I took one look at him after school and knew that things were serious. He couldn't even walk upright and was clutching his side in pain as he walked. Every bump in the road that we drove over (and there are many bumps here) caused him to wince and cry out in pain. Once I got him home, I saw that he was also running a fever. As soon as Tim got home from coaching football, he took him to the local clinic.
Josh has had a rough couple of weeks and has been to this clinic not once but twice for X-rays on both hands (no fingers broken, just badly sprained). While they were sitting in the waiting room this time, the doctor that had treated Josh in the past remembered him and greeted him on his way out the door for the night, asking how his finger was. Tim explained that, although the finger was healing, we now suspected appendicitis. This doctor immediately dropped his things and ushered Josh into a room to examine him. An exam and an ultrasound confirmed that he had appendicitis, and the doctor recommended going downtown to the hospital immediately. (Side note: this doctor even came downtown to check in on Josh several days later - I was so impressed with him!)
Thus began a flurry of calls to our insurance and to friends with medical backgrounds. The number one worry on all our minds was, Is the care here in Dar acceptable? And if not, where should we go and how should we get there? This to me was the worst one hour period of the experience. Tim was with Josh and I was with Charlotte. Trying not to panic while sorting through options and getting childcare settled was extremely stressful. I'm very thankful to Amy and Lauren for being clearheaded thinkers and keeping me (mostly) grounded. Once Tim and I were together again, I felt much better. This whole experience has confirmed to me that we are a really good team and much stronger together than apart.
Pretty much from the start, Tim and I felt very uncomfortable taking Josh anywhere outside of Dar. We believed that time was of the essence and there were just too many unknowns with flying him to Nairobi (not the least of which was that it was Friday night and even getting to the airport could have been a multi-hour process). When our doctor friend said that Aga Khan was very experienced at appendectomies, we felt a lot of peace with the decision. In fact, it turns out that another appendectomy had been done earlier that afternoon! Even this hospital, although probably less than 10 miles away, felt really far away from home. Traffic is unbelievable, and our multiple visits to and from the hospital involved a traffic ticket, dangerous debris in the road, crazy drivers, a near-overheating of the car, and an attempted extortion of money to park in the free hospital parking lot.
The next 3 hours in the ER were a blur. More testing was done, including a CT scan, bloodwork was completed and an IV tube was inserted into Josh's hand (which was extremely painful. I'm sad to say he inherited my deep veins so it took them two tries). Just before 11 pm, he was wheeled up for surgery. We were hoping that we could stay with Josh until he was put under anesthesia, but unfortunately we had to wait outside. And by outside, I mean actually outside in the open air. I spent a lot of that time quietly freaking out that we were probably getting bitten by malaria-infected mosquitoes.
Although we were promised that the surgery was very fast, between 15-30 minutes with some recovery time, that was not the case. I had mentally given myself an hour and 15 minutes before allowing myself to panic and unfortunately we passed that threshold. Fortunately, I really felt a sense of peace and calmness and I know it was due to the hundreds of prayers being offered up around the world on his behalf. We were so thankful for our friend Marc, who posted Facebook updates on our behalf since we did not have a working smartphone.
It turned out that Josh's appendix was actually tucked away differently than most peoples' and so it took longer and required a bigger incision. It also turned out that the cecum, which is the adjacent part of the large intestine, (which I only learned after looking this up) was also badly infected and so Josh was put on strong antibiotics.
Finally, the surgeon emerged to say that all went well. He then showed us the appendix in his surgical tray, looking like a curved swollen pinky finger or little hot dog. It was "fresh," meaning "covered with blood" and I really did not need to see that at all!
We then waited a long time for the nurse to wheel him into his room. We were literally in the middle of the OR corridor (or as they say here, the "operating theatre") and the surgeons were getting antsy because another emergency surgery was about to happen.
In this hospital, the 2nd floor houses both pediatrics and chemotherapy patients (which I find to be an interesting combination). Therefore, Josh's roommate the first night was an adult cancer patient. Hooked up to chemo drugs, she was in evident pain and crying out in Swahili most of the night. There was only one chair in the room and so I tried to sleep on Josh's bed with him. It was a surreal, out of body type of experience. At around 3:30 in the morning, Tim left to get stuff from home and returned around 7. I went home around 1 pm and decided to spend the night at home with the girls (which turned out to be a really good decision, because multi-night sleepovers are difficult for everyone).
Josh was in pretty bad spirits that whole day. He was in pain, but unfortunately the pain relief in this hospital involved a morphine shot in the posterior. He was nauseous from the anesthesia, couldn't get comfortable and wasn't interested in doing anything. It was a long day for Tim, made longer by the fact that a stranger entered his room and tried to extort money from them...so Tim felt uncomfortable leaving Josh alone for any length of time, including getting himself food. Thankfully we were moved to a private room which had AC (albeit frigid AC), and a little couch for us to sleep on. We also got a final viewing of the appendix (now housed in a specimen jar).
I took the girls and Josh's iPod the next morning, both of which cheered him immensely. He also got a visit from his buddy Carson in the afternoon. The hospital wouldn't allow kids under age 12 (except siblings) in the room and so Josh had to walk out to visit with them. That tired him out so much that he slept for 2 hours afterwards and also started running a fever.
Although I was very impressed with the surgeons, the nurses were pretty hit-or-miss. Some were good, some spoke excellent English, most did not. I was really thankful for my Swahili lessons when I had to ask for his temperature to be taken. After about the first 12 hours, they stopped checking his vital signs, which was a bit unsettling. This hospital had excellent technology in some respects (CT scan), but they didn't even own a digital thermometer! Therefore, Josh had to hold the old-school variety under his armpit...then they'd forget about him so it would be in there for 10 minutes...then it would be in Celsius so I didn't know what it meant, anyway. But thankfully he only had one fever that came down with Paracetemol (aka Tylenol).
I was also thankful for my Swahili lessons because it has helped me to understand Swahili-accented English so much better. I often acted as an English-English translator between medical personnel and Josh!
The hospital had a little snack shop and restaurant which had pretty decent, reasonably-priced things (including the most Western-style coffee I've seen in Dar). Unfortunately, they did not serve food on Sunday (although this information was never posted anywhere) and so I was pretty hungry. Thankfully our friend Mark brought some things that evening.
Josh was not allowed to have any real food for the majority of his stay. He was offered broth, gruel, and black tea with sugar. Unfortunately, he didn't like either the gruel or the tea. The repeated rejections of the tea (Tanzania's national drink) greatly upset all the medical personnel. They said multiple times that drinking tea is necessary for the healing process (which I doubt is backed up by scientific evidence, but I forced Josh to take a few sips anyway).
As with hospitals in America, next steps are usually unclear. A lot of time is spent waiting around and then, BOOM! you're discharged.
The total cost for everything was $3.3 million Tanzanian shillings, which sounds like a big number but is right around $2,000 USD. Unfortunately, our medical policy has a $2,500 USD deductible so we're probably out of pocket for the whole thing. But we are grateful that medical care is so inexpensive here. I am wondering what an equivalent U.S. surgery would run - tens of thousands of dollars? It was also amusing that we got a 3 page itemized bill, listing every single item used during our stay, including such things as "surgical blade size 10, 493.75 Tsh" and "Syringe 2 cc, 2@ 129.99 Tsh" (the total cost for those 3 items is less than 50 cents U.S.).
Overall, I feel everything went about a smoothly as an emergency appendectomy in a Third World country can go. So many people here supported us with childcare, meals, visits, transportation and prayers, and we really felt the outpouring of love from around the world. Thank you, one and all, for the part you played in our African Appendectomy Adventure!
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