TDA rider observations from Iringa Tanzania to Chitimba Beach Malawi: March 20 – March 25
I am writing this blog from my kitchen table in Roseville, MN. Beside me is an emptied glass of orange juice, my 3rd cup of decaf coffee, and a mostly eaten bag of pretzels. On the table with me is the note pad I am writing on and my foam arm rest which helps elevate my right arm. Nice that I am left handed…
Below me, by my side, is my dog Maji – an ever faithful Brittany Spaniel. Every now and then I hear a ‘barking spider’. It’s Maji (Lloydie will understand).
Exactly one week ago- at about 9:00 a.m. Wednesday March 18th – I was riding on flat terrain on a gravel road at about 25 kph – not fast, not hard. We were 1 21/2 days ride north of Iringa, Tanzania. The sun was shining, but it was not yet hot. Too late I saw a big hole in the road. I went into it- but didn’t come out of it successfully. I fell on my right side and remember thinking ‘this hurts..it’s a skid, not a role.’ A lot of blood from the right arm, and road rash on the right hip. Other riders came and assisted.
Initially it was thought to be a major scrape. But the cut went deep – maybe to the tendon or bone. It was difficult to control the bleeding and eventually it was decided I needed to go ahead of the group in Eddies’ Land Rover to the hospital in Iringa. That proved to be a good move, because with x-rays it was obvious the major wound was not caused by a puncture from the outside, but instead by a puncture of the skin from the inside – caused by a broken bone – the ulna. I had sustained a compound fracture. Surgery would be required relatively soon to regain full functionality of the forearm. What I heard loud and clear: you will ot be riding a bike for 6 to 8 weeks. Officially I had an ‘open right olecranon fracture.’ I was put under, and the wound was thoroughly cleaned, ‘debribement’ they call it. The arm would need ‘definitive internal fracture fixation with either a tension band or plating’ – a fancy way of saying further surgery.
I spent the evening of March 18th at the Iringa Regional Hospital in Iringa, Tanzania. The next day I was transported by Flying Doctors to Aga Kahn University Hospital in Nairobi, Kenya, where I would spend Thursday and Friday nights.
At the Aga Kahn Hospital the situation was reassessed. Still surgery and therapy were needed and required – the same conclusion as in Iringa. Starting late Saturday / early Sunday I was on a series of flights back to the U.S. With layovers in London and Chicago, I was in transit for 30 hours before arriving in Minneapolis at 8:09 p.m. on Saturday evening.
I had the required surgery starting at 7:30 a.m. Sunday morning, March 22nd at Regions Hospital in St. Paul. It went well. I had a metal plate and some screws inserted in the ulna. Although I haven’t yet seen the scar from the surgery, I suspect it is substantially longer than the initial puncture wound. Later in the day on Sunday I was still feeling the positive effects of the surgery drugs and was fairly conversant.
Most of Monday was a different story as the effects of the initial surgery drugs wore off. I elected to rest and recuperate on Monday, and didn’t desire to see or communicate with anyone except the immediate family. By noon Tuesday I had completed the intravenous antibiotic series and I was allowed to be discharged. Later that afternoon I began washing some of my dirty cycling clothes which had been packed way wet for over a week.
It was nice to sleep in my own bed on Tuesday evening for the first time in a long time – but I have to admit I am still restless and I didn’t sleep all that soundly.
I end this blog by again thanking many people for assisting me this past week: TDA riders and staff; staff, doctors and cooks at the Iringa Regional, Aga Kahn, and Regions Hospitals; the Flying Doctors and folks at Medex, Health Partners, and the University for arranging all the transport back; Hedera for assisting with the communications; and the TSA X-ray lady who believed the bundle in my duffel bag was in fact tent pole parts.
(Not in original audio-blog: On Thursday March 26th – 8 days after the fall in southern Tanzania – I stopped in and spoke briefly with the students in the class (CFAN3480 ‘Food and Agriculture from Cairo to Cape Town at 10mph’) on the University of Minnesota St. Paul campus. I believe they understood when I said I really would’ve rather not been there…)
Nairobi, London, Chicago and Minneapolis
Not that the two previous days haven’t been long, but today was an especially long day for me – in part because I traveled west through 8 time zones.
I departed Jomo Kenyatta International Airport in Nairobi Kenya in the wee hours of the morning. Yesterday, being the spring equinox, the sun crossed the equator – today in the wee hours of the morning I crossed the equator also.
