Ward 5C - A tale of poop and professional growth

After working for 2 weeks on Ward 14, I felt ready to graduate to the next stage – Ward 5C, the high-risk labor ward. Rumor has it that it’s just like Ward 14, except with ten times as many patients, and half as much staff. You really have to know what you’re doing in order to not get lost amidst the chaos and turmoil. I’ve been well-trained by the midwives and Lauren. I was ready for the challenge!

I arrived on Ward 5C, fresh and ready to take on the world. Minutes after joining the team on morning ward rounds, a mother started screaming her 2^nd stage scream. Nobody else paid her any attention, so I rushed over to assess her. Yep, just as I had suspected. Her baby was crowning. I gave her strict instructions not to push (“TOSINDIKA!!!!” I yelled.) and ran around prepping the delivery set. When I was ready, I took up my position on the maternal right, ready to support the perineum as the baby’s head popped out.

Now, to truly comprehend the profound horror and irony of this upcoming moment that I’m about to describe, you have to first understand something about me. Throughout my medical career, I’ve gotten used to dealing with all sorts of nasty secretions and excrements that most people wouldn’t consider topics suitable for polite conversation, even for war criminals or rapist-murderers. Nothing really fazes me anymore. I’ve ducked from massive splashes of amniotic fluid exploding out of the uterus (sometimes not altogether successfully…), I’ve jumped back just shy of a giant gush of blood shooting straight out of an accidentally nicked vessel directly at my face, I’ve gotten urine sprayed all over my face when a careless doctor slip-shoddily pulled a catheter after surgery, scrubbed in on a surgery when a man’s complete intestinal contents (mostly in the form of fully-formed feces) spilled right out into his peritoneal cavity, and we had to wash it out with over 30 liters of warm saline, with most of that shit-soaked saline flooding out of his body, off the operating table, and onto my surgical scrubs – yes, it soaked right through the supposedly water-proof sterile gown and got to my scrubs; and yes, I went straight for evening rounds without changing my scrubs because the case had taken so long that we were waaaay late for rounds, and my chief resident deemed it more important to get the rounds done than for certain members of the team to not be a health hazard to herself or anyone around her. You could say that my tolerance for intense grossness is quite high. But one thing that I absolutely cannot get used to, that I absolutely detest, is dealing with human feces passing out of the anus.

From my experience so carefully detailed above, you would wonder how that can possibly be, wouldn’t you? Shouldn’t my month-long rotation on colorectal surgery, with all my varied experience with all the varied forms of products of digestion, have sufficiently immunized me against my personal disgust for shit? But you see, shit you encounter during a procedure or a surgery, while you’re fully dressed with layers of protective gear (which as we have already found out, may not be that protective after all), that kind of shit is enshrouded by a sterile, clinical atmosphere, which removes you from the usual connotations and associations that you may have developed with regards to human excrement. So what I’m trying to say is, the shit you visualize with your camera while doing a colonoscopy is NOT the same as the shit you visualize with your very own eyes passing out the anal canal of a woman who is pushing out her baby. The latter is infinitely grosser than the former, and I have not become acclimatized to it. Yet.

So back to the story. I’m standing next to the laboring mother, waiting to deliver her child. Imagine my surprise when instead of the head, it is the baby’s butt that’s popping out. When I had checked her, what I had thought was the head was actually the baby’s breech. This was a super-premature baby, and the “head” felt softer than it should have, but I figured, hey, it’s a premie, maybe their heads are just softer like that. I had also read the patient’s file, which listed the presentation as cephalic, and so, I guess I felt what I expected to feel, without really doing my job. Hopefully, I shall never make that mistake again.

“Breech! Breech! It’s a breech delivery!!! I need some help!!!” I started yelling, hoping to capture the attention of some senior medical personnel, someone who actually knows how to conduct a breech delivery. I was completely ignored, of course, my cries blending in harmoniously with the cacophony of laboring women’s shrill screams of pain. I didn’t know what to do, so I did what I was taught to do – support the perineum – not that this lady needed much support. The baby’s butt was so tiny it posed no danger to her perineum at all. However, as the tiny baby butt slowly moved out of the mother’s vaginal canal, it started passing meconium (fetal poop, for those of you lucky enough to be uninitiated into the world of medical euphemisms for poop), a slow steady paste, like toothpaste being squeezed out of the tube. At exactly the same time, the mother also started passing feces, perfectly in sync with the fecal motions of her baby. I was in total shock. I didn’t know what to do. How do I deal with this dual onslaught of poop? Whose bum do I wipe first??!

