my trek. I spent the next few nights attempting to pack my stuff although it was difficult in the dark. Luckily I got some time on the last day to give the house an overall clean and hopefully I did not leave anything behind. My Last day at hospital was very sad saying farewell to all the staff. There were also patients on the wards who had their casts put on by the changa man and it appeared as if something was weeping. We decided to remove the casts and to our amazement found open fractures which were simply left and plastered over. It was atrocious. All in all there was 2 patients who was in that category and we had to clean the wound out. My last patient that I looked after had arrived as I was about to leave. This was a boy who was hit by a mini van driving on the dirt road. It was not considered an emergency and the x-ray man refused to do a mobile and insisted that we resuscitate the boy first then bring him up. After some convincing he eventually came down and performed the x-rays which revealed multiple fractures including base of skull. It was very sad as I will probably never find out what happened to this patient.

Eventually I made my way back to wagai and said farewell to all the kids and people working there. Of course I had to have a final soccer game with the kids. We made our way back to Kisumu for the night and I returned to Sunset hotel. I also met up with Andy from moving mountains who organised the entire experience for me. He was bringing up two new people for wagai.
These were John and Kate who were teachers doing Gap years and basically living out here for 3 months. We had plenty of fun having some drinks and giving them the low down on Wagai. I was mildly jealous that they were taking our place and part of me longed to return. The sunset was simply amazing this week and I think the Sunset hotel is truly the most amazing place to stay in kisumu.


Eventually we flew back to Nairobi and was met by Osman and the gang.
We spent the day visiting animal sanctuaries and I had a chance to get real up and close with them. We spent the evening with Dr OChieng who was in town for a meeting to sort out the staff problems. It appeared as if things were moving and change was going to occur. IT was very positive. We spent the rest of the evening at Dr Ochien'g house which was situated near the slums. It was an eye opener. Although the house is amazing by Kenya standards, it still saddened me a little to see a clinician live in such conditions.
There was also tight security around the whole neighbourhood because it wasnt safe.

Overall an amazing week. Tomorrow I make my way towards Mt Kenya for the first part of my journey. I am hoping for some amazing photos. I just can't believe how quickly everything has flown by.

The week has been quite a mind blowing experience. After leaving siaya because Dr Ochieng was stuck in Nairobi I headed off back to Dolphil. Dr Philip was very keen for us to meet these Kenyans who were studying medicine in Australia. I happily agreed and was quite suprised to find a few GMP2's here in Kenya. Aman was visiting renee who was a local here in Kenya. I discovered a different side to Kenya as Renee was obviously quite well off and living a different life here than most of the locals. She had a country house in western kenya and her dad was a big lawyer here in Kenya. They drove around most places and was quite suprised when I informed them that Kibera was the only place I have visited in Kenya. Anyhow, they drove off in their red merc and it was a huge head spin to see some people from home here in the remote area of western kenya.

The afternoon was so quiet and I decided to head home and continue playingfootball with the kids. It was great to spend time playing football and I don't think I could get sick of it ever... I was however so sick of eating beans and rice at hospital. Lunch was reasonably bland and I begged the lady to cook some additional sukuma and she obliged. Steven went and got some ugali and stew for dinner and I had a great meal for dinner.
The next morning I spent going through the inventory at Siaya Hospital. I had discovered some old orthopedic tools and bone traction devices as well as a plate and some screws that was removed from a patient a long time ago. They also had a manual operated drill which was hilarious to use. The day was spent in theatre performing various operations including caesarians and the like. Eventually the doctors performed the osteotomy but we could not perform the closed reduction. Therefore it appeared as if bone traction was the only option left. Through the day I sat with Kodada (the anaesthetist) and spoke at length about life and religion in kenya. Unemployment is supposed to around 80% he said although I am unsure as to the validity of his statement. One of the nurses had also died today from HIV and all the sisters were attending her funeral. Just before the osteotomy the Physio had arrived and was trying to convince the team that the patient was fine and just needed a plaster for 4 weeks. He believed that the union was acceptable (see xray) and was frustrated that we were about to change the protocol and routine for managing fractures. He said he had been doing this for 10 years. In an area of so much trauma only 7 patients were admitted. Siaya had developed a reputation for doing absolutely nothing for patients with fractures. Local villagers believed it to be the same outcome if they just sat home for 7 weeks and walked with permanent deformities as opposed to coming to hospital and paying for the same result. Either way, the physio was overturned and we continued with our plan. Dr Ochieng would later inform me that the Physio has an alcohol problem and so has the one of the other doctors (who never turns up) and that is why we are so busy every day. He stressed that kenyans consider many factors in life and to dismiss the doctor and physio would be damaging for their families. Therefore, he was trying to get these people transferred which irked me to think that these people would continue practicising.

