Fun times at the zoo

April and Abbi went with the Fulks clan to the Kansas City Zoo today. It looks like it was fun. I was there in spirit, I guess. I worked all night and slept most of the day, so Abbi probably had more fun at the zoo than watching dad sleep all day. Last night was busy, with multiple babies delivered and lots of sick patients admitted to the hospital. Tonight looks like it's shaping up the same way.

aIt's plain to see that everybody had a good time.

I thought I'd include another of my favorite songs of all time sung as done by another artist I like alot. It's Sufjan Stevens doing "Come Thou Fount of Every Blessing." I love old Hymns, maybe it's because that's how I grew up worshiping God. They just don't make 'em like they used to.

Missing my girls.

I'm sitting here in the middle of the night on call and I miss my girls. I thought I'd just give you all a dose of cuteness tonight. Don't take it all at once, though. I don't want to have to admit anybody tonight with a cuteness overdose. Abbi and April went to Kansas City today to see the family. She went to her first pumpkin patch today and I think she had a great time, as you can see from the photos below! enjoy.

All quiet on the McQuillen Front

All is now quiet on the McQuillen front. Abbi is nestled in her little chair, throughly engrossed in Sesame Street. This is a huge improvement over the pre-terrible-twos exorcist-style fit she was throwing only moments earlier. A couple readings of "If You See a Cuddly Kitten" and some Elmo and she's good as new.April is out getting her hair done, so Abbi and I are just kickin' it with Elmo, as noted above. I've been able to spend a lot of time with her and April this week, due to my schedule recently. I am acting as faculty for the residents this week. This draws lots of funny looks from the nursing staff. It's been great working with the residents as most of them are my friends anyhow. Lots of the stuff I'm learning this year doesn't fit neatly into the standard "Family Practice" body of knowledge, so faculty work is nice for keeping the medical skills I've gained over the last 3 years sharp. Just this week, I've delivered several babies, cared for newborns, ICU patients, and general medical patients. We've even had plenty of complicated stuff come in, which has been very satisfying to manage.

We've been able to hit the county park recently several times. I've included a clip below for your viewing pleasure that shows some of the park and also proves that my sweet little girl can get kinda feisty.

I spoke with Rick and Jack, my partners who are currently in Zimbabwe. They seem to be having a very good experience. They'd been without internet for 3 weeks and so we were all a little anxious to hear from them. They're healthy, healthy, and safe. Rick emailed me a list of the operative experience they've amassed so far. I'm sure that he won't mind me sharing a bit about what they've been up to, though you might be able to find out on Rick's blog: www.internationalfamilymedicine.blogspot.com. His list goes something like this:

• Anesthesia – Conscious Sedation (ketamine)
• Anesthesia – Retrobulbar Block
• Anesthesia – Spinal
• Appendostomy
• Articular Aspiration
• Articular Injection
• Bronchoscopy
• Burn Debridement
• Cataract Removal/Lens insertion
• Cesarean Section
• Closed reduction of Femur
• Closed reduction of Radius
• Club Foot Repair
• Colon Resection
• Conjunctival Squamous Cell Carcinoma removal
• Cystectomy
• Cystoscopy with Biopsy
• EGD
• Enucleation
• Exploratory Laparotomy
• Fistulotomy
• Hydrocoelectomy
• Incision and Drainage of abcess
• Interosseus access placement
• Laceration Repair
• Lipoma Removal
• Lumbar Puncture
• Lymph Node Biopsy
• Open Gastrotomy Tube
• Orchiectomy
• ORIF Femur – Intramedullary Rod
• ORIF Humerus
• ORIF Radius
• Paracentesis
• Parotid Gland Tumor Resection/Face and Neck Dissection
• Pterygium Removal
• Radical Hysterectomy
• Saucerization of humerus
• Saucerization of tibia
• Skeletal Traction Pin insertion
• Split thickness Skin Graft
• Suprapubic Catheter Insertion
• Suprapubic Prostatectomy
• TAH BSO
• Thoracentesis
• Thoracostomy tube insertion
• Thyroidectomy
• Trabeculotomy
• Traumatic Bladder inury repair
• Ureteral Stent Placement
• Urethral Dilatation
• Uretosigmoid Implantation
• US Scan – Abdominal
• US Scan – Cranial
• US Scan – Obstetrics
• Vaginal Delivery – Low Forceps
• Vaginal Delivery – Normal
• Vaginal Delivery – Vacuum
• Vaginal Laceration Repair - 2nd Degree
• Vaginal Laceration Repair - 4th Degree
• Ventriculoperitoneal Shunt Insertion
• Ventriculoperitoneal Shunt Revision
• Vesicovaginal Fistula repair
• Wound Closure – Secondary
• Wound Debridement
• Wound Dehisence repair
• Ovarian Tumor removal

It seems a little bit pretentious to say that we're learning all of the above. But, for those who may follow the blog with the desire to learn more about the fellowship we're doing, it's at least an accurate list of what goes on at Karanda.

