On Wednesday August 6th, a group of volunteers from Issyk Kul Oblast got together and excitedly boarded a train from Balakchy to Bishkek for Phase 3 of our Peace Corps service training. After having been at our respective permanent sites for one month we were all very excited to rejoin our other K-22s and share our experiences.
On Thursday August 7th, I earned myself a trip to the National Surgical Center in Bishkek to have my appendix removed.
Thursday morning all 54 volunteers met at the hub site in Krasnaya Rechka and happily greeted each other, exchanging hugs and stories. I was, of course, thrilled to see everyone but was bothered by some severe stomach pain and nausea that eventually I concluded couldn’t just be gas from the welcome home dinner of bread, sheep and oil I had been served the evening before. Something was wrong. I called the Peace Corps doctor on duty and he asked some questions and told me he would call me back. Upon receiving his return phone call he told me not to eat anything and that I would travel from Krasnaya Rechka to Bishkek with another Peace Corps staff member later that afternoon to visit the doctors office. My Russian language group is lucky enough to live with host families in Krasnaya Rechka near the hub site where our training meetings are held so our group, and the group of Kyrgyz speakers who also live at hub site, walked to my host family’s house for lunch. After sitting through lunch with no appetite I stayed at home both to get out of the heat and to see if I could find a position (stomach, back, left side, right side, curled up, spread eagle) that would relieved some of the pain and pressure from my stomach.
When the Peace Corps car came to pick me up we drove to Bishkek on one of Kyrgyzstan’s nicer paved roads so it wasn’t until we arrived at the road to the Peace Corps office, which is notoriously bad and extremely potholed, that I realised with every bump how much the pain had intensified. The Peace Corps doctor asked me a series of questions and listened closely as I recounted my symptoms and how the pain had moved and localised. He took my temperature (low fever), poked and prodded my belly a little (lower right abdominal pain) and checked my mouth (dry tongue despite having been drinking water all day). Finally he looked at me and calmly informed me that he thought I had appendicitis. Of course the logical reaction would have been to recount the symptoms with him that matched the illness, ask what the next steps were, prepare to leave for the hospital, but my reaction was to burst into tears. Not only was the thought of being cut open in a foreign country terrifying, but considering that I had no idea what questions to ask, where we would go, or how the Kyrgyz health system would deal with me, a freaked out foreigner, was even more distressing. The strong sense of independence and capability of dealing with new experiences on my own had quickly faded into panic and hysterical tears. The Peace Corps medical staff were more than wonderful in calming me down and acting as the comforting role as we walked into the old soviet emergency room and I was poked, prodded and asked about my pain by surgeons and the head of the hospital (in Russian of course).
Eventually it was agreed upon that my symptoms were, in fact, indicative of appendicitis and that I would need surgery to remove my appendix as soon as possible. Phone calls to our country director and to Washington DC were made, approvals were given, mothers were informed, and before I knew it I was walking into an operating room with nothing but a robe on. The room was cold and looked like something out of a soviet spy movie, the big operating light with fifteen bulbs, the brown pleather coated surgical table, the team of medical staff bustling about prepping trays of shiny metal tools. I was told to remove my robe and lay down on the table. So, naked and feeling more vulnerable than ever, I waited as nurses strapped down my ankles and wrists and began prodding my forearms in search of a vein large enough to jab an IV into. After what seemed like half an hour (but was probably only a few minutes) an older woman approached me and asked if I understood Kyrgyz. I shook my head. “Русский понимаешь?” (Do you understand Russian?) she asked. I nodded. She explained to me in the same slow, clear voice you would use to speak to a child, that she was the anaesthesiologist (thank god the word is a cognate) and she would be helping today. I must have looked terrified as my eyes darted from the many doctors and staff scampering around the room, to the surgical instruments, to the intubation tubes they were about to shove down my throat, to the nurses still prodding my left arm trying to find a vein. I asked her in broken panicked Russian “I slept – er – I mean – I will sleep? Yes? I will be sleep?” “Конюшне” (of course) she nodded sympathetically and told me not to look at my arm, “only look to the right,” she said, tilting my head right. As I felt the cold rush up my left arm my eyes fought to stay open but I was soon, as promised, asleep.
When I awoke I was completely naked and half covered by a sheet, but most alarmingly I was strapped to a gurney and still intubated. I gasped for breath as they unhooked me from the pump but choked on the tube, which they left in my throat. I shook my hands as best I could (which probably looked laughable, like a fish trying to flap around on dry land, as I was still under much of the affect of the anaesthesia) in an attempt to indicate that I was, in fact, awake and that I would, in fact, like to attempt to breath normally instead of through the inch and a half wide straw that was stuck in my throat. My attempts to move it around and get it out with my tongue only made it more difficult to breathe (and I’m sure my flustered appearance more laughable to the on looking patients and the busy nurses). When they finally removed the tube I gagged and felt the need to cough but immediately regretted giving into that need when I felt the pressure from one heave explode from my abdomen. I was sure I had ripped out all my stitches but was still too numb in all my limbs to sit up and check. So I gave in and allowed the orderly to position me whatever way he wanted, presumable the position that was most useful for him to keep an eye on the tube protruding from my belly.
