One last day with the kids

As excited as I am to be heading home, I will definitely miss my children at The Way Home.  It has been an adventure for sure - playing the roles of CPR certified lifeguard at the beach, Ukrainian cooking assistant, camp counselor, and primary care provider.  I learned a lot about medicine by watching my father practice medicine - it also helped that he spent his free time in Ukraine studying for his medical recertification.  We spent many evenings in the hostel discussing medical conditions and looking at images of different pathological conditions.  I also learned more about what the organization could use in terms of medical assistance.  My brainstorming trip went better than ever expected.  I loved patching up cuts and giving medical exams, but I especially loved playing with the kiddos!

My dad even got in on the playing action

On our last day volunteering, my dad and I bought toys and trinkets for the children at the kindergarden.  We wanted to leave a favorable impression in their minds of the primary care providers who came to give them medical exams!

Little girl picking out her new backpack

Cars or Spongebob?

Look at those smiles!

Kindergarden leader

So excited!

This little boy drew me a picture and gave it to me to take home

My main question now is not "if" I am coming back, but "when?"  I assume my time and resources would be better spent waiting until after I am a PA.  I know the skills I learn in graduate school will enable me to better serve the needs of the children of Odessa, but can I stay away from Ukraine that long?  I am already in touch with an organization called PAs for Global Health!  I cannot wait to see what services they offer and how I can learn from their international efforts.

In the meantime, I look forward to keeping everyone up to date on my application process! 

Another day on the streets

Before hitting the streets, I was confronted by the daughter of one of the foundation's employees.  She had injured her toe doing some extreme sports, but luckily it was not too bad.  It was not deep and did not look like it needed any serious attention, so we patched her up with no problems.  

Our first stop was in the most unlikely of places, Arkadia.  You may remember my last posts about visiting one of the famous night clubs in this region, ITAKA.  Today we were there on strict business - to find a homeless family known to frequent the area.  We walked down the tourist-filled road until it cleared out.  Down the road, we veered left and walked off the main road into the shrubbery.  We were told that there was a homeless family that lived in the catacombs there.  The catacombs are dangerous and people are frequently getting lost in them.  They are largely unchartered, so when people get lost inside, they are often not found until they are dead and gone.  There was a story not long ago about a girl who got lost in the catacombs - her mummified body was found two years after she went missing.  The catacombs are a very interesting part of the history of Odessa.  You can read more about it here.  I took a guided tour of the catacombs with Claudia in 2010 so you can read about my impression on my old blog, My Trans-Siberian Journey        

Arkadia

Not a bad place to spend the afternoon volunteering

Walking to the Catacombs

Unfortunately, no one was home so we were unable to see the catacombs and I didn't want to ask if we could have a peak inside.  We then made our way back to our old hot spot in the roundabout.  Today, our friends were more willing to let us help me.  I bet the gifts of Coca-Cola, chocolate and water we gave them warmed them up to our company.  They even let us take photos of us working with them.  One girl had fresh self-mutilation cuts on her arm.  I didn't even have to ask her if she needed help.  She asked me if I would help clean her cuts.  They were luckily not that deep, so they were easy to patch up.  I have treated more self-mutilation injuries her in Odessa than I ever did in my two years as a psychiatric technician.     

Back at the roundabout

Self mutilation is a huge problem here

Applying the ointment

After care questions

Then one of the boys told me he had problems with his feet.  He asked me if I could help him so I gloved up.  Looks like he had some bad blisters that had popped.  The dirt was so impacted on his foot that it was difficult to even clean it off.  I used an antiseptic towelette and then proceeded to clean it with alcohol.  Next up, you guessed it, Neosporen.  I tried my best to prevent the injuries from getting infected by putting bandaids over them.     

BSI - Body Substance Isolation

check out these cuts

Interesting callous

Start off with an antiseptic wash

After cleaning with alcohol and applying Neosporen, patch up with bandaids

More bandaids

Happy to have been helped

All in all, we had a great day.  We did not go back to see the family in the underground - the folks with the guttate psoriasis - so I gave the cream, Q-tips, some chocolates and a bottle of nail polish to the street patrol worker.  He will give it all to them next time he stops by their place.  Back at the center, we were greeted by one of the little girls who had gotten a physical the day before.  She was happy to see us.

little kindergardener joined our photo

This is what we call preventive care

Yesterday, my dad and I went to The Way Home's office to continue our volunteer efforts.  The organization runs a kindergarden daycare type service for low income families out of their main office.  The children get dropped off daily by their care givers and spend the day playing under adult supervision, having regular meals, and taking naps.  Yesterday, however, they were in for a special treat - a primary care examination!