We seem to be in a constant state of compiling more resources for those desiring to work on the mission field. This is both for the benefit of our future patients and ministry as well as for the good of those who will follow behind us in this sort of preparation. On really good set of resources is put out by Hesperian (http://www.hesperian.org/publications_download.php). I'm not sure that we are completely on the same page philosophically and all, but the dental book "Where There is No Dentist" is great. It's geared towards teaching community health workers to do dentistry. But, it also makes for part of a decent "crash course" in dentistry- which is what we need. Other books-all available FREE online- by Hisperian are listed as well.

A Community Guide to Environmental Health

Where There Is No Doctor
Where Women Have No Doctor
A Book for Midwives
A Health Handbook for Women with Disabilities
Disabled Village Children
HIV Health and Your Community
Helping Children Who Are Deaf
Helping Children Who Are Blind
A Worker's Guide to Health and Safety
Cholera Prevention Fact Sheet
Sanitation and Cleanliness for a Healthy Environment
Water for life
Pesticides are poison
Safe Handling of Health Care Waste
Women's Health Exchange
Global Health Watch 2005-2006
Global Health Watch 2
Where There Is No Dentist

On a completely unrelated note, I thought I'd include my favorite song in the world sung by David Bazan- the front man of one of my favorite bands, Pedro the Lion. He only sings two verses of the song, I wish he'd of sung more. This rendition pulls on my heart strings every time I hear it.

Here's David Bazan singing my favorite song in the world.

Hangin' with the girls

Today was a rainy day in Kansas. My afternoon schedule cancelled on me after a morning full of
ultrasonography. I spent time between patients researching the best way to learn ultrasound for life on the mission field in a developing country. I found two texts put out through the World Health Organization after reading a really good article about the use of ultrasound in a Tanzanian refugee camp. The article can be found here:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2657264

The books, as you may or may not be able to tell are entitled "Training in Diagnostic Ultrasound, Essential Principles and Standards" and "Manual of Diagnostic Ultrasound." The entire text of the former book can be found on Google Books. The later can be purchased online lots of places.

Interestingly, here is a nice breakdown of the distribution of the studies done in the camp:

Study type	No. of studies	% normal	% abnormal	% of total exams
Pelvic–gravid	132	86	14	24.1
Abdominal (not RUQ)	124	44	56	22.7
Pelvic–non-gravid	120	27	73	21.9
Renal	54	60	40	9.9
Right upper quadrant	49	51	49	9.0
Prostate	10	30	70	1.8
Cardiac	5	60	40	0.9
Soft tissue	2	0	100	0.4
“Ultrasound exam”	51	100	0	9.3

RUQ right upper quadrant

I thought it was nice to get some guidance, anyhow. Interestingly, a google search will reveal that ultrasound has been used to accurately identify even rib fractures, long bone fractures, guide joint injections and regional anesthesia, as well as find intra abdominal blood on trauma exam. It's truly a remarkable technology and I've found a renewed interest in it.

This afternoon, as I said earlier, I had off. It was nasty out. So, after a quick run I decided to take the girls to a local science exploration museum. Abbi had a blast, as did we. We found the "tornado machine" to be a lot of fun, as you can see below. I'm really not as annoying as I appear in the video. Well, not quite as annoying. Also, you can see April teaching Abbi how to fly an old fashion Wright Brothers style airplane on a flight simulator!

It's been a great weekend. I thought I'd go ahead and include two of Abbi's favorite "things" at the moment. On any given day, we wake up when she wakes us up. one of us typically heads to her room and picks her to take her into our room to snuggle for awhile. This morning, particularly early this morning, she just pointed to the door and said "dada" But on most mornings, the first thing out of her mouth is either an emphatic "Elmo" or "Beau," always said

through the sides of her mouth with her pacifier firmly in place.

As I said, this weekend was great. Today, we just got up and went to church early. The sermon was on the book of Jonah and really brought up some good points. We came home and had a huge nap and relaxed most of the afternoon. While hanging out with Abbi today, we went into the hallway to do some laundry. It's fun to have Abbi help me with stuff- she always loves to be involved. I figured she'd like to ride around in the laundry basket, so I tethered it to a leash and started pulling her around. This rapidly evolved into John and I running down the runway (hallway) outside of our place, as you can see in the video.