I stayed in the post operation room with six other patients for the night, sleeping on an off as new patients were rolled in on squeaky gurneys and nurses periodically handed me a water bottle or answered my requests for the time by nodding to the blurry clock on the wall (I had not yet been given my personal belongings and was still without glasses thus my inquiries at fifteen minute intervals were not meant to be annoying but rather were due to the fact that I simply couldn’t see the clock they kept nodding to). When I awoke, I realized that the large barred squares on the wall I had been staring at all night were windows, and the light shining through them meant I had made it through the night and to the next day, which I had been promised would mean I would get to move to a recovery room. When the surgeon arrived, accompanied by a large group of nurses, orderlies and other important looking men and women in various colors of scrubs, he proudly told them that I was the American (among other quick comments I didn’t understand) and asked me in slow stammered Russian “How – are – you – feeling?”
“Tired,” I responded and tried to inquire about when I would move but he and his gaggle of followers had already moved on to the next patient, looking over a new folder.
Soon after, a new patient was rolled into the room, her gurney parked beside mine. She was asleep and still had the intubation tube down her throat. She looked peaceful and as the intubation machine pumped on and off I imagined it was what I had looked like before awakening and realising just how sore I was.
The Peace Corps doctors arrived within an hour and asked how I was doing. Having nothing to compare it to I described as best I could what I felt like, tired, sore, ready to put on pants, and probably the bag of typical feelings post surgery. They went to go fill out some paperwork and talk to the doctors and before long I was being transferred into a new gurney (upside down since I’m pretty sure my feet were not supposed to be inclined slightly above my head) and rolled backwards down a maze of hallways. We finally arrived to a warmly lit hallway and stopped just outside a door that clearly wouldn’t fit the gurney’s wide girth. The nurses yammered back and fourth to one another for a few minutes before I told them I could just get up and walk to the new bed in my room. They helped me swing my legs over the side of the rolling platform I had been laying on and stepped gingerly with my right foot onto the floor. Immediately, I realised that the single position I had been in all night had not allowed me to feel the extent of my soreness. Pain shot up the right side of my body and I stumbled a little but the nurses ushered me into my new room and plopped me down on the bed.
Peace Corps medical staff visited me to return my belongings and help me dress myself (bending to put on even the stretchy pants we had hurriedly purchased the day of my surgery before heading to the hospital was pretty impossible without help the day after my surgery). They helped get me situated and asked if there was anything else I needed. In my drowsy state I couldn’t think of anything but gave them the number of a friend in my Russian group and my room keys so that they could at the very least collect some clean underwear for me. Then, still slightly under the affects of the anaesthesia, I drifted off to sleep.
When I awoke it was early evening and, my legs being numb from doing nothing but laying down for almost 48 hours straight, I decided to attempt to sit up and inspect my surroundings. I was in a private Палате (room) with a shared toilet and sink. Thank god there were flush toilets I could sit on, I thought, squatting with my swollen, sewn up belly would have been a challenge I wasn’t quite up to. I tried to sleep that evening but could not keep my eyes closed for more than an hour or so without becoming restless or being awoken by someone peeking into my room, the heat or simply being uncomfortable. I assessed my situation.
On the plus side: I had my own room and as much Russian television as I could watch (news, dubbed American films and Russian knockoffs of CSI and Dharma and Greg)
On the down side: I had a tube of my own fluid leaking out of me and over the course of 36 hours I accumulated 106 mosquito bites, more back sweat than I ever thought possible and an a slightly hysterical tendency to cry whenever someone asked me a question.
Lack of sleep and the emotional exhaustion caused by not knowing what was going on, how long I was going to be stuck in the hospital or being able to communicate with the nurses (who seemed to only pop their heads into my room to see what I was doing, the American on display) had not been good to me. Over the next few days I slowly got up and began to walk around, first with the assistance of Peace Corps staff who visited and brought company and lunch, and then eventually on my own. But occupying myself in a single room with only one hallway to roam was difficult and I found myself becoming more and more uncomfortable every day and less able to rest at all. Finally on my fourth day in the hospital, I broke down. I was hotter than I had ever been and the same sweaty clothes I had been wearing for three days were beginning to stink more than my unwashed hair (it had been about a week since I had gotten to banya at permanent site and I came to the hospital only two days after arriving in Chui so I was going on almost 9 days of unwashed filth). In an attempt to cool down my room I had foolishly left the windows open and allowed mosquitos into my room (I will not hypothesise to the number of mosquitos but if there were any less than 50, they were truly the hungriest, un-killable warriors of their swarm). I was itchy, hot, stinky, nervous, exhausted and still uncomfortable with a bag of leaky surgery fluid (I have no idea what it actually was since when I asked in broken Russian I only received blank stares as a response) still hanging out of me. So when the nurses came in around lunchtime to find me scratching my mosquito bites with a towel and sobbing, they were quite alarmed.