“Ok, MY,” I told myself. “Get a grip. You can do this. Breathe, just breathe, and do your job. Deliver this baby, damn it!!” I took a private moment to swallow my anguish and disgust, and sprung into action. I grabbed some cotton and brusquely pushed the maternal poop out of the way. I decided to ignore the baby’s poop. It seemed a little more innocuous. I continued supporting the perineum, and the baby was progressing along just fine, slowly sliding out of the womb. I had stopped shouting at this point, deeming it a waste of my time and effort to continue trying to draw attention to this maternal complication. However, I was still mumbling “Breech! Breech!” at a barely audible decibel, probably because I was still mentally stunted by the shock of this whole experience, more so than anything else. An American doctor working with Mulago to improve their maternal health practices happened to walk into the labor suite, and heard my feeble mumbles. She immediately realized the gravity of the situation, and that I was way out of my league, delving in unchartered waters. She donned a pair of sterile gloves, and took over from me, just as the baby’s body had been fully delivered, and proceeded to safely and successfully deliver the baby’s head.  

I breathed a massive sigh of relief. Everything was going to be fine. I had even managed to escape the situation psychologically intact, more or less. No situation involving a laboring mother and her poop will ever faze me again. Not after this – my first delivery on Ward 5C. Oh, and one more thing… All the horrible rumors you’ve ever heard about this ward – they’re all true.

Ward 14 - The knight in shining armor, aka nurse in cutesy scrubs

I’ve been clinically depressed for a while now. I made a self diagnosis a few days ago with the help of SIGECAPS. Why am I depressed, you ask? You may guess that it’s related to work, but you’d be wrong. It’s related to life. Our landlady is having some family problems, specifically involving her husband, and him not really contributing to this household. He has another wife, whom he stays with most of the time, and he doesn’t really support our landlady, as all his financial resources is poured into his other home. Our landlady fell behind in paying our water and power bills, and so we have not had running water or electricity since early September. Her husband had initially promised to help pay off those bills, but then started having financial problems related to his work, and so couldn’t contribute any money when it came time to foot the bills. Now, our landlady is sick and tired of her husband never supporting her financially, so she decided that since he had promised to pay the bills, he shall have to pay the bills – she won’t pay off the bills, even though she had the money to do so after collecting our rent. And us, the poor innocent tenants, find ourselves caught in the middle of this family drama, having to suffer the waterless, powerless conditions because of their stupid fight.

So at night, we do everything by candlelight, which only retained some romantic flavor for the first week or so. We go to bed super early, because there is nothing else to do. I charge my electronic appliances at the hospital, usually at the nurse’s station, and have to deal with the constant worry of having my electronics stolen while charging. So after a few weeks of these deplorable living conditions, I realized something important about myself – despite my career aspirations to help develop health infrastructure in third world countries, I could never work for more than a few weeks in a setting with no running water or electricity. I am much too spoiled for that. I have reached my personal limit that simply cannot be crossed. And I started to feel homesick in a truly bitter and miserable fashion.

Luckily for me, I started work at Ward 14, the low-risk obstetrics ward in Mulago Hospital. I LOVE Obstetrics, and enjoying myself tremendously at work made the miserable home life much more bearable. My days are filled with the joys and wonders that only the birth of new life can bring. Can you imagine a more fulfilling job? Also, on my third day at Mulago, I met a true life-saver at this crucial point of my Ugandan experience – Lauren Rogers-Bell. Lauren is a fantastic nurse newly graduated from the prestigious Johns Hopkins University. She is actually pursuing a dual degree – a Bachelor’s in Nursing and an MPH. The MPH is currently on hold as she’s spending the year in Uganda, building up her resume, but more importantly, spending some time with her fiancé, Cary, who is working for UNICEF in Kampala. What an international work oriented couple! Since Lauren is mostly interested in maternal health in developing countries, and envisions concentrating on that aspect of global health in her future career, she has been spending most of her time in Uganda working on Ward 14. She quickly took over most of the teaching responsibilities, guiding young students, both Ugandan and international, through many of their first vaginal deliveries ever. So luckily for me, Lauren showed up and really set me straight in terms of my delivery skills and technique. We got to chatting a bit about our private lives, and I told her about my deplorable living conditions. I needed a vacation in a first world country – stat! Especially now, when my room-mate was going to be away for 2 weeks on a work trip, leaving me all alone in the dark, dark apartment. Lauren immediately invited me to stay with her and her fiancé, assuring me that her home situated on top of a hill in Muyenga, the residential district favored by most expats, with glorious views over the city, hot water showers, almost constant access to running water and electricity, was as close as you can come the first world, while being physically situated in Kampala. So I happily packed my bags and moved in the very next day.

