Shanksteps 115
I have just completed my work day. Rounded on all the patients in the hospital, approximately 40. Have seen 18 outpatients. And did a bladder prolapse surgery. Now I have only one left. It’s a child who apparently got their foot stuck in the spokes of the bicycle. They have done dressings on him at a another mission clinic for the past week and now the foot smells rotten ( like rotten eggs) and has a large amount of dead skin up to the mid-calf. After prepping the leg with betadine I start
cutting off the dead tissue to expose the living tissue beneath. It goes well. I release the tight tourniquet that placed before surgery and everything starts bleeding (living tissue). It’s a good sign! I finish up my note and prepare to go home.
The maternity nurse askes me to see a patient that is not progressing in labor. She tried to deliver at home with the “forgerone” ( the blacksmiths who also bury people and make clay pots. How they ever got chosen to deliver babies is beyond my understanding). After trying for a while they were not successful in anything other than making her external genitalia look very abused and extremely edematous (swollen). A traditional birth attendant was then called who evaluated her and tried his hand
at it for a little while and then sent her to the hospital. As I evaluated her abdomen I feel what seems to be a “band” around the middle of her uterus. I worry about a uterine rupture. On examining her further I find meconium (baby poop in the amniotic fluid). The baby was distressed. The nurse had found a heart rate. But either way this baby was not coming out without surgical delivery. I called for the other OR staff and we headed in to prepare her. I make a low transverse incision. Take
the different layers, and as I open the abdomen blood gushes out. I find the baby free-floating in the abdomen with the placenta detached and the uterus contracted, baby dead! I’m to late! She was to late! But that doesn’t make me feel any better as I attempt to repair the damage to the uterus. She wants to conceive again because she only has three children. I also find her bladder is also torn. I repair her bladder and pray that the uterus and bladder, that are so fragile after being torn,
stay together for her to heal without creation of a VV fistula (a connection between the bladder and the vagina). I head for home at 10PM. Hoping that I am not called tonight so that I am rested for another day. I remember on the way home that I was supposed to have done vaccination supervision too. I guess it won’t be done. I hope they did a good job and that the women included got their tetanus vaccination. I sleep through the night and thank God for the rest in the morning. Today I have
the gentleman with the mandibular (jaw) fracture to repair. I will wire his mouth shut for 6 weeks. I pray he heals well. “God give me wisdom and strength for today!”