Thursday was a large day. So many emergencies including delivering a foetus which had died in utero. It was sad to see the baby delivered dead. When it was delivered I laughed uncontrollably. It was such a strange moment. Dr Ochieng laughed a few seconds later. It was laughter that was uncomfortable. I felt like vomiting or crying yet all I could do was laugh. We sat down later and discussed this over tea. To see so much death and so much suffering was overwhelming and at times all you can do is laugh and continue. We operated until 10pm with the insertion of the bone traction being last. It was extremely difficult to drill a pin through the bone manually and I got some nasty blisters on my hands from the process. But it was a good feeling to see it go in and the subsequent x-ray showed the bones being aligned in the same plane. Union might not be perfect but at least the bones were not overlaping each other any more. We drove off to the hotel in siaya and had some dinner where I tried Kenya Spaghetti. I also tried some Redd (apple beer) which was pretty decent. Eventually went home and crashed at around 11:30.

Friday was the most draining of all. Because the doctor who had an alcohol problem (changa, which is metho) had not come in for days and Dr Ochieng was left with doing the ward duties. Most of the patients had been neglected for days and some were at the brink of death. We also performed minor dressing changes and other minor procedures. IT was insane to see how much the doctors had to perform in a day. We also had to perform an autopsy which was quite an eye-opener. They morgue here holds only 15 bodies yet there was 57 bodies packed into it. Some from as far back as 2002. The police were not willing to sign off on the bodies and many of them were unidentified. Today's victim had been the target of mob justice. Mob rules here in Kenya and even petty crime are not tolerated. On Tv they showed a pickpocket which was beaten to a pulp by a mob around christmas. Police shot at a man they felt was a car jacker in the leg yesterday. Our dead body was a man who was carrying a plastic toy gun. He had not committed a crime but the fact he was carrying a weapon was enough for the mob. They beat him to a literal pulp and set his body on fire. We had to sit through the autopsy while the relatives sat in for legal reasons. Dr Ochieng spoke of his experience being car jacked which sounded so brutal and violent that I shall not repeat it here. Both him and Kodada justified the mob behaviour inciting the get them before they get you attitude as a reason why it is accepted to murder this man. It was horrific to hear this...Dr Ochieng even spoke of a recent man who stole a chicken (about 150 shillings or 3 Australian dollars) and was beaten to death. It made me extremely sad for the rest of the day. Eventually Dr Ochieng and Kodada made their way to Kisumu and it was a great road trip for us as kodada travelled with us while ochieng had a meeting with the minister of health and the local hospital admin people.

We spent the evening watching the most amazing sunset at Sunset hotel in Kisumu which far surpassed Imperial in both price and quality. I felt truly relaxed


In the late evening I spoke at lengths with my parents about the upcoming plans to tackle Mr Kenya and Kilimanjaro. Dad was quite annoyed that I was to spend time holidaying here and wished me to return to Taiwan. It was difficult trying to express the need for me to complete this hike and I almost regret telling my parents about it. Hopefully they will understand when they see the video and the photos...

Christmas morning we made our way back to wagai and had a fantastic lunch with the 6 orphans. It was amazing to hear their stories and how much abuse they had suffered before they arrived. They ranged from 6 - 9 years of age. Lunch was fantastic and the chicken was freshly killed. Kids loved the presents from Sue and keith and played with the toys for hours. The chief was also there and was a jolly man (think lord mayor). We had a kick of the soccer ball and headed back to wagai for some festivities on the field.