I stayed with Lauren and Cary for 3 whole weeks, living the high life, feeling like a rock star. I was staying in a 5-star hotel. Every day, I piled into their Toyota Rav4, catching a ride to Mulago with Lauren. At the end of the day, I would ride home with Lauren. We would cook (I can actually cook as they have a gas and electric stove, and I don’t have to mess with trying to light charcoal with a burning plastic bag) all sorts of great food, sometimes accompanied by wine, always shared over amazing company. It was the perfect vacation, the break from my hard, strife-filled third-world living that I desperately needed. I shook off the shroud of depression that had threatened to engulf me, slowly but surely, usually while sitting on their balcony overlooking Lake Victoria and the hills of Entebbe, sipping a refreshing cup of tea… or sometimes wine. By the end of my stay, I had completely recovered, and was eager to embark upon my great African adventure again! Since I had gotten my energy and upbeat personality back, (and more importantly, since my visa was about to expire), I even decided to jump right back into the saga with a solo trip to Rwanda (stay tuned for more details…)!!!

I have so much to thank Lauren and Cary for. Their kindness and generosity are the only reasons I didn’t cut short my stay and fly straight back to America in October. Without them, my great African adventure would have ended on such a negative note – in complete and abysmal failure. A little bit of kindness goes a long way. I shall never forget that, and will try in the future to repay their kindness by extending a helping hand to others in need, others like me in my sad, lonely, depressed state back in that fateful month of October.

Ward 14 – Learning to deliver

I finally found my way back to Mulago Hospital for my much anticipated rotation on Obstetrics and Gynecology. As instructed by the many international students who have rotated there before me, I requested to start out my rotation on Ward 14, the labour suite in Old Mulago for low-risk obstetrics patients, entirely run by a team of uber-experienced midwives, and a perfect learning ground for newbies like me.

I met with a cold welcome when I first presented myself to the sister-in-charge on Ward 14. The midwives there are really busy and overworked, and in their experience, most of the students who pass by stay for only a short while, disrupting the overall pace of work in order to gain experience and knowledge, and disappear before they are actually skilled enough to help lighten the workload. Thus, that you really have to prove yourself to be eager to learn and help out before they will pay you any attention. When I first told them that I was only planning on staying for 2 days, they scoffed. “But what can you possibly learn in 2 days? You must stay for at least a week.” Sister Florence, the in-charge, informed me. And by the end of my first day, I had already learned so much from them that I decided to stay for the whole week. They showed me the ropes in terms of how to deliver women in these low-resource settings, and how different it is from what I’ve been used to in the US.

The first delivery that I observed totally shocked me. These women have to bring their own delivery set, which includes, at the minimum, the following items: a large plastic basin, a small bottle of Jik bleach, at least 2 large plastic sheets, a huge roll of cotton, a few pairs of sterile gloves, a razor blade, 2 sheets for the soon-to-arrive baby, and a change of clothing for themselves. Why these items, you wonder. Well, allow me to explain.