The British Airways flight from Nairobi to London took about 8 ½ hours flying time. My layover at Heathrow International in London was about 4 hours. Another British Airways flight – this time from London to O’Hare International in Chicago took about 12 hours. In Chicago I had to clear U.S. customs – which meant I had to claim my 2 checked bags, and physically move them from one terminal to another, then reenter TSA security for my last flight to Minneapolis-St. Paul (MSP). All this with one functioning are, as the right arm was in a hard cast. All went smoothly until the TSA x-ray lady flagged my green duffel bag and said ‘we need to open this one up.’ I think she saw the expression on my face as my jaw dropped about 2 feet. I asked politely ‘what did you see that gets you excited?’ She paused then said ‘you’ve got a bundle of narrow cylindrical tubes.’ It took a little time to process, then I said ‘oh yeah, those are my tent posts and pegs.’ By now other TSA employees were ready to dump the duffel bags contents, but the X-ray lady said ‘I’ll buy that – let him pass.’ I gave her one big smile, and a heartfelt thank you.
I rechecked the bags without hassle. During my 3-hour layover in Chicago I had the opportunity to buy a bit to eat. Ay you might imagine, I was hungry and had lots of options! So what food did I choose as my first food eaten back on American soil? An ice cream cone. From McDonald’s. I would have much rather been eating some of James’s cooking.
The flight from Chicago to MSP took 1 hour 45 minutes – it seemed to me to go quickly. We got in on time at 8:09 p.m. CST.
So – about 30 hours after boarding the flight in Nairobi – I was back in my home state of Minnesota. It was reassuring to have family and friends meet me at baggage claim. No hassles. Within two hours – by 10:00 p.m. Hedera and I had dropped off my luggage and the kids at home and were waiting in the Urgent Care Unit at Regions Hospital in St. Paul.
The process of getting admitted to Regions, being assessed and finalizing the next steps took about 6 hours. During that time, the splint on my arm and all the dressings were removed for the first time since Iringa. More x-rays were taken and evaluated. By about 4:00 a.m. on Sunday the 22nd it was decided I would have surgery on the arm at 7:30 a.m. – in 3 ½ hours.
It was nice to finally have some time to rest.
Started the day in Room 19 of the surgical ward at the Aga Kahn University Hospital in Nairobi and ended the day on a plane on the tarmac at the Jomo Kenyatta International Airport, awaiting take-off of British Airways flight 64 to London, England.
Food wise today I did get three solid (but skimpy) meals of hospital food. I selected the African cuisine choices – a millet-like porridge, corn ugali, and a chicken rice curry along with white tea and fruit in season (which turned out to be pineapple. I supplemented this with several PVM energy bars (Protein, Vitamins, Minerals) supplied earlier by TDA. I never did get sick of the various flavors – even the much maligned Rum& Raison.
It seemed it took a long time u- until early afternoon to hear back the results of the X-ray of the right arm. No surprise- it hadn’t magically healed. I had a choice of doing the surgery there in Nairobi or back in the States – I said I preferred the States. That posed no problem from their perspective and they thought I was fit to fly.
Communication back with Medex about insurance and who pays for the flight got complicated because I said I was fit to fly and that I would go economy class rather than business or first class in order to get an earlier and quicker flight without an escort. It was further complicated by the fact that today, Friday March 20 was an official University of Minnesota holiday, and Medex had difficulty contacting the University.
By early evening I had pretty much written off catching the evening flights and actually started washing some of the clothes I hoped to wear the next day. Most all my clothes were fairly rank from earlier rides. Thanks to facilitated communication between Hedera and the folks at Medex I got a call at 8:00p.m. wondering if I could catch an 11:30p.m. departure. Amazing I got to the airport and boarded on time. Our flight, however, was held up for over 2 hours as a couple of unruly passengers and their luggage were disembarked prior to take-off.
Ride: 0 K for Paul, 77 K for others
Nairobi, Kenya – Aga Kahn University Hospital
“I was once like you are now, and I know that it’s not easy
To be calm when you found something going on.
But take your time, think a lot,
Why, think of everything you’ve got.
For you will still be here tomorrow, but your dreams may not.”
Words from “Father and Son” by Cat Stevens (Yusuf Islam)
The TDA riders rode 77 kilometers today into Iringa. Not me – I was already in Iringa. I spend the night in a bed at the Iringa Regional Hospital. It was the first time in over 60 days that I slept in a bed, in a building, and not on the ground in a tent.