We arrived with the kids onto the field and it was a mess. There were so man people and most of them were amazed to see mzungu's with a wheelchair (one of the girl was sharon whose story is particulary sad and she was confined to a wheelchair). Needless to say, none of the locals had seen this many foreigners or a wheelchair and they must have thought we were about to put on a show because literally hundreds of kids and adults swarmed around us and it was very claustro... We quickly left the field and returned home.

The evening was spent just sipping some red wine and listening to damien rice. Perfect way to end an evening.

Boxing day was spent back at Dophil clinic with nothing to report. Spent the afternoon playing football with the children and the small goals in the pouring rain. IT was fantastic ! We ran around for at least 3 hours.

Eventually we finished the night with a small stew from the local pub and went to sleep. Sunset is wagai is always amazing...


Dr Ochieng was stuck in Nairobi so theatre was cancelled. found a little internet post at Siaya so I could fill in the details. Not much else to report. Just thought I'd post what it was like to sleep here in Wagai under the nets. A bit freaky really. My bed has also been broken because of my sudden weight increase I think...

After the fantastic weekend in Kakamega we returned to wagai and found it intially difficult to settle in especially because the battery (which relied on solar power) had died and we were reduced to darkness. I felt like I was a homeless person living in the dark with candles my only solace. It did provide some early nights however.

Monday began with surgical clinics but ended at about 11pm. Surgical day is placed for tuesday and yet there were just emergencies after teh next. I got to assist on a strangulated hernia and emergency caesarian. We finished theatre after the emergency caesarian (tube was strangulating the baby but we did not know that until we delivered it.. it survived) at around 10pm and went to local hotel for a meal with Dr Ochieng (eddie) and Dr Kodada the anaesthetist who was a jolly man reasonably big. We ate a nice dinner and Dr Ochieng let me drive the Hospital ute back home to Wagai from Siaya. It was an excellent drive and there was not a soul on the road.

After a few hours sleep we woke up for surgery day. This involved more hernias, a prostatectomy and removing an osteoma. It was a great day with Dr Otongo (magoo) and he was still a bit socially awkward but good fun nonetheless. We were quite bored at night once we returned from home in the dark and I resorted to setting tissues on fire in fletch's (one of the girls who lived there previously and was still in kenya) ashtray on fire. I was that bored. The boredom came to a head after the ashtray exploded from all the heat i had put it through. That was a sign from god for me to get to bed and off I went.

Wednesday started quite slow and ward rounds revealed what is to hopefully become my major project here. I had discovered 7 patients on the wards with severe fractures who were merely managed by skin traction and had no reduction for their fractures. Most of them had been on the wards for about 7 weeks now and the bone had healed with the new deviated angle. Some of them were almost 45 degrees deviated from their anatomical baseline. It was horrific to see and Dr Ochieng confessed he had little or no options as they could not perform ORIF's due to the lack of pins and plates and even basic tools. There was also no protocol set in place for fractures at Siaya hospital and the physio's managed all the fractures. I was determined to ensure that no further fracture patients had to endure such deformities. The closest hospital was in Kisumu and most of the patients simply could not afford to travel there for proper surgery. I was dazzled. I was thinking about contacting the rep from smith and nephew that I met at AOA for some promo pins and plates but I knew this would merely be a temporary solution. The doctors were keen to perform osteotomies on these patients to correct the deformity and place them in plasters. I was unsure... The doctors here perform all types of surgery and i was not so sure how it was going to go. I contacted Ed graham.. one of the legend reg's at RNSH but he was not to be found.. It has since been troubling me as they want to go ahead with the operation on Tuesday. I rang my sister and she was also quite hesitant with going ahead with the ostetomies especially with the risk of fat embolism and the like.

The afternoon was spent playing football with the kids and Fletch had arrived to celebrate christmas with us in the evening. We played some Texas poker in the dark by candlelight and used matchsticks for currency

The next two days were spent at Dophil clinic in Rabour with Dr Philip. It is like a small private clinic which has about 12 beds for patients and a small room for minor procedures. The first day was reasonably quiet and it gave me time to think about the orthopaedic problem at Siaya. It made me realise how much I love ortho.. At about 4pm a patient came in with severe DKA and we had to explain that insulin is for life to the entire family. They had to sell one of their cows just to pay for the medication.
The following day was spent at Siaya in the morning where we logged all the fractures in the hospitals in terms of their fracture and how long they had been in the hospital. The afternoon was spent at Dophil where I got to perform a circumcision on a boy all by myself. I also had the chance to type out a letter (Dr Philip Has a computer) of protocols for Siaya in terms of managing fractures which stated the importance for immediate reduction to correct deviation and ensure good union.