My dad getting the exams started

I could tell by the look on the kids faces that many of them had never really seen a doctor before.  It was definitely fun to introduce them to the world of medicine.  They especially loved to tuning fork, the noise it made and the vibrations it produced.  After walking me through the first couple of examinations as he did them, my dad let me take over.  I started by introducing myself, and then checking their mouths, ears, noses and eyes with my otolaryngoscope.  Then I listened for abnormal heart and lung sounds.  I used the tuning fork to check for hearing loss, and degenerative nerve problems.  I then asked them to stand so I could check their spines for Scoliosis.  We checked their limbs, palpated their bellies (which was always funny for them) and used the reflex hammer to check their deep tendon reflexes.

heart sounds

Brachioradialis reflex

Scoliosis check

Checking the nose

Is one side louder?

He got a "kick" out of this!

Checking the limbs

Checking out those teeth and mouth

He wasn't too sure about this one

For the most part, we did not find any serious concerns.  The biggest problem we saw was poor dental hygiene - so some children did have slightly inflamed nodules under their jaws.  My dad speculated this was normal considering the lymphatic system was likely just trying to work out the tooth infections these children faced.  In the future, it would be amazing to pair up with a dentist and come back to treat the myriad of dental issues I have seen.

After the examinations were all complete, we made balloon chickens out of gloves and gave them to the children.  I always used to love it when my dad made them for me, so I am happy to be returning the favor now as an adult.

Group shot with the children and their chickens!

The Scars of Odessa

I got the idea for the title of this post from my dad.  Yesterday was our first day volunteering together and it was an eye opening experience.  Odessa has many wounds inflicted by the wars and rise and fall of the Soviet Union.  The city is slowly healing though; worn out buildings and dilapidated roads are slowly being remodeled, but I am here to treat the scars of the local people.

Dasha met me at the center to donate clothes and books

Yesterday we started our volunteer adventure by heading to The Way Home's community clinic outside of town.  There I met some old friends of mine who used to work at the center downtown.  We had a joyous reunion and enjoyed catching each other up on the last few years.  They were excited to hear about my plans for PA school, and getting married, of course.  Our first patient was a 21 year old woman who's parents died many years ago, leaving her and her siblings homeless.  Her family quickly fell apart after that, and she reported that she no longer speaks to any of other family members anymore.    It is easy to understand why then she is a self mutilation victim.  She had more self mutilation scars than I have ever seen, and I worked in a psychiatric clinic where attempting suicide is often the only way to escape the relentless voices and hallucinations.  

Outside the clinic - known area where alcoholics and drug users hang out

My friend from 3 years ago

My first clinic patient

She allowed us to examine and treat some of her fresh cuts.  This cut was deep and should have been treated with stitches, but at this point it was too late - all that could now be done was allow the wound to heal by secondary intent.  Apparently the cut she had was much larger days earlier, since she had gone swimming in the sea and it had gotten irritated.  We cleaned off the site with alcohol, then applied Neosporen to the site.  Apparently Neosporen is the biggest thing since sliced bread here.  I had no idea that it was not available for purchase here.  Neosporen, a cheap and simple ointment found in almost every home in America, is a desirable luxury in Ukraine.  I will have to bring a suitcase full of it next time I come.  After cleaning the area and treating it, I applied a simple bandaid.  We told her to remove it tomorrow to let her wound breath - this would keep the bacteria out and would help it heal faster.  The most meaningful part of this experience was not the treatment of her injury, but the conversation I was able to have with her in Russian.  She came into the office after we had treated her, and asked my friend if she could chat with me.  It was a simply enough conversation - Where are you from? Where were you born? etc.  Just the fact that she took the time to sit us me and talk made me feel like she trusted me and appreciated my help.  I also got to learn more about her past life on the street.

Next up, street patrol.

Our van

We got into the Way Home's street patrol van and hit the streets.  We weren't sure what to expect, but the man who came with us did his best to explain what was going on and where we were to me.  The language barrier was there, since most of the vocabulary used is definitely not something you would learn in a generic Russian language course, but we did our best to communicate throughout the day.

Dr. B reporting for duty!