In a New York Times article that detailed various RPCVs experiences during their service, a retuned volunteer from Uganda wrote “You have never witnessed human discomfort until you see a confused Ugandan man try to comfort a hysterical, sobbing white woman having an emotional meltdown.” This is how I felt sitting in my hospital room, rubbing my legs with a towel and repeating “Комаре, Комаре” (mosquito) the only word I knew in an attempt to explain some of my frustration as six Kyrgyz nurses of varying ages (both ejes, older women, and younger but equally confused looking nurses) jumped around the room clapping their hands trying to kill mosquitos and patting my head saying “Не плачь, Пожалуйста не плачь” (don’t cry, please don’t cry). I had created quite the scene, and when the Peace Corps medical staff came to visit that day all of the things I had prepared to ask them went down the drain as I began uncontrollably crying again.
I was so incredibly thankful that instead of alarming staff members I would undoubtedly be seeing for the next two years as I had freaked out the nurses, the Peace Corps medical assistant knew exactly how to handle a vulnerable and broken down volunteer. She helped me ask how much longer I would need to stay in the hospital, gave me a clear explanation as to what exactly they were giving me shots of four times a day and how long the regimen of these antibiotics would be, and told the nurses she would be taking me back to the Peace Corps office to shower (promising of course to take good care of me and make sure we taped a packet over my wound as to not get it wet). Most importantly, upon our return to the hospital she translated for me a quick apology to the nurses and a somewhat coherent explanation of why I had been upset before (as it was no fault of theirs, I wanted to make sure they knew).
Ex soviet Kyrgyzstan offers excellent standards in medical procedures. Surgical staff is well trained, nurses are caring and sympathetic, especially to the occasional freaked out foreigner upset at the amount of mosquitos in her room. I felt that, given the circumstances, my care was excellent. However the experience did expose to me some of the dissimilarities between medicine in Kyrgyzstan and in the United States.
The biggest (and to maybe not to my surprise, the hardest to deal with) difference in medical care in Kyrgyzstan is that it is solely focused on the medical procedure. Unlike in America, where hospitals also operate efficiently, with staff who are well trained and experts in their fields, there is a patient centered realm of care. Doctors communicate with patients on details about the procedures, the plan of treatment for before and afterward any surgical procedure, the reasons behind these plans, clearly explaining what will be done to the patient’s body or what has broken down, what needs to be fixed and how doctors will go about treating the problem. In Kyrgyzstan the orientation of the patient is slightly altered. Doctors are experts in medicine and the human body and the attitude that patients should take the doctors advice to get better, no further explanation needed is the standard. Truthfully it’s logical. However, waiting 40 minutes for the lab tech to show up with twelve other moaning patients squatting on the hospital hallway floor waiting to get blood drawn seemed alarmingly strange to me and defied all of my previous medical experiences where patient comfort came first and foremost. This country’s type of care is efficient in its own way and works to keep people in this country healthy as well, but it also reflects on the fact that many people in this country do not seek medical assistance for preventative care, but rather only after a health problem has become so severe that there is nowhere else to go. As a terrified American who hadn’t been to the hospital for anything more than a bad ear infection in the past 19 years, this variation in the expectation of my patient role (combined with my slightly anal need for plans and order, thanks Mom) lead to a small emotional breakdown in my hot hospital room which not only terrified my nurses but myself as well. Thinking logically or coming up with questions to ask in a calm manner was no longer an option for my physically and emotionally taxed body. I had not slept due to a combination of nerves, heat, mosquitos and confusion about what the nurses were asking in their rapid fire questions to me every hour, and this stifled my healing process immensely.
Overall, missing almost two weeks of language and technical training (the purpose of my return trip to Chui Oblast) did leave me in a bit of a lurch as far as catching up goes. Needles to say I would have much rather sat through several hours every day of being hot in Russian class than seven days of being in a hospital bed (and this is saying a lot if you know my attitude towards Russian grammar) but this experience did provide me with a unique inside look into the medical systems of Kyrgyzstan, a pretty valuable experience for a health volunteer.
The National Surgical Center in Bishkek where my surgery took place.
In Kyrgyz (top) and in Russian (below)
When I began walking around on my own I ventured outside in the evenings when it was less hot. These hallways connect the surgical wing (which houses the emergency room and most of the operating rooms) to patient rooms and other clinics and offices. I liked the Kyrgyz Shyrdak designs painted on the windows.
The list for my hallways of patients and their rooms. These are handwritten because they change every day, however this means that my name was spelled differently every day too. The following variations were my favorite:
Паттон (Patton, the correct spelling and pronunciation)
My hallway and room.
The inside of my room. The private Палаты (rooms) were sandwiched between shared rooms with up to 11 patients at one time.
This was clearly post freak out when, much to the horror of the nurses, Peace Corps brought me a fan. It is a common Kyrgyz belief that if a cool breeze blows on you, you will probably get sick, so the fan was not received well at first in a healing patient’s room.