Bere 2018 #8
It seems unusually quite as I wake up. All I hear is the chirping of crickets and bird songs. Then I realize, it’s because my fan is off. I guess the power went out again. I was told yesterday we have 4 generators. 2 are old and don’t work anymore. The one we are using is only made to work 10 hours out of the day, so it gets to hot. And I’ve not heard anything about the 4th one. I consider laying in bed as there will be no elective operations today with out water and power.(water is still out today). I’ve not been told of any emergencies yet, so Ill rest. Then I realize there is morning worship and maybe another meeting too. So I get up and find a bottle of water that the accountant got for me last night and drank a liter. I read my own customary worship and head to the hospital. After worship at the hospital, I make rounds on surgical ward, then medical ward, and start doing ultrasounds, as the ultrasound nurse is gone this week. I am pulled aside to see a surgical consult in the OR preop area. It is a 7 day old boy that has hypospadius (opening of the penis is not the end but half way down the shaft of the penis). This malformation is somewhat difficult to manage and could be worse, if it was at the base of penis or scrotum. I recommend that the parents get it repaired at 1 year of age. He is continent, but the opening is in the wrong place. A little older he will have had time to grow and make it a little easier. I encourage the parents not to circumcise the child as a little extra skin there may make the reconstruction a little easier. Some of you are thinking- why would you do that surgery??? Well, there is no urologist any where near here, maybe in the capital, and no pediatric urologist at all. So, It’s whomever is here in a year. I go back and do a few more ultrasounds. They are done on almost everyone. The local population has grown accustomed to it and always want it, whether it will be diagnostic or not! So after a reprimand by the nurses, I’m doing them on whomever wants them and not objecting. I guess if the patient wants to spend 4500CFA ($9) to have a look, that’s fine with me. All the rounds are now finished and I head back to the house to rest and wait an hour before going back to see more ultrasounds I expect will be waiting. I’ve hired a cook while here, and he is getting 2000CFA ($4) day to make a meal for me in the evening. He also does some housework and works about 4 hours a day. That is decent pay for a day here. [By the way, I went in the village and ate the other day with Sarah and Gabriel for 300CFA ($0.65) for a plate of rice with beans and green leaf and peanut sauce and sweet potatoes. Way more than I could eat. So he is doing well with that amount.] I relax and read an interesting book called “The Insanity of God”. The electricity is back on but no water. I ask in the OR if they have any urgent cases and there aren’t so I go back to doing ultrasounds. I’m doing one ultrasound when I get an impression to ask further questions. This one is for abdominal pain. I see ascites, but she doesn’t seem to be in much pain. I push around and she doesn’t make any faces or grimace nor try to stop my hand. I look at the uterus and it looks empty and normal. She says she has irregular periods when I ask. My impression is to get a pregnancy test. She’s had a number of children. (one today was on her 11th child). After a number of other patients she comes back to the waiting area and is pregnant. Well, that must mean she has an extrauterine pregnancy (ectopic pregnancy). I re-examine her abdomen and she still doesn’t seem in pain. If she has an ectopic and this is blood she should be VERY tender. She doesn’t appear to be. I set her up for an exploratory laparotomy and find out her Hemoglobin is 4.7 (normal >12) So it must be blood. Later on, in the OR, I put a needle in to the abdomen with the ultrasound, and get dark blood, my diagnosis must be correct. We still have no water. A new pump was purchased and brought in, a price of 800,000CFA about $1600. Ouch!!! That’s a financial hit to the hospital! They are still installing it. The OR staff dump diluted bleach water over our arms as we scrub with soap and the brush. Dr. Sarah takes the lead and does the surgery. As soon as she enters the abdomen, a fountain of black blood erupts forth! Our cloth gowns are covered. Blood is running off all sides of the bed and there is a huge puddle of blood on the floor. We find a 3cm bulge in the left fallopian tube and remove it. After irrigating out the abdomen as much as possible, we close her up. At the end of this operation, my cloths are dry (I don’t know how) and Dr. Sarah is covered from mid abdomen to her knees in blood. Again I hope we get water tonight! This lady has had pain for a week. And apparently is very stoic! It is hard to read stoic people and the opposite as well, people who cant tolerate a small thing either. Both are exaggerated in opposite directions with reality somewhere in the middle. My guess is that those that seem exaggerated in either direction, more things are missed; because either every little thing is a disaster or nothing is ever a problem worth looking at. Two extremes. Fortunately, today, I listened to that Holy Spirit voice that told me to get a pregnancy test.
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