Cooking!!!
In NYC I was barely at home which means that I was barely in the kitchen… I have always been eager to become a better cook… but without anyone to cook for, the work of cooking never seemed worth the effort.
Robertsport is a fishing city and most of the people eat fish and rice every day. They do not have a grocery store to speak of. In the “market” you’ll find okra, egg plant, cassava, plaintains, potato greens and casava leaf. Sometimes bananas but no other fruits.
Since I’ve been here, I have been practicing my cooking skills and learning how to cook from my new friends (the children). It’s been fun to start cooking again…
I have a bread fruit tree (bread fruit is just like potato once it cooks!) in my back yard and thanks to all of my boys going out and picking them for me… I was able to enjoy bread fruit while it was in season in July and August 
Fufu is a commonly eaten food here. It is made of casava which is dried, beaten and made into a powder which is then made into a dough like consistency by adding water. When you buy it — it looks like dough. Cooking it is difficult (in my opinion)… you have to wash it first and then sift it to get all of the dirt and large pieces of unground casava out. Once you do that, you boil it, but must keep mixing the mixture so that it doesn’t burn. You have to mix it hard and fast for about 20 minutes… (thank goodness for helpers!!). In the end, I wasn’t too fond of the taste but was glad that I successfully made it at least once during my trip here…
When the gas stove that was bought by the last doctor ran out of gas… I had to learn how to use the koopa… again, thank goodness for my kids!!
My neighbors helped me bake a cake on the koopa… in a pot with a baking pan placed inside.. and coals on the top and bottom of the pot!! Pretty insane… it was yummy!!
“Health Talk” on Radio Piso
For the past two weeks I have started to talk on the radio for the weekly Thursday evening “health talk.” Last week, I gave the talk with Thelma and Amelia two of the student nurses on gastritis and this week Jackson, Yah Yah and I talked about diarrhea and dehydration. The format of the show was to talk about the illness, what causes it and how to prevent and treat it. Because my Liberian English is not too great — I would speak and then the student nurses would translate after me in “Liberian English”…
Jackson and Yah Yah during our radio show…
We had a great time being on the radio and it was also nice because many of the patients came up to me the next day and told me that they had heard the show and learned something new 
Too many losses in one week…
September 7th and September 13th, 2011
Last Wednesday night we lost a little 4 year old girl named Victoria to malaria and fluid overload from a blood transfusion. Her mother brought her in after being sick for almost 2 weeks – initially the mother said that she had jaundice and she was giving the child “country herbs.” But her mom decided to bring her in because Victoria started to have increased work of breathing. When she came into the ER she looked like all of the other cases of malaria I had become accustomed to seeing. She was breathing fast but very alert and responsive. She was not having seizures and was able to sit up which is a good sign compared to many of the other patients. She was positive for malaria and was later found to be very anemic – the two most common diagnoses here in children. I left her in the pediatric ward that day thinking that she was going to be fine with the treatment we had ordered for her.
I came in that night to use hospital internet and was “busy” when Mr. Marlu came in to tell me that he put her back on oxygen for tachypnea. I didn’t think too much of it and he didn’t ask me to see her so I continued my work but figured that before I left I would go by the ward to make sure that she was ok. 45 minutes later when I was ready to go I went to the peds ward and found her in the corner bed on the right and what I saw I didn’t expect. She was completely unresponsive, tachypneic, diaphoretic and posturing. I looked at the student nurse who was taking care of her and asked her how long she had been like this… she said for the past 20 minutes…. when I listened to her lungs all I could hear were sounds of fluid. As I ordered what medications I thought she needed, she suddenly stopped breathing and her heart had also stopped. We tried CPR but the mask that we were using was not appropriate for her age… and I knew that with the limited resources we had we would not be able to help her even if she started to breath again… but she never made it. I cried and I couldn’t help but wonder if I had come 45 minutes earlier could I have prevented her death????
