Chad #6 2019
They are working on the air conditioners in the OR when I arrive- yeah!!! I do rounds on the surgical ward. It seems the guy with the pus in his abdomen is doing better and another with an appendectomy isn’t doing well. I wish I had a CT scan for him. He is distended, says he’s drank some bouille (rice milk and peanut butter porridge) and says he’s passed gas. I’m concerned but decide to wait and not re-explore him today. The lady that had an amputation for a leg cancer appears to be doing well but no one around can speak her language to really know. She just smiles and points and rubs certain spots near the lower leg stump. Another 14 year old kid with abscesses on his head- appear to be granulating well. The perforated intestine man is doing well and starting to eat.
While I wait for the OR to be ready, I’ve found out there is a cloths washer behind one of the other volunteers houses, so I go outside the hospital compound to get some laundry detergent. There are small bags of three different types. I choose from the biggest pile, assuming that that one is sold the most. I give the guy 2000 CFA ($4) and see what he gives me back, rather than asking the cost. He gives me back 1800. So these small bags cost about 10 cents each. I need to do laundry because all my scrubs are dirty now. You remember that I had that guy with pus all over- I hope this soap is good and takes care of everything. So I put in a load and go to the hospital. Later I come back and hang my stuff on a line that’s hung under some huge mango trees. The missionaries and volunteers are in a compound that’s behind and attached to the hospital and have large mango trees all around. I asked other volunteers here if my cloths would be stolen and they said they hadn’t had any problem with people jumping the brick wall that’s about 7 ft tall. I guess they wont see what’s in here unless they climb the wall
They first install a new air conditioner that was somewhere else in the hospital and it works. We do our first hernia of the day. Then they want a little to install the old air conditioner that has been repaired today. We work with that one running the remainder of the day. The OR starts out the morning at 95 degrees. After running all day we end the day at 85 deg. This feels so wonderful after being at 101! At 85 I still sweat, but I can stand in front of the AC and cool off enough to not sweat for a little while. I also feel like I’m not dehydrating nearly as much.
Around the OR anyone waiting for an operation is sitting on a bench or the ground. Any time I walk out, there are questions as to when their patient will be done. I explain again and again that we do it in the order they paid.
I do a couple of hernias then there is a combination hernia with a hydrocele. His scrotum is about 13 inches long and about 7 inches in diameter. As he lays on the operating table I pull it up and put his legs together and it sits high on top of his legs. We prep and drape him as usual and now the room is cooler and I’m not dripping on the patient with my own sweat constantly. I’m very grateful for the AC. I work through the outer layers and get to the hernia. It is inflamed and stuck to the surrounding tissues. Slowly I separate out the hernia sack and am able to reduce the intestines back into the abdomen with a bit of difficulty. I do a suture repair of the area after taking off the sac. For the hydrocele I make a separate incision and go down to where the testicle is. A large sac of fluid surrounds it normally in a hydrocele. His sac appears dark. I wonder if he has bled into his hydrocele. Or is this a cancer. After dissecting all around I pull the sac out of the scrotum with it still attached at the vessels and I open the sac. Dark brown fluid with chunks comes rolling out. This is disgusting! I try to keep it away from my incision of the scrotum to not contaminate that area. I decide this must be cancer, and decide to do an orchiectomy. I tie off the vessels and spermatic structures and put that off to the side to open more later. I close up the empty side of the scrotum and decide to leave a glove finger as a drain. After I finish this operation I cut the “hydrocele” open further and find what appears to be a necrotic tumor. It’s difficult to tell though, it doesn’t look like anything I’ve seen before. I show pictures to Dr. Danae and she says she’s seen it a number of times.
After a few more cases I finish and I am walking out the OR door as I see a carnet (little booklet) of a consultation waiting. I feel a little perturbed that no one told me there was still someone waiting. I have them call the patient in and my irritation disappears. The patient is waiting with her mother to be seen. Dad comes in too. The child has an abscess on her neck. This is no Dr. Pimple popper abscess (I’ve never seen her show), but a huge abscess that is so big on the right side of the neck that the head is tilted off to the left at a fairly sharp angle. I’m surprised by how large and hard it is. I hear from the father that the abscess started and later they took a knife that was heated in the fire and stabbed it, draining pus. Then it re-accumulated. It’s been going on 2 weeks now. Abouna says they just lance these without anesthetic, but I feel sorry for the child and give local anesthetic. It works somewhat and she screams before I touch her. I sit down on the bed next to the child and immediately realize that was a bad idea. My butt is very wet! The child had urinated then when I sat down, I became the lowest place in the mattress, making all her urine flow to me. AHHHH, everyone else has a good laugh. I incise the neck and very thick pus flows out. I poke my finger in the hole to ensure I’ve opened it enough and to make sure there aren’t any loculations (compartments) that have to be opened. My finger can go in the side of the neck and as I feel around, I feel the back side of the trachea (wind pipe). This is horrible!!! I don’t think there is a connection between this abscess and the trachea or the esophagus because she’s not coughing nor vomiting pus. I flush this with Dakins (dilute bleach) solution and pack what I can with gauze. After we finish and send her to the surgical ward, I and my wet butt head back to the place I’m staying for a change of cloths and some food that Zache has made.