Bere 2018 # 16

Aud’s day.
Friday morning I actually woke up on time to make it to morning worship. The day before I slept til noon after being up til 1am with the surgeries, and suffering from jetlag. After worship I did rounds on pediatrics and adult ward. Of course all the kids I saw had malaria. Fortunately none were terribly sick, and there weren’t even many kids on the ward. It took me a little time to familiarize myself with the way things are done here. They do have an electronic medical record that is fairly simple, but I am just not very computer savvy. After rounds I went to the OR to see what was going on. This is probably the most interesting site in the hospital. It is where we see most of the strange medical presentations. Greg and Dr Sarah were just about to start a surgery on a young woman they expected had ovarian cancer. Ultrasound showed a mass in the pelvis and a lot of fluid in the belly (assumed to be ascites). Having finished the work I had planned to do, I decided to stay, watch and take pictures. Greg has been teaching/guiding Dr Sarah in surgeries so that she has more training when we leave. So, Sarah started the surgery, opening the belly to be able to remove the mass. They realized that with a lot of fluid present that they would need suction, so someone ran to the surgical ward to retrieve the only suction machine in the hospital, that was with the old lady who had gotten the tracheostomy the night before. They opened the belly, and NO FLUID CAME OUT. Instead, here was a copious amount of clear/yellow gelatinous material. So the first thing they had to do was scoop out, handful by handful this jelly-like stuff. (When we return there will be several videos posted so you can experience it too). They found the mass which appeared to be an ovary, and removed it along with the fallopian tube. Diagnosis: probable ovarian mucinous cystadenoma. Of course we would never get a true diagnosis as there is no pathology available. There are also no chemo agents available. Or specialists. Or specialty hospitals…
The next surgery I did with Greg so that Dr Sarah could finally have a break. She has been here as the only doctor for the past 3 months. I assisted Greg with an inguinal hernia operation. We see a significant number of hernias here as the people do so much heavy lifting. The surgery went without any problems, so we started to prepare for the next operation which was a prostatectomy. The next patient was in the operating room and we were about to scrub for surgery when a midwife comes running into the room, sweating, carrying a limp newborn. The baby was born at 33 weeks gestation and was delivered in the maternity ward just moments before. She didn’t cry immediately and was now limp and turning blue. The midwife placed her on the newborn incubator table (which doesn’t work). Greg grabbed a small mask and ambu bag and started bagging air into her lungs and giving chest compressions on her tiny chest. I listened to her hear beat and lung sounds. She did have a heartbeat but it was much too slow for her age. She did not however take any breaths on her own. He continued to bag, I continuted to dry her and try to stimulate her to breathe. When Greg was bagging, it sounded like air was entering her lung through thick mud. Yes, lung-singular as there was absolutely no air going into her left lung. At one point she started to breathe on her own and I was ecstatic, but this was very short lived and soon her breathing stopped and heart beat slowed. We tried for almost 45 minutes to convince her to live, but we were never able to get her oxygen saturation above 48% (normal 98-100). I also never heard breath sounds on the left. Greg had left to scrub for the next surgery and I finally realized that nothing I could do would help this little one. I had wanted to intubate her, but no such luck to have anything to intubate with- tube, or lighted laryngoscope. Finally I stopped bagging and watched her oxygen saturation and heartbeat go to zero. I don’t know exactly why we couldn’t bring her back; too young, undeveloped lungs, something critically wrong with left lung, perhaps other malformations (she didn’t look quite normal). There is so much death here in Africa. Some unavoidable like this kiddo, some frustratingly avoidable like that which Greg has written about in the little boy with rectal prolapse.
We just do our best and pray, pray, pray for God’s guidance and mercy. Til next time, Aud