September 13th, 2011
Tonight, we lost a 2 month old infant whom I have been taking care of since the day after little Victoria died… Thomas had come in with severe pneumonia and he was finally doing better; we had all thought that maybe he would go home with his mother tomorrow. I don’t know why or how but he acutely became ill again and had signs of pulmonary edema and CHF… within an hour of being sick again he was gone…
After they wrapped his entire body in a lapa cloth, I sat on the bed holding Thomas… He was still warm in my arms…. the nurses were looking at me empathetically as one of them put gloves on and motioned me to give her the child. I didn’t want to let him go…. I stood up and told her that I would take him with her if that was ok with her… We walked towards the OB ward together and then they stopped at a door marked “bathroom”— as they opened the door I saw the door just to the left and it was marked —“morgue.” It was a dark room and I couldn’t really see what it looked like… Tears started to flow down my cheeks and I had a huge lump in my throat — “Do we have to put him in there???”” I asked all of the nurses that had walked with me… Again, giving me a sympathetic look they nodded their heads and one of them took Thomas from my arms. I watched as she lay him down on what seemed to be a shelf in the dark room and shut the door… “You did your very best doc…” I heard one of the nurses say as I turned and continued to cry on my way back to the pediatric ward to check on his mother who had fainted after he had stopped breathing.
Thomas was her 11th child. She had already lost 7 of those 11 children. She said that her tay tay (breast milk) was not good— she had breast fed the first 7 children she had and they had all died. She was advised by her father to stop breast feeding after her children kept dying but she said that she didn’t believe that a baby “couldn’t take tay tay” so she would give her tay tay when no one was around. After 2 more deaths she said that she finally believed that her tay tay must be bad. She stopped giving her breast milk and the next 4 babies survived… but tonight, her 4th living baby died in her arms and it was too much for her to take. She is a good mother; diligent in the care of her infant and the father had also been there every day after his night job as a security guard on the beach…
That night, as we worked to try and save Thomas we got news of another tragedy not too far away. An ambulance from a town close by had turned a corner too quickly and had run into a group of people who were waiting to see one of the presidential candidates…
http://www.anhourago.in/show.aspx?l=26571322&d=502
It was a wet and rainy night … and I knew that the ambulance had been at fault. I was nervous every time when one of our ambulances went out to pick someone up because of the way in which I had seen them driving in town. Earlier that week I had mentioned this to the new doctor who had come, to see if he could talk to the drivers about their driving. Unfortunately, tonight would be a lesson that no one would forget…
Sunday is the day for Prayer
Similar to what we do in the states, every Sunday Liberians put on their best clothes and go to either the church or mosque with their families. Not surprisingly, “my kids” are excited to have me come with them to see their place of worship. Last Sunday, I was able to attend church with Mo, Abraham and Nathaniel. It was a special ceremony for the youth of the church. They crowned the “Youth of the Year” and other special youths for being hard working and good members of the church…
Today, I had to miss service (Aug 21st) because of an “emergency” in the hospital but surprisingly the encounter ended up being religious in nature…
One of the nurses from the hospital had came running down to my house to call me (since I was the only doctor in town that weekend). As we ran back to the hospital together on a particularly warm day she told me about the patient; a woman had been brought in with seizures and was now having difficulty breathing. When I entered the emergency room the patient was lying there with her eyes open and was looking around and breathing heavily. She did not look to be in distress and all of her vitals were normal. It was the same woman who had been there several days earlier with complaints of severe lower leg pain that would not respond to multiple drugs. As I evaluated the patient I felt that something didn’t seem right and I kept asking the nurses about the seizure that the patient had sustained prior to my coming: Had it been a true seizure or a pseudoseizure (not a true seizure)? As we tried to put an IV in a woman who had difficult veins we heard a group of people singing church hymns outside of the hospital. 2 minutes after the hymns started the patient stopped breathing heavily and raised both her arms and said: “everyone please stop and pray, please stop and pray, please stop and pray…” All of the nurses stopped what they were doing and started to say prayers out loud as they touched her body. I was surprised but not shocked. I had known all along that this did not seem like a truly ill person and later when talking to the nurses they said that they felt that the patient had an “african sign.” According to the nurses this means that she has been taken by some spirit and that all of her symptoms are from this spiritual abnormality.
