Chad 2022 #2
It was a busy day.  All of us doctors worked from morning till late at night.  Even when we were done with the operations we did, there were still about 15 people that wanted to be consulted by a doctor. I was to tired to help any longer with jet lag and lack of sleep.  So about 9 PM i left to eat lunch and supper, then just crashed.  I still woke up to early this morning, but feel pretty good.
Yesterday began with worship at 7AM.  I understood about half of what was said and it takes quite a bit of concentration.  It’s been to long for my French.  After that was a nurses report about what happened over the weekend. I went to the OR to see how things were lining up.  They had lined up a number of surgeries for me.  And to start out were 3 men with inguinal hernias.  Now these were MANLY hernias.  They don’t get them fix when small here, they are obvious and large when they come to have them fixed.  Once the meeting was done with the nurses, we began.  The first three were relatively straight forward.  Then there was another guy that had an incarcerated hernia that they were able to reduce the day before and was ready for his operation.  His was larger and had colon and small bowel down into it.  It went something like this:
Powell is a nurse anesthetist missionary here for a few months.  He placed the spinal and we waited till it took effect and the man couldn’t feel or move his legs any longer.  He was washed and scrubbed in his groin and painted with betadine.  Then I made an incision through the skin, then thin layer of fat down to his hernia and testicular cord structures.  It was quite large so after opening the external fascia, I was able reduce the intestines back into the abdomen and dissect out the hernia sack.  I opened the sack and looked at the intestines that had gone back in, none seemed damaged so I sutured the sack and took off the excess.  Next I did a suture repair of the hernia site.  Ive chosen not to do mesh here for two reasons.   One is Im not certain of the sterility of the surgical packs, and second is that there is very little mesh to be used and so its used sparingly.  I then washed out the incision and closed it.  During the middle of the surgery, the power went out as they changed generators.  This hospital runs 24/7 on generators as there is no local power.  So I operated by headlamp, which I always bring for that reason.  After about a half hour, it came back on.  Ill try to include a pic below of that timeframe.
Next there was a guy with LARGE hydroceles (fluid around the testicles).  Well not large like needing a wheelbarrow for your scrotum large, but larger than anyone in the US would wait.  He walked in normally, but after i saw the hydrocele, I was surprised he wasn’t waddling.  He got his spinal with Powell and then a local Chadian doc assisted me as he is learning surgery.  I cut into the scrotum and into the muscular tissue surrounding the fluid sack of the hydrocele.  I started to shell out the sack then I ended up tearing into it.  A light yellow fluid was everywhere.  We suctioned what was left.  I suspect it contained about a quart of fluid per side!  Then I finished shelling out the side, and took off the excess sack and reversed the sack and sutured it back to itself.  Then I put it back in the scrotum and sutured the testicle back into place.  This keeps it where it belongs and doesn’t let it rotate, which can kill a testicle.  Then I left a piece of sterile glove as a drain and closed the muscle layer then the skin.  Then I repeated the same thing for the other side.
I did a hystorectomy with fascial suspension of the vagina for uterine prolapse, Then another surgery I cant remember this morning.
Now Ive gotten some rest and am ready for another day.  God give me Your strength and wisdom for today and for each patient I see.  Thank You!

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Chad 2022 #2
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