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April 4th 2017
Published: April 8th 2017
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Yeah, went to bed earlier just to wake up at 1:30 am this time. But I feel less wrecked than yesterday. I did a mini hotel work out and now I’m drinking my instant coffee and having some quiet time while overlooking the pool. I haven’t ever seen anyone in this beautiful pool… I’d like to see a Burkini. After breakfast, I head to the medical school and give a lecture to the students. Women are seated on the right, men on the left. They interact with me if I ask direct questions but mainly it’s just like a U.S. medical school lecture: some paying attention, some nodding with various points, some nodding off, some disinterested. I try to focus on a few keys points rather than hammering them with too much information.

Rick leaves today. He spent the last 24 hours in Samawah, the modern capital of the Al Muthanna Governorate midway between Baghdad and Basra,with one of his former fellows. We miss his company. He lights up any room and emits kindness, stability, and warmth. Waleed tells me that Rick performed the first total knee replacement EVER in Iraq. He then brought over 50 total knee prostheses and taught a surgeon how to perform the surgery. After 6 joint cases, he left the implants there, and now that surgeon is the lead joint replacement surgeon in Iraq, having performed hundreds of cases. What a legacy.

Now I’m sitting in the OR lounge. Well, a concrete room with some shelves and some instant coffee and 4 or 5 broken chairs. I am waivering between tears and anger. I had two cases set up today, two children with foot deformities that I could really help. And no one is here. No one knows where the patients are, who they are, or if they are coming. Why the FUCK am I here if I can’t do anything? Was I supposed to do something more to ensure they arrived? How the FUCK was I supposed to know to do that? I am writing so I don’t lose it on anyone else. Scott is operating and I don’t want to bother him with this. Ultimately, I am extremely frustrated, upset and currently feeling like this was quite a long trip for a cultural experience if I’m not actually giving back in a meaningful way to patients.

And… 30 minutes later and after 20 phone calls made by Waleed - the patient is here in the room. Sigh. I guess I shouldn’t have gotten so worked up, and again, just gone with the Iraqi flow. I have a feeling this may be every day for them. I wish there was something I could do to benefit the infrastructure, but there’s no way to do that in such a short time.

The surgeries go GREAT! I am joined with Waleed as my assistant and Basan and my scrub. Basan is quick and smart and really helps the case run smoothly. You can tell he cares and wants to help make the cases go smoothly. Quite the departure from the two OR days previously. I realize how crucial it is to understand your environment and guarantee set-up rather than assuming that things are set. The Iraqis often say “Yes, we have” but then I look for the instrument and it’s nowhere to be found. I don’t know if they mean, “Yes, we have it somewhere in the building” or “Yes, it exists in Iraq” but now unless I have my hands on an instrument, I don’t count on it being available. I perform a tendon transfer and osteotomy in a 16-year-old and then repair a 12-year-old boy’s foot, deformed from a neurologic disease, and his father thanked me and cried. This is enough to make my trip worth it. Scott also has a much smoother OR experience – but just when we get the knack of it, it’s our last OR day. And if I really think about it, if I come back next year, I don’t expect anything to be different or improved. So how do we effect true change?

We have a full clinic afterward and I only have a few patients so I join Scott in the pediatric clinic. The children are so full of life and smiles I just want to hug all of them. A lot of them have really severe deformities, deformities that would be difficult to treat in the U.S., much less in Iraq with far fewer resources. And some of those deformities would have been easily treated if caught earlier in development. Shows how much work we still have to do.

My favorite moment was when we were evaluating a teenager with cerebral palsy. His gait is labored and honestly painful to watch, his legs cross and scissor and buckle. Scott asks the family if he speaks and communicates. This is translated and the family says, “Yes yes, he does”. To my eye, his disease looks very involved and I doubt his verbal capacity. And then the patient, in slow English, looks as Scott and says, “Hi. My name is Mohammed. I am 10.” I teared up.

We wrap up around 10:15 and head to Ali’s house for dinner. His wife Zaneib (my patient) is doing very well, and she actually made us dinner. They allow their 13-year-old, She-hed to stay up with us and eat because she’s so excited. She has a beaming smile and is obviously very bright. She enjoys American movies and Turkish television, which helps with her language skills. I ask if she plays sports or instruments etc… and then I realize, Basrah still isn’t safe. There are no parks or playgrounds to run around in, no organized groups or extracurriculars. An activity is a trip to the small mall and maybe a movie. Makes me sad.

Dinner is maybe the best yet. Fresh baked naan, a goulash-type dish, and meatballs wrapped in eggplant and baked in a tomato sauce. Dessert is a coconut cardamom cake, not too sweet and utterly delicious.

I find out some more back story. Zaneib’s father is Professor Thamer Hamdan, the Chancellor who has been our host. She is concerned for his safety. He has been kidnapped twice. He refuses to align himself with Muqtada or any political party, and his position and power makes him a target. She hopes he retires and moves back to London, where he has a home.

We take one last photo and we head back to the hotel, asleep by 12:30am.


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