She had continued to ask everyone to pray for nearly 20 minutes and after the prayer she told everyone not to let her go back to her father because he wasn’t good for her and that if she went back she would need someone to take care of her daughter because the lord would take her…
We came to find out that her father is quadriplegic and she is the sole caretaker for him. Unfortunately all of her symptoms seem to be a cry for help; it was obvious that she is not happy in her current situation…
First week in Liberia… July 24th- August 1st
I arrived in the early evening on Sunday, July 24th. As I got out of the customs area I immediately saw a woman in a lapa (African dress) with a sign saying “Dr. Gupta”— after a long week, I was relieved to have someone waiting for me. My luggage was one of the last to come off the plane since I had checked in so early (4 hours before my flight was departing in Brussels) (I didn’t want to miss my flight this time!! 
… As we waited, I heard my name again — “Dr. Gupta, Dr. Gupta…” it was another Liberian woman looking for me; I soon found out that she is the superintendent of Robertsport (the town I am serving) and she had just learned that we were on the same flight from Brussels to Liberia. We would be driving back to Robertsport together…
As we got out of the airport another friendly face was there— “Mr. Harris” the assistant to the supper-attendant and soon to be one of my good friends in Robertsport. We got in the car and after introductions — Mr. Harris and the governor quickly started to talk about all of the business she had missed while she was in the US visiting family. They talked for 4 hours and I could feel the positive energy in the car. It was nice to see the other side of politics—productive and seemingly honest… with elections coming in November they had a lot to discuss…
IVAN
By the time we reached Robertsport it was late but I was greeted by a new friend– Ivan. Ivan is an ER doctor from Alaska and he quickly became a friend and a mentor for me in the one and a half days we spent together in Robertsport… He had been in Liberia for a little over a month and had spent the first two weeks working to get the house that was once ready for a volunteer— ready again— and to get his papers from the government so that he could work. My new home was clean and organized—thanks to Ivan.
Ivan and I talked for about an hour the first night — the next morning we woke up early and had coffee — and nutella (YES — NUTELLA) with bananas on a pita – it was yummy 
and then we walked to the hospital, a quick 5-10 minute walk (depending on how hot it is) up hill thru a small trail.
The Hospital and Mr. Kuaye
At the hospital, we met Mr. Kuaye— one of the nicest and most hard working men I have ever me. He is a “physician’s assistant” but I would soon find out that he knows more than 5 physicians put together, having worked for more than 30 years in a resource poor environment, he has been forced/ eager to learn about every field of medicine. (With only one medical school in the country – doctors are few and far between and unlike the US where we are so specialized in our small area of medicine, here in Liberia the physicians must know everything and more because they are responsible for it all!!) I have since found him reading a pharmacopeia or an anesthesia book everyday after work… Kuaye was also soon to be one of my closest friends in Robertsport…
The Beach
(Ivan and Steven (During his stay Ivan helped Steven learn how to surf ))
So, yes – Robertsport is known for its beach. It is about a 20-30 minute walk from my house and it is lovely. Just like everyone else, I love the beach —but not alone and after recent near drowning experiences in Hawaii and in Brazil I am a bit more cautious about getting in the water… So, I was happy to find out that my new friend Ivan is a fish in the water and a surfer — during his last two afternoons I had the opportunity to enjoy the beach. I knew that I would not be back out on the beach until another visitor would coerce me to join them. Ivan helped me learn how to manage the large waves (in Monrovia the water in Liberia is a major cause of ex-pat deaths— the waves can get large and many people die every year) and we had a great time.
(Independence Day kids party…)
On his last day in Robertsport, Independence Day in Liberia, we were lucky enough to borrow the hospital motorcycle — if you’ve ever seen me around a motorcycle you know that I’m like a child — I love them!!! ) We had the opportunity to cruise around town and we were lucky enough to run into Harris who was on his way to the special kids party in honor of Independence day. We entered the town hall and found almost 100 children gathered for the special day. All of them were dressed up and excited for the big day. Inside, they were playing music and all the children and adults danced — so, Ivan and I joined them and took some pictures and videos…
Ivan’s departure
(Ivan before leaving in his new Vai clothing given to him by Mr. Harris. You can see the house that I am living in in the background.)
I arrived on Sunday night and Ivan left on Tuesday afternoon — so, essentially we had only spend 1.5 days together… but it was a great time. I think having another person to enjoy the experience was fun for both of us and naturally made for a great connection.