Our first stop was in the middle of a large round-about away from downtown Odessa.  We carried food to the middle of the area where we found a group of 4 teenagers hanging out drinking vodka.  They all seemed to have some neurological defects, similar to the signs I had seen last time I was in Ukraine.  I suspect the defects are due to a life of drug abuse on the streets.  We gave them some food then proceded to ask if any of them had any medical issues we could assist them with.  We cleaned up some cuts with alcohol, then applied the magic Neosporen.  The young woman approached us to show us how the sides of her lips were infected.  She likely had a fungal infection, but unfortunately we did not have much to treat her with.  It is so hard to see problems that would be easy to remedy in the states, but impossible to treat here due to lack of access to medical supplies and equiptment.  Some of the guys were asking about antibiotics, but apparently they are too expensive to even consider buying.  Even if we did buy the medicine, it is unlikely they would be taken correctly.  The street patrol leader told us that even buying toothbrushes for this population is ill-advised.  Seems like encouraging basic hygiene is a losing battle.  

Walking through the round-about

Checking out a minor abrasion on  his forehead

Next one of the guys started telling us he was having abdominal issues.  My dad asked if he could take a look, and what we saw was terrifying. It looked like this kid had been attacked by a shark.  He had the meanest looking scar I have ever seen.  My dad said it looked like a nephrectomy, kidney removal, scar, but that they were highly unusual in children.  The kid sitting next to him, as if to get in on the attention, slowly started lifting up his shirt as well.  To our surprise, he had a nearly identical and equally disturbing scar.  It looks like organ harvesting is an epidemic in Ukraine.  One woman I had met in a bus earlier in the week had told me about how children were being stolen from the streets for their organs, and I could not believe this to be true until I saw those two scars.  I am still trying to find out the full story.  Were they victims of organ harvesting?  Did they willingly sell their kidney?  How much money was given to them if they were sold?  I hope to have my questions answered tomorrow when we attend the street patrol again.

The boy with the unusual scar

Our next stop was through a mini forest behind a few buildings.  It looked like a camp site, but no one was home to greet us.  I was shocked to see people lived here, out in the open, without even a roof over their heads.

No one was home

Our last stop was underground.  We had to wait for a minute before being invited inside.  It was dark, since there were no windows, but the myriad of families that shared this basement level made life comfortable by laying carpets down over the dirt and rocks, making privacy walls out of curtains, and using Christmas lights as decorations.  They were nice enough to let us into their home.  We returned the favor by patching up some minor injuries and treating some guttate psoriasis.  The young man who met us had it on his arm, elbows, and knuckles.  Luckily I had a homeopathic remedy with me - the one I had bought with my future mother-in-law when I needed alternative treatments for my bout with poison ivy/oak (Thanks, Jenny!).  I cleaned the area with alcohol and then applied the ointment using a Q-tip and gloves.  

Life underground

After seeing me treat her son, the old woman who was standing in the back made her way to me and sat down where her son was sitting.  She also wanted to be treated!  The fact that she also had guttate psoriasis confirmed my dad's diagnosis that it was a non-contagious genetic disorder.  After treating her, we left a supply of ointment and Q-tips for them.  I believe tomorrow we will be going back to visit this family, so I bought more Q-tips and intend on leaving the rest of my ointment with them.

All in all, it was a very successful day.  We may not have made the biggest difference, but maybe we helped heal at least a few of the scars of Odessa.

On our way to the Opera

While we were getting ready to head to the opera, my dad was approached by one of our fellow hostel mates.  He had been running up some concrete stairs in Odessa the previous nights and had slipped.  He cut his face badly in a few places, so he needed to have stitches.  After being turned away by one emergency doctor, he was finally seen and given the care he needed.  Our hostel friend wanted to get my dad's opinion on his injuries.  After examining him, my dad noticed that the stitches were way too tight so he decided to loosen them.  When stitches are too tight, they get engulfed by the surrounding skin and cause what is known as railroad tracks.  So, we went through my little black bag and got to work!  I sterilized a needle I had brought to sew clothing with a lighter and used the forceps I had brought.  

 My dad taught me that injuries swell, so stitches should be looser than expected to accommodate for such swelling.  He then showed me how to safely loosen stitches.  It was interesting to see him get to work in the most random of places.  Proving medicine does not have to be confined to a clinic! 

Forehead stitches

Loosening some more stitches

Only in Ukraine

After this impromptu post-surgical after care, we made our way to the opera.  We had purchased tickets to Tchaikovsky's Iolanta earlier that day, which was an adventure in and of itself.  The lady didn't speak any English, so when other tourists heard me speaking Russian they all crowded around me and asked me if I could help them.  I did all I could for them then we headed off to do more exploring around the city.  The opera was beautiful, but the opera house was stunning.  It was built by an architect from St. Petersburg in the neo-baroque (Vienna baroque) style in 1810.  It is guilded in gold, making it extra beautiful.

Admiring the opera house

Ready for the show

Beautiful mirror!

Papa

artistic shot

I am so glad I finally got to go to the opera in Odessa.  It was totally worth the $17 for two tickets!