We then packed up for our obligatory weekend getaways to electricity, hot water and of course internet. We decided to stay at imperial hotel (based on recommendation from Lonely planet). It had a great view of lake Victoria. Fletch also received a text from her girlfriend that they were never going to get back together and she was quite down. We spent the evening of the 23rd having a few beers in the bar and having good discussions on life and love.

Today is Christmas Eve. Its mainly a day for recharging and sorting life out. I purchased a overnight luggage bag so that I can reduce the number of bags. I also went and saw Harry Potter here in Kenya. Interesting experience attending the cinemas in Kenya. The film was a bit scratched and the audio was dodgy but I loved the film nonetheless. The boy who wants normality despite being special.

Tomorrow we return to Wagai where we will spend Christmas with the Orphans. Will hopefully get back next week for another update.

The weekend had finally arrived and much has happened since the last entry.

After dropping Rosie off and doing internet we headed off to Kundu Bay early next morning to a mission hospital. It was run by the Seventh Day Adventists and I was amazed at how organised everything was at this hospital which compared to Siaya. We had woken up at 4am just to drive out to this mission hospital and it took us 3+ hours just to get there. The car broke down a few km out of town and me and boys had to push the car for 2km along a flat. All in all a funny day. It amazed me how friendly people were and how eager they were to help in the pushing.

After returning home from kundu bay we quickly packed and headed off to the Golf Hotel at Kakamega city for a bit of relaxation on the weekend. It took about 2 hours drive and the most beautiful sunset and moonrise (yellow dusty) before we arrived at our hotel. It had electricity and hot water so I could not complain. It was an amazing night of sleep.

On the saturday we woke up and lazed about before going to Osman's brother's hotel for some lunch. There was also a HIV conference on at the hotel and we spoke at length with the organisers on their tactics to reduce HIV prevalence in Africa. It was fantastic. Lunch was equally amazing as there was all the skoomo wicky and mutumbo I could eat. We followed this up with a relaxing game of golf and we were all pants. VEry funny to watch how pants we were. Took about 3+ hours to play 9 holes.

The evening was spent watching over the videos of ourselves over the last week and enjoying some meals. We ordered some room service and I could not believe how rude most of the staff at the hotel was. They were openly hostile and rude. They even came in and cleaned up the dishes after we ate without even knocking. Then a call came at 12am to inform us that they needed to come and pick up the receipt. I was enraged and spent the better half of 5 minutes yelling down the phone. Eventually it all settled and I went to bed.

Today I awoke a bit grumpy due to last night's events. The manager came and apologised at breakfast and all was well for a bit of time. We made our way to the forest and saw some fantastic scenery and wildlife. We then packed up and left Kakamega knowing that our weekend was at an end and we had to return to wagai.


We stopped in Kisumu and hung out with Osman's family for the rest of the afternoon and hung out at the large shopping centre.

The up and coming week should be great with Christmas arriving and a large event being planned at the orphange. I hope the packages arrives and that we can have festive celebrations.

After 40+ hours travel time I eventually made it to Wagai in Western Kenya. I landed in Nairobi after about 24 hours of flying and waiting and met an interesting man on board the plane whose sole job was to get water out to people in Kenya. He offered a place for me to stay and we became rather friendly. It was an excellent start to meeting the people of kenya. I hopped off the plane and lone behold there stood Miss Kenya fresh from the Miss World contest in China and I got my photo taken with her. It was all very special. Rosie, Osman and Kelly met me at the aiport and we all became friends very quickly. Our plane for Kusumu did not leave for another few hours so we decided to head to the Kibera Slums and have a look at the original project that was completed by Moving Mountains.