After, we headed over to redbox, one of my new favorite things. We picked up a movie, which April and I enjoyed this evening. Redbox is sweet, because it's free with this cool new site I found. You can use the coupon codes for free movies, and re-use the code with each new credit card. It's free, provided you get the movie back on time. The late fees are where they get you, after all. You can even rent stuff online at www.redbox.com and then go pick it up. wow!

http://www.insideredbox.com/redbox-codes/

Yesterday, we played at the county park and then headed to the state fair. We all had a lot of fun, riding the rides, eating various fried foods, and watching guys on horses juggle fire. Lots of interesting stuff and people were there for our viewing pleasure.

Playing Catch up

Two posts in a row. Hold onto your hats, people. Today has been a slow day. I got to hang with the ultrasound folks this morning as usual, but got to take off early to go to our library for story time with April and Abigail. Abbi really likes the songs, dances, and books read by the very talented librarian storytellers. During the morning, I did a paracentesis and got more familiar with gynecological ultrasounds- an important skill to have anywhere in the world.

As the year zips along, we continue to prepare for our trip overseas. For all of you who are curious about various specifics of the trip, I thought we should include the some good information. Also, we are very excited about our long term practice in Rural Iowa that will follow this year's training.

Here's a photo of our crew:

The websites for the hospitals our fellows serve at are found at:

http://www.teamzimmoz.org/
http://www.tenwek.org/

I guess I'm just posting this stuff for family and friends, and I'm trying to be a little more vague in the details of our life after realizing that people actually read this stuff.

The Center for Disease Control has a good web page on Zimbabwe, including recommended vaccinations. It's a little overwhelming at first glance and definitely errs on the side of safety (i.e. I wouldn't get the rabies "vaccine" if just coming for a 2 week visit). This touches on the dos and do nots of coming to Zimbabwe and pre-travel preparation.
http://wwwnc.cdc.gov/travel/destinations/zimbabwe.aspx

A pretty good article on Zimbabwe in general can be found on Wikipedia.com:
http://en.wikipedia.org/wiki/Zimbabwe

It's more like a thumbnail sketch of the country and it's issues I guess, but it will bring people up to speed on what the country is like.

Health related issues as it pertains to the country of Zimbabwe can be found in a very dry format on the World Health Organization's website at:
http://www.afro.who.int/home/countries/fact_sheets/zimbabwe.pdf

No.

It's Abbi's stock answer to everything these days. She's talking lots more these days and seems to love the word "NO." If anybody has any good parenting books on strong-willed kids, send 'em our way. We have to stifle laughter often as Abigail demonstrates to her general orneriness. Don't get me wrong, she's absolutely delightful to be around and she keeps April and I in stitches, it's just that she's very wordy and free spirited...I have no idea where she gets it.
We're trying to figure out the best way to discipline her when "time out" loses it's efficacy. I tried my hand at spanking her the other night. I forget what she was doing, but I put her in my lap and spanked her (with her diaper on) as hard as I was comfortable doing (which wasn't very hard). She immediately stood up, did a little dance and laughed out loud all the while spanking herself. Needless to say, I didn't achieve the desired effect. It took lots of restraint to keep April and I from laughing out loud. We'll have to retool this discipline thing.
In other news, April wrapped up her residency on September 2nd. Becoming a stay at home mom (for the time being) has been a switch for her. The responsibilities on her plate have shifted. We have a lot more time together as a family now, which is only one of the great things about this year of fellowship training.


As for Fellowship activities, I continue with my month of ultrasound and dental work. All in all, I'm having a really great time. It's largely been comprised of GYN/OB/abdominal ultrasound, echocardiography, and dental extractions.

Again it's been a great month. The reason for so much ultrasound is that at many hospitals in developing countries, ultrasound machines exist- but few people know how to use them properly. Will I ever have the proficiency of a radiologist or full time ultrasound tech? Highly unlikely, but I am becoming much more familiar with the equipment and technique and I'll be able to pick up on most of the more common ailments that could be identified with ultrasound. The ultrasound techs here in Wichita have been very kind and patient with me as I blunder through the month (though I'm blundering much, much better now than at the beginning of the month). The dental training has been phenomenal, too. The dentists are really good teachers and give us lots of autonomy during our dental training. Pulling out bad teeth is strangely satisfying and I'm getting better at it all the time. Most importantly, I almost always get home to eat lunch with the girls.
Hopefully we'll be writing lots more as we had wireless Internet installed yesterday!