Liberia #22
Precious is standing at the nurses station and Bendu walks up. Bendu says “Doc, der a patient fo ultrasound”. I’m just finishing rounding on most of the 10 inpatients we have. And surprising enough they are mostly surgical. I saw the guy I did the bilateral large hernias on. The guy who I did a below knee amputation, let me digress and talk about him.
So this man came in with a long standing bone infection and a hole in his leg about mid calf. The foot was swollen, I opened the joint and pus flowed out. After many days of dressings, he developed a necrotizing infection that can kill you quickly. I finally convinced him to let me amputate the leg below the knee. In the operating room, I asked what saw they had to cut the tibia and fibula (two leg bones). They had some giant cutters for the smaller bone, and a hack saw for the larger bone. I did the usual operation of cutting through the muscle with cautery and a scalpel. Then cut the smaller bone with the cutters, then slowly sawed my way through the tibia with the hacksaw. It had been autoclaved, but the blue paint on the blade stuck to the cut surface of the bone. The bone marrow had been replaced by fat- not a great sign. I used a pitiful appearing rasp to try and get off the blue paint unsuccessfully, but took off all I could. Eventually I closed it with a drain. He has been healing well and no sign of infection- in spite of blue paint on his bone! I am certain that God protects many things we do, especially in these locations where what is best, isn’t available. Why He doesn’t or can’t intervene in all circumstances- is a question I want to understand some day in Heaven.
So back to rounds. I saw the old woman with an infected foot, who is slowly improving after debreding off a lot of dead tissue. I see the burn guy Ernest, that we have been doing daily dressings for my whole time here and slowly is healing most areas. A young woman with PID (infection of uterus), likely sexually transmitted diseases we don’t have tests for. I get called downstairs to see a man we did a prostatectomy on. He wants his urine catheter out. I go see him, and tell him we cannot take it out for at least a couple more weeks. He had a catheter placed incorrectly and it all needs to heal over the tube before removal. He’s not too happy, but will come back on a couple weeks.
I do some ultrasounds. Most of them are pregnant women who want to know the babies position and sex. One says she was told she has twins at an outside hospital. I can only find one 8-month-old fetus. I look and look and cannot find another. That is rather disconcerting. I tell her I do not know why she was told that, but I can only find one child. Is it my ability to identify the correct findings, or was it the other place? Either way, I don’t like it! Another woman has excessive bleeding at her periods. I find a small fibroid and treat her with medicines to help the bleeding. Another 18 year old comes in with her mom, to know the sex of the child.
In the evening we hear that there has been an explosion at a rubber plant “in the interior”, meaning anywhere but Monrovia. And that we will be getting up to 9 patients that have been burned. Later we hear that this explosion occurred 5 days ago, and that the four most critical went to Firestone hospital (named after the town where Firestone tire company has it’s plant).
I finish what I’m doing and Dr. Seton needs to go the store, so I ask to go along to get some bread, lentils, and drink mix (Fosters). Just as we are ready to go, the “ambulance” arrives with the 9 guys. I grab a bunch of blank paper and head down there. A quick glance, and I observe a group of guys that look tired but not severely ill. Most have bandages on arms and legs. One has a cast on a leg, another with his arm in a sling. At least they don’t appear to be dying in front of me. So I take my time and go one by one. Dr. Seton helps when she is free. Of course, whatever x-rays they have had- they did not bring with the patients. And as I’ve mentioned before, there is no functional x-ray here. The reference form for the guy with his arm in a sling- says that he has a posterior dislocation of his shoulder! For 5 days no one has put it back in it’s socket after a diagnosis? He will be one of the first I deal with once he gets to the floor. I question the guy with the cast on his leg. He says a piece of metal hit his leg. I think he says that his skin is not broken, but I will have to verify this later by cutting his cast off. I’ve seen to many open fractures that don’t heal or pus out, for lack of appropriate care. So will not just take his word. Besides, I’m not entirely convinced that he said there was no break in the skin, even with the translation of one of the other guys. Another guy has total hearing loss after the explosion. He has no visible injuries, and nothing draining from his ears. We do not have even an otoscope to look in his ears. Wish I had brought my personal one. He motions and “reads” lips. Others have blisters on their arms, where steam burned them.
Later on, we go back and change all the dressings and look at each burned area. I give the guy in the arm sling a slug of Ketamine and he goes out. Then with traction and counter-traction, I am able to get his arm back in socket. It feels a little different than before. I wait till he is awake later and confirm that he can move it all over, without pain. Surprised that it went back in so easily after being out of joint for 5 days. The guy with the cast, I cut in half along either side of his leg. After taking off the top half, I inspect the lower leg; it is swollen and tender in the lower half. I move the bone and see a place where it is moving but shouldn’t be. No break in the skin. I replace the half I removed and then replace plaster of paris cast material to solidify it again.
During the course of the day we admitted 3 others. So we went from 10 yesterday to 25 patients today in the hospital.