Entering the slum was a real sight. The people, the smell and absolute poverty overwhelmed me. The house in the slums was equally mind blowing. We headed off to the ushrika clinic where I was originally going to work (before the tom easton thing fell through) and I got a great tour. I also met Helena and Fletch who were two poms working with moving mountains. It was a real sight to see the clinic but I felt relieved that I was not going to be working here as it appeared like things were under control here in Kibera.

Eventually we made it back to the airport and Rosie and I underwent our journey to Kusumu. 1 hour later and some sensational scenery, I arrived at Kusumu, the third biggest town in Kenya. It was dark and there were little in the way of electricity and lights. We hopped into a taxi which took us to our place in wagai (near Siaya) 1 hour away. After the turmultuous beginnings, we made our way up to the Moving Mountain House in Wagai. Wagai is like a small suburb. It is very similar to the little towns you see as you drive from sydney to brisbane or brisbane to cairns. Its about 100 metres long and it disappears very quickly if you do not look carefully. The drive over was equally disturbing as the roads were in terrible condition. A diesel truck had collided with a coffee truck and had ignited on the side of the road since Saturday. IT was still lit when I arrived and even today (thursday).

The house appeared to be horrific when I arrived. IT was pitch black. There was no electricity, no phones and no running water. I entered and was greeted by a British Just qualified doctor named Kiren. She had cooked us dinner (kenya stew) and we sat down and ate a fantastic meal.

I opened the door to my room and immediately my heart sank. It was very dank and dark and there was one small window which was conveniently broken. I was also warned about the cockroaches that were an ever lingering presence and one had even snuck onto Kiran's face the night before while she was asleep. I will never forget that moment of opening the door to my room and realising this was going to be my home.

After some shuffling and settling in I eventually entered bed under my cocoon of a mosquito net. I felt trapped and suffocated. I spent the entire night in fear of the cockroaches and the supposed sounds they would make in the night. Nothing came to pass through the night and I awoke the next morning.

It was at this time that I realised the true majesty and beauty of this little house. The darkness did it little justice and the sunrise over the horize gave the entire home a new meaning. The toilet and shower were a basic thunderbox out the back and I ran in and out as quick as I can and had a bucket shower thanks to some boiling by Rosie. We then hopped on a muttatu (mini vans) and headed to Siaya Hospital. The muttatu's are a Kenya Symbol. They pack as many people as they can into it and people are often seen hanging off the side of the vehicles. We also had mandazi (doughnut bagel) which was great and the staple breakfast food

The entire day was spent touring Siaya hospital. This is a district hospital which is similar to Hornsby back in sydney. The conditions were quite atrocious however. Words cannot do it any justice here and I will post photos up later once I arrive back in technology land. Needless to say the entire experience for me was like nothing else I have witnessed before.

The doctors then took us out to lunch. Kenya eating is a experience in itself. Everyone uses their hands and Ugali is the stape diet here. ITs like a damper but made with maize flour and tastes like hard porridge as Kaz would put it or hard Mash as I like to put it. Eventually I returned back to Wagai with a couple of cans of Mortein and other assortments and decided to bugproof the house.
Sitting in the house at dusk was a beautiful experience and I truly appreciated where I was in every aspect. After returning home from the clinic I decided to go down the oval and play a game with the local wagai team and they put me on as Number 9. It was so much fun even though the younger kids were a bit scared to pass to me (plus I was pants). I also began to enjoy the showers in the Thunderbox so much more.
After gasing the entire house I had a fantastic second night sleep with next to no disturbances.


Visitors would also just enter our house and greet us. From children to teenagers, these were Kenyans under the scout program which severed as a mentoring program for youths. IT promoted no drinking/smoking etc and pushed kids to finish education and lead in the community. It was great to meet the kids and their fascination was always good for a laugh. Muzungu was the name for a white person but I was not white. IT confused the children alot. Eventually we came up with JAckie Chan for my nickname and I even heard someone yell it out to me from the street on the way to hospital.

Second day and we attended the HIV clinic. It was simply amazing at how extreme the conditions were. Although free ART was available, the backlog was amazing and many patients were simply left to die with bactrim and multivitamins the main treatments available. This was when I met Peter, a 16 year old boy who was HIV positive. His mum and dad both had HIV and he did not discover he had it until he was 14. They are all patients of the hospital and all came in at separate times. He was at school, Loved football (as most kenyans do.. they also support Arsenal) and had a zest for life. He also was losing his sight and had diplopia whenever he focused on an object. His spirit and his thirst gave me this boost and reminded me why it was I came to Kenya intially. So often it is hard to explain when such experiences are so beneficial for medical students and yet when one actually has a taste it becomes so abundantly clear.