After Ivan left, I was left alone… I did not know anyone yet and it was starting to get dark — so, I sat in my new home and I thought about the year ahead — I was nervous and excited. I had chosen to leave New York but as I sat and thought about the long and exhausting week I had before reaching Liberia and the excitement I felt in the last day and half I knew this year would be full of ups and downs. I unpacked, ate dinner and went to bed early.
First day on my own…
Had my first night alone in the house and woke up a little down (I hadn’t slept well – partly because all of the new noises were scaring me my first night on my own.)…. But once I got started and headed to the hospital I started to feel more awake and ready to work. I was about 10 minutes LATE (some things are the same in the US and out in Africa ) — met Kuaye at his home (which is directly in front of the hospital at the foot of the hill) and we walked over together… I was welcomed by the staff and the patients. The first day was uneventful and lighter than we had expected after independence day holiday.
I was done at around 1pm and headed home to find that the neighborhood kids had already made plans to get to know me. As I walked down the path to get home I met with several kids wanting me to take their pictures…
(Nathaniel (pink top) and Abraham (striped top) – two brothers… you can tell which one is the more naughty one )
From my previous trips abroad— the children are always my best friends — and Liberia is no different. The innocence of children can make any trip amazing and memorable.
First week in the Hospital (sorry limited pictures… I try my best not to be a tourist in the hospital…)
I wasn’t yet “credentialed” in Liberia so I was basically “shadowing” this week …. it was nice to be oriented to the diseases and the way that everything functioned by having Kuaye guide me every step of the way. Essentially, we did rounds on the inpatients in the morning and then had “OPD” (outpatient clinic) for the rest of the morning into the afternoon depending on the patient load. Ivan had told me before he left what to expect from OPD and I couldn’t help but laugh inside every time I saw a patient with chills — Liberian’s have the cutest way of saying that they have chills and Ivan had impersonated it perfectly — “doctor my body can be feeling COOOOOLD at night” – the complaint that over 80% of patient’s came in with. Not surprising because chills and feeling cold is a common symptom of malaria but still very funny.
Patients in my first week…
Woman with diarrhea and dehydration
On one of my first days I saw a woman die from dehydration— she had come after being sick for many days and was critically ill when we saw her. She had been experiencing severe diarrhea at home and had become unresponsive to her family. I soon found out that the capabilities of the hospital are limited and that we would have to use a lot of intuition in order to be able to effectively manage many of these sick patients.
After 3 days of trying our best to help her… she passed away overnight…
Patient with Ascites: family and trust
One of the patients Ivan and I had seen before he left – continued his stay — he was a 30 something year old male with hepatitis C, ascites and what we thought was peritonitis — we treated him for his infection and then he started complaining of leg pain. His leg did not look to be swollen or injured initially but as time went on, his left leg was swollen and painful. Although he had liver disease and was probably prone to bleeding and not clotting – I thought that more than likely this was a blood clot in his leg – unfortunately the only medication to treat this illness was not available. I asked the staff what we should do and came to the conclusion that referring the patient to Monrovia to JFK Hospital (one of the biggest hospitals in Liberia) would be best. The journey takes 3 hours and transportation costs are expensive. The patient didn’t have much time if my diagnosis was correct. When I discussed the situation with the family it was soon obvious that money was an issue although they wanted to do what was best for him. Ultimately, we decided that maybe we could lend them some money and have them take him as soon as possible. Not knowing that giving money was still not enough and that the family would have to run around and try and find a car to transport them… Regardless, they found a car and took him the next morning — after 3 hours I heard from one of the nurses that the patient had died on the way to the hospital…
Child with malaria and seizures
My first child with malaria and seizures turned out to be a pleasant surprise. The first day when I managed her seizures; I was sure that she would have some residual brain damage because of the prolonged nature of the seizures she had sustained all night… to my surprise she was awake the next day and eating
The resilience of pediatric patients is amazing and I am thankful for it.
Medicine and Money
One thing that seemed to be a theme with conversations that I had with the healthcare workers in the hospital was the infrequency of getting paid. St. Timothy’s Hospital is a government run hospital — and for some reason the government does not have its payroll people in-check. They work every day and live right next to hospital — 1 week of time off every couple of months (if even that)— and then they don’t get paid for 3-6 months at a time! So, obviously the staff turnover is very high.