The laboring mother who is found to be in the active stage of labour gets a bed in the labour suite, and she proceeds with her suitcase (presumably filled with the items of her delivery set) to the bed. She spreads the large plastic sheet on the bed, both to protect her against the nastiness of the bed and to protect the bed against the nastiness of her labour-induced fluids soon to be spread all over the plastic sheet. She also provides the sterile gloves for the midwives to use while doing vaginal exams and during the delivery. Then, if she is lucky, she may get checked once or twice before her actual delivery. If she is super unlucky, she may end up pushing out her baby on her own while the midwives are busy with other deliveries. Let’s say she’s lucky. She screams her classic second-stage scream (if you work in a labour suite for long enough, you learn to recognize the unique scream that soon-to-be mothers emit when their babies are crowning – it is a terrific combination of pain, anxiety, and anticipation, brushed with a hint of desperation and a tinge of hope – that directs you to the woman who needs your attention most immediately in a room full of laboring women screaming in agony, forming a strange cacophony of sweet but unbearable pain) and you rush to her side (after hopefully having had time to don a plastic apron to protect yourself against splashes, and if you’re me, you also wear goggles for eye protection, though I don’t always have time to put these goggles or the apron on before the baby starts popping out). You prepare your delivery “tray”, in case you don’t have an assistant by your side when the actual delivery happens. Note that this preparation precedes the checking of the mother to see if she indeed is in the second stage of labour, because we cannot afford to waste a precious pair of sterile gloves on the vaginal exam, which results in the not-uncommon tragedy of the mother pushing her baby out while the deliverer, in this case, me, is busy preparing the “tray” and does not even have gloves on to try and catch the baby before it pops out traumatically, ripping a nasty tear into the mother’s vaginal wall and perineum. Anyways, back to the “tray”. You first track down the plastic basin that all laboring women bring with them. You place it beneath the mother’s bed. Then, you find the huge roll of cotton, a necessary part of any delivery. You break off a big chunk and set it close to the mother’s perineum, ready to wipe off and push away poop that may get squeezed out as the baby’s head descends, to catch the amniotic fluid that may fly out as the membranes rupture, and to support the mother’s perineum as the baby’s head exits the vagina to prevent tearing. You open one set of sterile gloves, tearing off the rubber rings located on the wrist end of the gloves that are meant to provide some elastic traction to keep the gloves from sliding off your hands – these rings are used as ligatures to tie off the umbilical cord. You place the rings on top of the sterile-ish package holding your now not-so-sterile elastic ring-less gloves, and this serves as your delivery “tray”. You break open a glass bottle of Pitocin for use after the delivery of the baby to help the uterus contract and prevent post-partum hemorrhage, and fill a syringe with the drug (it is to be delivered as an injection intramuscularly), making sure to save the broken glass bottle in case you need to use it to rupture the membranes (if the membranes are not already ruptured). All these items are placed on your delivery “tray”. Lastly, you open the razor blade and add it to your “tray”. Finally, you search around the suitcase until you find the baby sheets, and place one of these sheets on the mother’s abdomen. You now open another set of sterile gloves, so that you can double-glove. You first don the not-so-sterile pair of gloves on the inside, and add the actually sterile pair of gloves to the outside. You do a vaginal exam and more often than not, the mother is in the second stage of labour just as you had expected, and is ready to start pushing. Good thing you already prepared your “tray” so you’re ready for the delivery.

If the mother is still dressed, you ask her to strip. Yes, these women give birth absolutely naked. Not a whole lot of dignity gets retained during this birthing process. The mother starts pushing, with shouts of encouragement from you. “Sindika! Sindika! Yongera! Sindika!” “Push, push,” you yell. You tell her to raise her head off the bed, and hold onto her legs with her arms. This goes on until the baby’s head is crowning. Usually, this process proceeds smoothly. However, once in a while, the mother demonstrates “poor maternal effort”. This basically means that the mother is not pushing effectively, either because she is tired, or because she doesn’t know how to push. Now, for outsiders like me, there is only so much we can do to encourage these women. But there comes a time when encouragement alone does not suffice, and some intimidation is necessary to get the baby out. Now, I have not yet fully adapted to the delivery process here, and so intimidation is not currently in the arsenal of tools I have at my disposal. So I call in an experienced midwife, usually Sister Sarah, the most experienced and intimidating of them all. She comes, screams at the mother, pushes her roughly into the optimal position for pushing (head tucked, legs pulled way open) and sometimes slaps her a few times on her thighs. Now, this may seem barbaric to some of you back home, and when I first witnessed this, I thought it was so unbelievably mean and unethical to treat women who are already suffering so much with so much cruelty. But it turns out that it is not cruelty, but the lesser of two evils, and I swear that it works like a charm. What I couldn’t get the mother to do with some 30 to 45 minutes of eager encouragement, Sister Sarah gets done in a matter of minutes, and when I say minutes, I mean usually less than 5. Suddenly, the mother is able and willing to push, and push effectively, and the baby pops out effortlessly. I have carefully considered this matter, and discussed it at length with both my American and Ugandan friends working at Mulago. As a result, I have drawn a tentative conclusion. I believe that Ugandan patients do not respond as well to encouragement as American patients do, and they certainly respond much better to threat and intimidation. I have seen and experienced this many times myself. For example, when I politely asked a patient’s attendants to leave the labour suite, they dragged their feet, and basically didn’t move. When a midwife came and ordered them sternly to leave, yelling at them, and shooing them away, they left immediately. So perhaps, when polite encouragement fails, threat and intimidation is the way to go. In fact, all of the mothers I’ve seen who were yelled at, and even slapped, were super grateful to the midwife who yelled at and slapped them, despite their apparent “meanness”. These midwives got the job done, and got the babies out before they became distressed, or worse. All of the mothers seemed to prefer a few slaps and rough words to a sick or dead baby. I know I would. Interesting food for thought, isn’t it? Where would you draw the line between ethical and humane conduct, versus doing everything you can to avoid a possibly terrible and tragic outcome?