We took an early afternoon after the only surgeon (a very magooy man) pissed Kiren off and we decided to head off. We also decided to eat lunch at the kiosk which was a backyard shed at the front of the gate which sat 10. This was where I tried mutumbo (intestines) and fish and Skoomo Wiky (a kenya vegetable). Note the spellings are terrible. The food was simply amazing and I was beginning to appreciate the ugali more each day. I also enjoyed walking around the town of siaya more. People would either be hostile or overtly friendly. There was no in between.
Osman also joined us today and the evening was spent having a chat talking to him about his childhood. Osman is a orphan who has lived an amazing life. I video taped him for half an hour as he talked candidly about his childhood and the experiences of going through civil war and losing his dad. We also drank some Kenya Beer (Tuska) which was warm. Rosie brought a guitar back from Kusumu for the house and we spent the night teaching kids a few chords and playing around

Today I woke up feeling great as we headed back to siaya for ward rounds. The doctor in charge (Eddie Murphy as we call him.. photos will explain) who is also the administrator of the hospital would take us around and we would decide on a management plan. We were basically residents. It was fantastic. We also met one his childhood friends who lives in bologna in italy and we all went out for our second lunch (the first being the obligatory mutumbo and ugali).

I thought I would lose weight here but it has not happened yet. The afternoon ended on a rather sour note however as we attempted a lumbar puncture on a lady. They do not use local anaesthetic and it was a real harrowing experience having the doctor try a lumbar puncture on the patient. None of us could aspirate any fluid and her screaming continued.

Rosied turned up in the cab at this time and we all hopped in and headed for Kusumu to send her off in a big way. IT was sad to say goodbye to Rosie and I am so glad that she was here to take us around. I have no doubt I would have surely perished in the first few nights if it weren't for Rosie and Osman and Kiren.

I have spent the last few morning enjoying My Name is Earl on the laptop and draining the battery. God I love Jason Lee. Such a clever show. I hope it survives and doesn't get the ARrested Development, family guy treatment. ITs an interesting concept for me that I have to go down the road and pay someone to have my things charged but its sure worth the 20 bob we pay to have mobile/laptop and the rest. You don't really know how important electricity/refrigeration/telephones are until you are stripped from them. The Kenya goverment has obvious concentrated the wealth in central areas.

Nothing else to report. In Kusumu with Osman's Family. Fantastic. Found e-mail and spilled all this stuff on the page. Hope it makes some sense to whoever is reading it. Especially me down the line. Can't wait to post all the photos.

I'm sure I have missed many key events and will definitely fill in and edit bits and pieces down the road.

Sitting down is beginning to kill me. After a reasonable 17 hours flight I have arrived in Dubai. Getting off the plane was a nightmare as we were slowly taken in a bus for 10 minutes to our stop. Then we had to go through security again just in case i picked something dangerous up on the plane. Feeling drowsy and tired. Just want the journey to be over relatively soon.. There will probably be no internet for a while so i am enjoying it while it lasts.

Wonder how Kaz is going on her travels. Her parents rang me last night and they hadn't heard from her. I hope she is ok and she is faring well in her travels.

Otherwise all is well. The pills and sleep have done the trick and I only have a sore throat and mild gastritis remaining now.

Oh my god !. woke up this morning at about 12 (went to bed about 3am) and I felt terrible. Had the sweats, sore throat and felt very nauseous.

Took some cold and flu and hoped for the best. About to leave for the airport in about 5 hours and I hadn't even started moving yet. Thankfully I finished most of the packing yesterday...

Final year of medical school and am about to embark on a journey of mass multitude. My journey will begin on the 12th of December in Wagai in Western Kenya near the border of Uganda and closest to Kusumu in Kenya.

Much anticipation and fear are blended with adventure and excitement. There is dread but joy in knowing that I am about to dive head first into an unknown territory.