Uneventful morning in the hospital bed – except lots of nurses and cleaning staff stop by. I received pain medications and a series of three antibiotic shots.
Surprised to see Alex and Lone at about noon. Lone, with a cast on her left ankle arrived in Iringa yesterday from Arusha. (She had broken her ankle many days ago, but is determined to carry on.) Alex was on top of all options: medical, insurance, and travel. Once the compound fracture was identified yesterday it was obvious I wouldn’t/shouldn’t/couldn’t be riding a bike for about 6 weeks. Surgery was required to reconnect (with wires) the broken ulna. Where to have the surgery was the question. Could do the surgery in Iringa, but my insurance company preferred Nairobi or the United States. ‘Flying doctors’ based in Nairobi could get me to Nairobi, perhaps as early as today. Reassess the situation there in Nairobi – if surgery is urgent do it there, otherwise in the U.S.
The decision is that is what will happen. I get discharged from the Iringa Regional Hospital by 1:00p.m., and finally get to eat something. First food in 24 hours – since breakfast prior to the accident yesterday. Energy bars, peanuts, andazzi, then an omelet, chips and chai after being discharged from the hospital. Went then to the Baptist Conference Center where TDA trucks and some riders were staying.
Total cost for the hospital stay, which included 1 night, an x-ray, exploratory surgery, anesthetics, antibiotics, and 3 stitches was $182,000 Tanzanian Shillings or about $150 U.S.!
With assistance from many I got my bags together to repack. By 3:30p.m. we would know if I flew out to Nairobi yet today. I showered for the first time in several days. At 3:30 we heard that Flying Doctors were coming by 5:30. Eddie and Alex would take me to the Iringa Airport about 30 minutes away. I unloaded some bike and medical supplies and managed to get everything (with Tom’s help) in my two 90 liter duffle bags. My bike would be boxed and ship later by TDA (‘Not to worry’).
Lots of quick goodbyes. Too quick. Edward gave me a sunflower. I received the Maasai Steppe Master Stage Winner’s Plate, which I gave to Ernst. Paul M. gave me a silver medallion made by Addis of Ethiopia with the TDA logo imprinted on an outline of Africa. I fought back tears and couldn’t effectively begin to say thank you. Or goodbye.
Eddie, Alex, and I made it to the airport by 5:30p.m. The small Flying Doctors Beachcraft airplane with two pilots and a doctor arrived shortly thereafter, and we four were off to Nairobi – a 1 hour 45 minute flight.
I need to express my gratitude to TDA and its staff for how professionally and effectively they handled my situation – especially Alex, the paramedic who, at age 29 was cool, calm, and collected at all times.
(Here the audio-blog ended. I had a heck of a time getting this recorded completely. I did it from the roof of the Aga Kahn Hospital, and I kept loosing satellite signal. It didn’t help that I was still fairly drugged while trying to do it. Below is what else I had written:)
As we departed the Iringa airport I took a photo of a rainbow arching above the rocky hillsides of this relatively prosperous region. By 8:00p.m. we had landed at Wilson Airport in Nairobi, Kenya and by 8:45p.m. I was on a cot in the Urgent Care ward at the Aga Khan University Hospital. Only later did I come to believe that was a mistake. I didn’t need urgent care – not relative to the other people coming in the ward (50 bee stings to the head; gunshot in the chest; car accident victim). I didn’t get urgent care – 3 hours later I saw a doctor of the first time, and 2 hours after that I got an x-ray. So it was after 2:00 a.m. before I got a room so that I could go to sleep. Earlier, as I was waiting in Urgent Care, the insurance / Medex folks had been in touch with me. That was reassuring, but I was a bit cranky with them because it was well past my bed time and I was constantly being told (from Flying Doctors on) what I couldn’t eat because of the possibility of surgery. After the way I have been eating the past two month I was hungry. I will enjoy my next meal!
Ride: ~37 K for Paul, 97 K for others
Iringa – Iringa Regional Hospital – ‘Hospitali wa Khoa Iringa”
This morning we were about 174 kilometers out of Iringa, and our ride was to be 97 kilometers. The road still is gravel, rocky and sandy, with only an occasional hole under water. Moving out of agriculture land and into more bush and forest. The first hour was relatively flat – and the best line to ride was typically on the edge. At about 9:00 a.m. I looked at my distance traveled and it read about 25 K. I was on flat land and moving about 25 K per hour. I remember thinking ‘a little over an hour to the Mtera hydroelectric dam, then another 11 Ks to the lunch truck.’ Today I thought would be a breeze.