While talking to Kuaye about this issue I was so impressed and in awe of his attitude. He said that he “didn’t go into medicine for the money” and was willing to work with the hospital head (Dr. Garbo) whom he respected in order to help take care of the patients. But after almost 6 months of not getting paid it was getting hard for him to wait for payment and he had to do something to change the situation. He has given Dr. Garbo a notice stating that if the situation does not change by mid-October he is going to leave St. Timothy’s. Although that would be an ENORMOUS loss to the hospital — I was glad that Kuaye was doing something to stick up for himself — Kuaye is older and he has worked hard for many years and doesn’t know how to slow down; but at some point I don’t think he’s going to be able to work as hard as he does. I reminded him of this and also thought about how he would survive once he couldn’t work without a savings … or a retirement plan. another good human being not being appreciated for their hard work 
“Sis Payel” and the KIDs!!!!
By the end of the week the neighborhood children and had started coming over to draw on the porch… an activity that gave me company and gave them a lot of joy…
Getting to Liberia
July 16-24th
Well, I can honestly say that July 17th — the day that I missed my flight from Brussels to Liberia was a tough day for me. I felt a rush of emotions — from pure fatigue to anger… I was tired from two long weeks of preparation and moving— and then angry that I had been so careless and missed my flight.
In the end — thanks to the support of my brother, family (in England) and friends (Ibi, Lynda, Daniella…) I didn’t feel alone and was able to enjoy some of Brussels…
![clip_image001[1]](http://1.bp.blogspot.com/-7ckDAOH_NnM/TjR9oQu1i4I/AAAAAAAADlA/V0U8Ey26cqI/s1600/129.JPG "clip_image001[1]"){kind=small}
![clip_image001[2]](http://1.bp.blogspot.com/-gAf9tVd6e4g/TjR9oIwKbaI/AAAAAAAADk4/eGEYuB6--Zk/s1600/123.JPG "clip_image001[2]"){kind=small}
…and ultimately had a chance to see a lot of my family in England (after a 6 hour bus ride) — which was wonderful. ![clip_image001[7]](http://1.bp.blogspot.com/-8vPoW5qAbbk/TkcKuRGKMBI/AAAAAAAADmA/oDv9wtdwNJk/s1600/IMG_2238.JPG "clip_image001[7]"){kind=small}
And I also met some wonderful people along the way….
While staying at ETAP hotel in Brussels (a fairly low budget airport hotel) I met G.D. — he saved my life with food one night and then continued to be my savior as my time in
Belgium got longer and longer… thanks G.D. — you are the best.![clip_image001[9]](http://4.bp.blogspot.com/-qx-HBWIvF8w/TkcH7OhquMI/AAAAAAAADlw/rTr7hMnXsnU/s1600/094.JPG "clip_image001[9]"){kind=small}
I then met Stan — one of Ibi’s close friends from D.C. who is now living in Belgium. He took me to a great Italian restaurant and took my mind off of my flight issues– you are also the best (and p.s. I secretly want you to marry Ibi
And lastly, the clinic staff at the Brussels Airport Medical Clinic — my new friends Frank and Nick (docs at the clinic) helped me save some much needed medical supplies from being thrown away… (Packed too much and needed to get rid of a lot of stuff!! — p.s.- I hate you Brussels Airlines.)
Saying Goodbye…
New York…
Lots of mixed emotions as a I packed and left New York. The last month before leaving was exhausting; from attending weddings to visiting family and then packing my whole life up into boxes and carrying them down 4 flights of stairs… it was overwhelming.
The last week was extra exhausting but my going away party was great…. even though Ibi the “organizer” wasn’t able to make it. I felt extra special and loved. New York was definitely my home and it was nice to know that I had made a good group of friends that I would be coming back to…
I heart NYC. New York and all of my lovely friends and family you will definitely be missed…
Family…
Saying goodbye to my brothers and sisters (sister-in-law makes two sisters 
) was HARD… I knew that it would be, but wasn’t expecting it to be so hard because we are always apart. But that weekend I had realized that for the past 18 years I had seen my siblings at least every 2-3 months and there wasn’t any way that I could wait 15 months to see them; especially my nieces. I decided that weekend that I would come back in February for my nieces first birthday… My father would be coming to India in November… 4 months wasn’t so bad…
