Shanksteps Bere April #8 with pictures
Yesterday was different at the hospital. There were a few surgeries scheduled and one lady for a hysterectomy had a low hemoglobin and needed transfused first, the other two or three ate that morning, so I suddenly had no surgeries to do. I did rounds with the nurse and about 6 nursing students. I looked at everyones incisions, opened all the dressings on those with chronically healing wounds, and it took about 2 hours to round this way on about 28 people. The ward is full and I even saw a few that are living under the trees, discharged but Dr. Denae still wanted to check on periodically. I got done early afternoon.
So I went and ate some lunch at Netteburg’s and then decided to go out to Bendele where a missionary friend of ours just flew in with his plane a few days ago. He has a plane that can carry a number of people and still take off and land in a short runway. I think i mentioned that i often come here with a perimeter spray to help with mosquitos and other insects that infest or eat a house. So I wanted to offer to spray the missionaries house down there too. So I rode a motorcycle down there. It was hot but nice to be outside. Im on Doxycycline for my malaria prophylaxis so the sun feels especially hot and I burn easier with it. So by the end of the day Im a little sun burned. I spray Deietrichts house. Then I help in the hanger. He wants to pull a large motorcycle down to the hanger from the hospital. It’s not been used for years and he wants to get it going. So we go back to the hospital on one other large motorcycle with a rope. The one that’s been sitting has flat tires, and eventually we find a pump that works and then he pulls me motorcycle to motorcycle back to Bendele. We don’t have a key for it so can’t do much. We move planes around and get one that’s been sitting started and it needs a lot of work. So i help with a few things till dark then head back to the hospital. It’s nice to see long time friends again.
Today I did rounds and I had the patient with an open neck drink water while I watched his neck. It poured out his neck. His neck is finally starting to granulate as he is getting some nutrition. So he has survived the infection, will I be able to convince the family not to get him enough food for him not to starve to death. It’s hard for people to give adequately when it’s not going in their mouths. They showed me the bouii (porridge) that they were about to give and it was scalding hot. I told them it would burn his stomach and only give him cold bouii. Since it’s Friday we only schedule a few cases as we expect other hospitals to refer patients in to us on the weekends when their doctors don’t want to work. I guess there are 1-2 distant hospitals that do this at times. So the first person I operate on is an older woman with a large lipoma (fatty tumor) on her back. It is lobular and takes a while to get it all out. She tolerates it well, and I though she would need sedation, but they said do it under local, and she did well.
The next was a a boy about 10 with osteomyelitis (bone infection) of his left femur (upper leg bone). I looked at his X-ray and it appeared to be the whole bone. He has had osteo of his fibula on the other leg and Dr. Denae had removed that a number of months ago. Now he has pus coming out the side of his upper leg near his knee. So the treatment of this in these rural locations is not months of antibiotics but open drainage. So in the operating room he is given a spinal. Then I make a long incision down his later upper leg and slowly go down through the muscles with cautery. I get into a few pockets of pus. To open the bone is challenging with the tools we have here. I have a drill in a sterile pouch and a chisel. So I drill numerous holes in two lines down his femur and then use the chisel to get the bone in-between out. This opens up the medulla and allows for drainage of the internal pus. I worry about my chisel action cracking the bone across, creating an open bone fracture than he cannot walk on- likely ever again. I’m grateful that didn’t happen. Cleaned out all the medulla and packed a dressing into it. He will be here for months of dressing changes now.
In the evening we all get together for Sabbath vespers at Netteburg’s house. Vespers here is one of the highlights of my week. We worship God with songs and words and say what we are thankful for this week.