Anyways, back to the hypothetically smooth delivery. The baby’s head is crowning, and you use cotton to support the perineum as the baby’s head pops out, and if you do your job well, the mothers generally do not tear. Once the head is out, you wait for restitution, and the shoulders to descend. Then, you deliver the anterior shoulder, followed by the posterior shoulder, and the rest of the body follows. You deposit the baby on the sheet on top of mom’s abdomen, and quickly dry the baby off. If all is going well, the baby is pink and feisty, and crying at the top of his/her lungs. You give mom the Pitocin injection, often without cleaning the skin with any kind of antiseptic, and hope the mother’s immune system will prevent her from getting an infection. You tie off the umbilical cord with the elastic ring ligatures, and grab the part of the cord between the ligatures with a piece of cotton to absorb the blood splashes before cutting it with your razor blade. You clean the baby off and show the sex to mom – “Muana ki, mommy?” Then you wrap the baby snugly in the second, clean sheet, and find a relatively clean area of the bed to place the baby. By this time, the placenta should have separated, and you use another piece of cotton to firmly grip the umbilical cord. You use firm traction to deliver the placenta, while applying pressure just above the pubic symphysis to prevent uterine inversion. As the placenta reaches the vaginal introitus, you let go of the cord and grab it with both hands, twisting as you gently pull to gather the trailing membranes into a stronger cord, so that hopefully no membranes will be left behind. You examine the placenta for completeness, and then drop it in the large plastic basin beneath the bed.

Now you get to the really nasty part – the cleaning. I’m telling you, I’ve never properly appreciated nurses and patient care technicians until I had to do the cleaning part myself. I will never again take any nurse or PCT for granted, I swear. The first few times I witnessed this process, I almost ran away. But I had to start cleaning as soon as I started delivering. You have to take charge of every part of the delivery, including the gross aftermath. So here’s what you do. The mother is now lying in a pool of nasty fluids such as amniotic fluid, blood, urine, feces, etc, atop the plastic sheet. You roll up this plastic sheet, trying to catch all the fluids in it, without letting any leak onto the bed underneath (not always a possible feat). You ask the mother to lift herself off the plastic sheet, which you then pull out from under her. You then drop the rolled-up plastic sheet into the basin. You take the basin with you to the instrument room, separating the placenta out from the rest of the waste, depositing it into the placenta bin, and then toss the rest of the contents of your basin into the biohazardous waste bin. You rinse the basin off, and fill a small tin bowl with Jik diluted with water by a factor of 6. You bring the now relatively clean basin back to mom, and drop her soiled clothing, sheets, etc into it. You ask the mom to get off the bed, and clean her with some cotton soaked with diluted Jik. She starts getting dressed as you wipe off the bed with more cotton soaked with diluted Jik solution. You dry off the bed with cotton (see the importance of cotton in all of this?) and then spread a new plastic sheet over it. If the mother has a bed sheet, you place it on top of the plastic sheet, and the mom gets back into her bed to recover. You then weigh the baby, and write your delivery notes. A job well done!

P.S. I am never giving birth at Mulago.

