Bere 2018 #10
I’m on the moto (motorcycle), riding along the mud road. Periodically children are yelling “Nasaraaaaaaaaaaaaaaaaa”. There are huge pot holes everywhere. An S pattern best describes my continuous way of going around them. There are tire tracks from the many motos that have traveled this road on the way to Lai. It’s the next biggest town to our east. I weave along the main road through Bere and continue towards Lai. Women are walking with a load of about 4 ft long grass in a bundle laying on their head, with little children strapped to their backs. Boys aged about 8-16 are naked on the side of the road and a few are still playing in the rice field. They must be laying down, as it seems that the water in a rice field cannot be very deep. Or maybe a little stream that I cannot see since the whole thing is flooded. Other little boys stand on the side of the road with about a 10 ft cane of some type, and with a string and whatever- are fishing in the rice field. Others are slowly moving along on their bicycles in groups of 1 or 2. I pass a group of about 8 guys that have been out working the fields as they have the curved cutting implements laid across their shoulders. The special tree comes in to view. I pull up near by and get out the computer. I get out my phone and I create the hotspot. After connecting my computer I send my emails. I try to contact my wife, but she is already at work, so we aren’t able to talk.
There ended up being no scheduled cases today but I found one and Dr. Sarah found another. I had done the rounds on the surgical ward and then went to the medical ward. There was a kid there who was about 16, and had been vomiting a week now. The last two days I thought he was improving. As I step up to his bed he grabs a bowl and pukes a huge amount of green stuff into it. Part of it hangs in a string from the side of his mouth, and the dad grabs the stringy saliva and drops it into the bowl. His belly is not really distended, but he’s been vomiting a week they say. When I re-ask about bowel movements, this time he says it’s been a week. But he passed some gas yesterday. I finally decide he must have a partial bowel obstruction that must be real close to the stomach, since he doesn’t appear distended. I tell the father that we need to operate on him and send him to the pharmacy to purchase supplies. The whole surgery with postop medicines comes to 65,000CFA ($130). They pay it right away. He is the first surgery, and we start about noon. Fluid and then a spinal anesthetic is given. I smile to myself again, as to why we are giving a spinal to a guy with upper abdominal surgery a spinal anesthetic. If it were to actually work, then he would stop breathing, then there would be many hours of bagging him with a mask. I’ve told the anesthetist that many times, and he does it anyway so I don’t say anything. Dr. Sarah joins me and we scrub. We put our cloth gowns on and sterile gloves. We put four drapes around the abdomen that has been prepped, then apply the clips in the four corners. The large cloth drape with a hold in the middle is placed last. Now only the abdomen with it’s vertical, near top to bottom, scar is visible. I expect this to be difficult so I do it and she helps me. I cut through old scar, and eventually get into the abdomen in an area there doesn’t seem to be any scar tissue on the inside. I am glad, as sometimes intestine is stuck there and it is possible to make a hole in the intestine as you enter, even if done cautiously. Once I can feel the inside, I extend the incision where I can. Other places I have to use scissors to take down the intestine from the abdominal wall. There are adhesions everywhere. I slowly dive in cutting them, in areas I can see. As I get about a quarter of the way down, I see a loop traversing underneath others. As I free this up, I realize that this was the point that was pinched and blocking the flow of intestinal contents. I am happy that I chose to operate on him as this will fix his problem. It takes another 45 min or so to take down the rest of the adhesions. I decide to do an incidental appendectomy (means the appendix is not inflamed but I take it anyway), as I’d hate to be in this abdomen again, though it does add a little risk of infection. Eventually we recheck everything, wash out his belly, and close him up. He immediately pulls out the nasogastric tube in the postop/preop area, when the nurses aren’t watching him closely. The nurse sent out his father then left him lying there by himself. I reprimand them gently and I reinsert it. Then I have one of the nursing students hold his hands so he can’t pull it out again. I seriously doubt it will even last a few hours, but I hope it does.
Next there is a 18 year old girl with a wound infection who was told not to eat about 9 this morning. Instead, she ate breakfast after that, and had a glass of water at about 1pm. The anesthetist wants to put her off till tomorrow, and it seems reasonable to me, so we get the next one.
Next is a 18 year old girl who just had a delivery and has some parts of the placenta retained. Dr. Sarah is doing rounds on peds and asks me to go ahead. So I do a curettage to get out the pieces of the retained placenta. Im done by about 3:30 so I head out on the moto to send emails. What a beautiful afternoon! The sun is out, frogs are croaking, birds are singing, children are yelling Nasarraaaaaaaaaa. It’s beautiful!