Looked ahead at a nice clean line for over ½ K. Big baobab tree on the left. I was on the left. Only too late did I see a huge hole in an area which the baobab tree cast it’s shadow. Swerve? No time. Go thru seemed the only option. The hole was a rain washout over 2 feet in diameter and about 1.5 feet deep. Bam! – I hit the far wall hard with my front wheel and over to the right I fell. No roll this time – only a scrapping slide. Instantly I knew I hurt. I also noticed my right shoe was still in the egg beater clip. I disengaged from the bike, got up, and left my bike in the road. My right arm hurt and it didn’t take long before I felt and noticed blood flowing down onto my right bicycle glove. I never really bent the arm to see what kind of wound I had. Couldn’t bend it without a lot more pain. There was a big rock by the side of the road to sit on, but instead I tried to walk off the pain.
Tim came up on me and stopped, then Taryn and others including Alex the paramedic, Mark, Carola, and Tom, the bike mechanic. They had band-aids, gauze and wrap. I saw on the rock and someone squirted water on the wound, then put on iodine. It took awhile to get the bleeding stopped (two tampons, plus lots of gauze).
Could I ride on? Should I? I would try. The dinner truck was still behind. Alex and Mark kept an eye on me. I couldn’t use the right hand rear breaks – too reach around and grasp. I couldn’t do much steering with the right hand. Only in times when I needed more stability would I effectively grasp the right handlebar.
I rode on for about an hour, and covered about 12 K according to the odometer. At that pace I would make it to camp – but it would be painful. I stopped for a break and Alex and Mark came up on me. Lots of swelling around the wrapped elbow. Then the dinner truck came up on us and we flagged it to stop so Alex could get some supplies to better dress the wound. As Alex unwound the gauze out pulsed numerous shots of blood. Chevon saw more than she wanted to see.
Alex said ‘Paul – you’re riding the truck.’ Not words I wanted to hear from her, yet seeing the amount of blood I was losing it wasn’t so hard for me to say ‘you’re the doctor. It took about 20 minutes to stop the blood flow and band-aid it up again. On the dinner truck I went. Dreams of EFI gone. They had called Eddie in the Land Rover and mentioned he should come back to pick me up. He arrived and so I transferred over to his Land Rover. During the process I again began to bleed, but Alex and Erin (the other paramedic) got it controlled. I had my arm constantly elevated.
We traveled over the hydroelectric dam and made it to the lunch truck about noon. There they again reassessed my arm as the majority of medical supplies were on the lunch truck. As soon as they unwrapped my dressing blood pulsed out. Again, pressure point pressure under the armpit slowed blood loss. By now Alex and Erin thought perhaps I had punctured an aortal blood vessel. Eddie would take me to a hospital in Iringa, with Claire, Alex and I in the back seat. I would hold on to a hook above my head most of the way to keep my arm elevated.
Along the way there was bleeding, and Alex and Claire tried to stop it by pressing on the artery in the upper arm, but blood still dripped. At about 1:00 p.m. Alex put on a tourniquet and that stopped the blood flow long enough to band-aid it up properly. The tourniquet was on for 10 minutes. It seemed like a very long ~125 K drive to Iringa – first ascending and then descending a forested pass – and then coming upon corn and sunflower fields.
We arrived at the Regional Hospital at Iringa shortly after 3:00 p.m. The wound began bleeding again – which speeded my entry . I was seen by a doctor who assessed the situation, rewrapped the wound, and put it in a cardboard splint. He didn’t feel the aortal vessel was damaged, thought most of the blood was pooled blood from surrounding tissue. X-rays were taken and they looked pretty normal to Claire, Alex and I. The doctor who looked at the X-rays spent what seemed a long time before saying ‘your ulna is fractured. It is a compound fracture and you will need surgery for it to heal.’ We explored options and implications: assess it tomorrow in the ‘theater’ and decide where to have surgery – here or at home in the U.S. ‘No’ Alex said, ‘the bleeding hasn’t stopped. Paul needs it properly stopped tonight.’ I was in the surgical ‘theater’ 2.5 hours later for proper stabilization and cleaning.
Drugs, administered by two Swahili-speaking nurse, put me effectively out for the night. One of the few highlights of the day…