Menstrual Health Project in Kalisizo

I traveled to Kalisizo to work with Brick-by-Brick on a menstrual health project. The theory is that many girls in low-resource, low-income settings hit puberty, start menstruating, and start missing school, because they do not have access to sanitary products that ensures adequate protection against embarrassing leaks. These girls’ grades drop, and some of them probably end up dropping out of school. Thus, if we provide them with access to sanitary products, then they can stay in school, get an education, and get further ahead in life then they would have otherwise. This sounds reasonable and logical, but the theory is supported by little more than anecdotal accounts. In fact, the largest, and possibly only, randomized controlled trial conducted to study the subject found that girls missed very little school in general, and girls who were provided with free sanitary products had no difference in school attendance from girls who were not provided with the products. Thus, Marc Sklar, the founder of Brick-by-Brick, wanted to find out if there is an interest in and need for access to reusable sanitary products amongst primary school girls in Kalisizo, and I had been tasked with conducting the survey. I shall not delve into the details of the survey. Suffice it to say that there is a great interest in access to affordable and reusable sanitary products amongst the girls.

In order to derive enough energy to conduct this study, I had to find nourishment around town. And that was how the chapatti guys came into my life. I first met Frank and Hassan while hunting around for rollexes in Kalisizo. They sold chapattis and rollexes in the mornings and evenings, and I purchased at least one rollex from them every single day. Their rollexes were delicious, and I may or may not have developed a mild addiction to them. However, one fine morning, I woke up a little bit late, and arrived at the chapatti guys’ stand to find everything sold out. I was absolutely distraught. I was craving a rollex. I wanted it. I needed it. Frank calmly told me that there were no rollexes left, as he was preparing two rollexes right in front of me. “What about those rollexes?” I asked him. He shook his head. Those were for him and Hassan. The rollex he was preparing was the biggest I had ever seen – he had stuffed it full of eggs and tomatoes. He must have been hungry, but I was hungrier. I sat down and refused to leave. I want to buy that rollex, I told him. You told me you’d be here until noon, and it’s barely 11.30am! How can you already be sold out? That is unacceptable. A businessman must keep his word to his customers, especially one as loyal as I. Please. I really want a rollex. Please? Pretty please? Frank shook his head in defeat and sold me his lunch. “Webale nnyo nnyo nnyo sebo!!!” I screeched in delight. I sighed with complete happiness as I bit into my rollex, brushing aside the tiny tinge of guilt lingering around my cloud of bliss. I would make it up to him. And I did. On my last day in Kalisizo.

On my last day in Kalisizo, I woke up at the crack of dawn and headed to town. I arrived at the chapatti stand before either Frank or Hassan. I was their apprentice for the morning. I wanted to learn to make chapattis and they didn’t mind the help (or hindrance – these are really really nice guys). They taught me the correct proportions of flour and water to use, how to mix everything (that was really hard work – Frank did most of it, since I apparently do not possess the requisite upper-body strength to make a master chapatti chef). We added some oil, and started to break off pieces of dough to turn them into these little dough balls ready to be rolled into chapattis. This is a lot harder than it sounds. You have to first break off a piece of dough that is just a little bit bigger than the right size for making one chapatti. Then, you place the dough in your hands and start to tuck the outside edges of the dough piece into its center with your two thumbs, while slowly nudging it towards your left palm. Eventually, the dough ends up completely in your left hand, while your right thumb is still tucking the bottom edges into the center of the now almost completely round ball of dough. You close your left hand into a fist, squeezing the dough very gently so that it pops up as a completely round ball right on top of the ring formed by your thumb and index finger – it kinda looks like you’re holding an invisible ice-cream cone with the dough ball as the scoop of vanilla ice cream sitting triumphantly on top, basking in the glory of its perfect spherical geometry. This whole process takes about 3 seconds (if you’re Hassan or Frank), but I started out at 30 seconds with a semi-spherical glob, and worked my way to about 10 seconds with an almost perfect sphere. Progress!

We then flattened the dough balls and rolled them into flat pancakes. Hassan then showed me the next stage of chapatti making. He put a flat dough piece on the round chapatti grill, and then turned the dough with his left hand while stretching out the circumference of the dough with the curved medial edge of his right hand (the meaty part of his hand right underneath his pinky finger), so that the chapatti became further flattened out into a perfect circle of deliciousness. This was really hard for me to learn, as I kept worrying that I was going to burn the skin right off of my right hand. But I got it, eventually, kind of.

At this point, we had attracted a crowd of spectators. Apparently, they had never seen a Chinese person make chapattis before. Business was great! We sold all of our chapattis and rollexes by 11am. And my greatest triumph – I made my whole Rollex from start to finish and ate it with great relish!